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Fu K, Zhao J, Zhong L, Xu H, Yu X, Bi X, Huang C. Dual therapy with phospholipase and metalloproteinase inhibitors from Sinonatrix annularis alleviated acute kidney and liver injury caused by multiple snake venoms. Biomed Pharmacother 2024; 177:116967. [PMID: 38908206 DOI: 10.1016/j.biopha.2024.116967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024] Open
Abstract
Snakebite envenomation often induces acute kidney injury (AKI) and acute liver injury (ALI), leading to augmented injuries and poor rehabilitation. Phospholipase A2 (PLA2) and metalloproteinase (SVMP) present in venom are responsible for the envenomation-associated events. In this study, mice envenomed with Deinagkistrodon acutus, Naja atra, or Agkistrodon halys pallas venom exhibited typical AKI and ALI symptoms, including significantly increased plasma levels of myoglobin, free hemoglobin, uric acid, aspartate aminotransferase, and alanine aminotransferase and upregulated expression of kidney NGAL and KIM-1. These effects were significantly inhibited when the mice were pretreated with natural inhibitors of PLA2 and SVMP isolated from Sinonatrix annularis (SaPLIγ and SaMPI). The inhibitors protected the physiological structural integrity of the renal tubules and glomeruli, alleviating inflammatory infiltration and diffuse hemorrhage in the liver. Furthermore, the dual therapy alleviated oxidative stress and apoptosis in the kidneys and liver by mitigating mitochondrial damage, thereby effectively reducing the lethal effect of snake venom in the inhibitor-treated mouse model. This study showed that dual therapy with inhibitors of metalloproteinase and phospholipase can effectively prevent ALI and AKI caused by snake bites. Our findings suggest that intrinsic inhibitors present in snakes are prospective therapeutic agents for multi-organ injuries caused by snake envenoming.
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Affiliation(s)
- Kepu Fu
- School of Basic Medical Sciences, Jiangxi Medical college, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Jianqi Zhao
- School of Basic Medical Sciences, Jiangxi Medical college, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Lipeng Zhong
- Clinical Laboratory Center, The First Affiliated Hospital, Jiangxi Medical college, Nanchang University, Nanchang, Jiangxi 330209, China
| | - Haiyan Xu
- Blood Transfusion Department, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - Xinhui Yu
- School of Basic Medical Sciences, Jiangxi Medical college, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiaowen Bi
- School of Basic Medical Sciences, Jiangxi Medical college, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Chunhong Huang
- School of Basic Medical Sciences, Jiangxi Medical college, Nanchang University, Nanchang, Jiangxi 330006, China.
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Xie N, Luo Q, Zhang W, Yang X, Zhang H, Wang X, Mou J, Guo W, Zhou J, Ling K, Ma Y, Rao K, Yuan M, Zhao Y, Li Y, Lin Y, Ye L, Zou L. Comparative efficacy of three wound care approaches in alleviating swelling and pain associated with snakebite wounds in a Chinese hospital. Int Emerg Nurs 2024; 74:101438. [PMID: 38581857 DOI: 10.1016/j.ienj.2024.101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Nan Xie
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Qin Luo
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Wei Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Xinyi Yang
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Haihong Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Xiaoyan Wang
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Juan Mou
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Wei Guo
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Jing Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Kun Ling
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Yan Ma
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Kefei Rao
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Mei Yuan
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Yazhu Zhao
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Yuanhao Li
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Yan Lin
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China
| | - Lei Ye
- Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China; Nursing Department of West China Hospital, Sichuan University, Chengdu, China.
| | - Liqun Zou
- Department of Emergency Medicine, West China Hospital, Sichuan University, China/West China School of Nursing, Sichuan University, China; Institute of Disaster Medicine, Sichuan University, China; Nursing Key Laboratory of Sichuan Province, China.
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Shen Y, Hu S, Bao S, Tu M. Clinical characteristics of snakebite patients attending a tertiary hospital in Hangzhou, southeast China. Trans R Soc Trop Med Hyg 2024; 118:287-292. [PMID: 38073610 DOI: 10.1093/trstmh/trad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 11/24/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Venomous snakebite is a neglected yet an important public health problem in China, and few studies have focused on them so far. The aim of this study is to investigate clinical characteristics of snakebites patients in a tertiary hospital in Hangzhou, southeast China. METHODS A total of 416 snakebite cases were included in this retrospective study. The data were collected from the medical records including demographics, clinical manifestations, management and outcomes. RESULTS Of the 416 patients with venomous snakebites, 248 were male, and the average age was 54.6 years. The majority of cases occurred in rural in May to September. Out of all the venomous bites, Gloydius brevicaudus accounted for the highest percentage (55.3%). Hands were the most vulnerable site to snakebites (47.4%). Patients had clinical manifestations of pain (100%), swelling (100%), wound necrosis (25.7%), hemorrhagic blister (18.3%), and blister (8.7%). Three hundred and ninety-two patients received antivenom administration, and most were treated within six hours after bites. Twenty-six patients received surgical treatments, and 90 patients developed venom-induced consumption coagulopathy. No deaths have occurred in this study. CONCLUSION Hangzhou is one of the regions with high affecting of snakebites in China. The results of this study will increase the understanding of the clinical characteristics of venomous snakebites in Hangzhou area.
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Affiliation(s)
- Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Sipin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Shuhua Bao
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
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Yang Q, Gao Y, Fu W, Ma S. Impact of tourniquet use on severity of snakebite envenoming in Chongqing, China: a single-center retrospective study. J Int Med Res 2024; 52:3000605231225540. [PMID: 38258738 PMCID: PMC10807319 DOI: 10.1177/03000605231225540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To identify risk factors associated with snakebite severity and determine whether tourniquet use can affect the severity and outcome of snakebites. METHODS The clinical data of patients who sustained limb snakebites from 1 March 2021 to 31 October 2022 were reviewed. The patients were divided into three groups according to snakebite severity: mild (517 cases), moderate (112 cases), and severe (8 cases). We compared the clinical data of mild versus moderate to severe snakebites. Multivariate logistic regression was used to determine the independent risk factors for moderate to severe snakebites. RESULTS The study involved 637 patients. There were statistically significant differences in age, tourniquet use, onset time, white blood cell increase, platelet decrease, creatine kinase (CK) increase, activated partial thromboplastin time shortening, and length of stay between patients with mild snakebites and those with moderate to severe snakebites. Multivariate logistic regression analysis showed that age, tourniquet use, and CK increase were independent risk factors for moderate to severe snakebites. CONCLUSION The overall severity of snakebites in Chongqing is mild, and the prognosis is good. Age, tourniquet use, and CK increase are independent risk factors for the severity of snakebites. We do not recommend tourniquet use after snakebites in Chongqing.
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Affiliation(s)
- Qian Yang
- Qian Yang, Department of General Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), 1 Health Road, YuZhong District, Chongqing 400014, China.
| | | | | | - Shaying Ma
- Department of General Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
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Hu S, Lou Z, Shen Y, Tu M. Bacteriological Studies of Venomous Snakebite Wounds in Hangzhou, Southeast China. Am J Trop Med Hyg 2022; 107:925-929. [PMID: 36067984 PMCID: PMC9651534 DOI: 10.4269/ajtmh.21-1314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022] Open
Abstract
Snakebite is a common occurrence in Hangzhou, and identifying bacteria in wounds is very important for snakebite treatment. To define the pattern of wound bacterial flora of venomous snakebites and their susceptibility to common antibiotics, we reviewed the medical charts of patients admitted with snakebite at Hangzhou TCM Hospital from January 2019 to December 2020. A total of 311 patients were enrolled in this study. Among them, bacteria culture was positive in 40 patients, and 80 organisms were isolated. The most frequent pathogens were Morganella morganii and Staphylococcus aureus. According to the results of susceptibility testing, a majority of the isolates were resistant to some common first-line antibiotics, such as ampicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, cefoxitin, and cephazolin. Quinolones, however, have shown a better antibacterial effect. In conclusion, snakebite wounds involve a wide range of bacteria. Fluoroquinolones, such as levofloxacin and ciprofloxacin, could be an alternative for empirical treatment in patients with snakebite when the effect of other antibiotics is poor.
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Affiliation(s)
- Sipin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhengqing Lou
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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Sarkar S, Sinha R, Chaudhury AR, Maduwage K, Abeyagunawardena A, Bose N, Pradhan S, Bresolin NL, Garcia BA, McCulloch M. Snake bite associated with acute kidney injury. Pediatr Nephrol 2021; 36:3829-3840. [PMID: 33559706 DOI: 10.1007/s00467-020-04911-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 01/03/2023]
Abstract
Acute kidney injury (AKI) is a well-known life-threatening systemic effect of snake envenomation which commonly happens secondary to snake bites from families of Viperidae and Elapidae. Enzymatic toxins in snake venom result in injuries to all kidney cell types including glomerular, tubulo-interstitial and kidney vasculature. Pathogenesis of kidney injury due to snake envenomation includes ischaemia secondary to decreased kidney blood flow caused by systemic bleeding and vascular leakage, proteolytic degradation of the glomerular basement membrane by snake venom metalloproteinases (SVMPs), deposition of microthrombi in the kidney microvasculature (thrombotic microangiopathy), direct cytotoxic action of venom, systemic myotoxicity (rhabdomyolysis) and accumulation of large amounts of myoglobin in kidney tubules. Clinical features of AKI include fatigue, loss of appetite, headache, nausea, vomiting, oliguria and anuria. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Early initiation of anti-snake venom and early diagnosis of AKI are always desirable. Biomarkers which will help in early prediction of AKI are being explored, and current studies suggest that urinary clusterin, urinary neutrophil gelatinase-associated lipocalin, and serum cystatin C may play an important clinical role in the future. Apart from fluid and electrolyte management, kidney support including early and prompt initiation of kidney replacement therapy when indicated forms the bedrock in managing snake bite-associated AKI. Long-term follow-up is important because of chances of progression towards CKD.
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Affiliation(s)
- Subhankar Sarkar
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, 11, Dr Biresh Guha Street, Kolkata, West Bengal, 700017, India
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, 11, Dr Biresh Guha Street, Kolkata, West Bengal, 700017, India. .,Department of Pediatrics, Apollo Gleneagles Hospital, Kolkata, India.
| | | | - Kalana Maduwage
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Asiri Abeyagunawardena
- Department of Pediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Niladri Bose
- Department of Pediatrics, Apollo Gleneagles Hospital, Kolkata, India
| | - Subal Pradhan
- Department of Pediatrics, Sardar Vallabhbai Patel Post Graduate Institute of Pediatrics (SVPPGIP), Cuttack, India
| | | | | | - Mignon McCulloch
- Pediatric Renal and Solid Organ Transplant Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Savu AN, Schoenbrunner AR, Politi R, Janis JE. Practical Review of the Management of Animal Bites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3778. [PMID: 34522565 PMCID: PMC8432645 DOI: 10.1097/gox.0000000000003778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. METHODS A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. RESULTS The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. CONCLUSIONS Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
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Affiliation(s)
- Andrei N. Savu
- From the Ohio State College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Rachel Politi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Jeffrey E. Janis
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
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Sathish K, Shaha KK, Patra AP, Rekha JS. Histopathological profile of fatal snake bite autopsy cases in a tertiary care center in South India. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2021. [DOI: 10.1186/s41935-021-00218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Snake bite is a major public health problem, especially in the tropical areas of the world, which the World Health Organization aims to eradicate. According to the National Crime Records Bureau in India, where agriculture is the mainstay of employment attributes about 8660 mortalities in a year. Histopathological results are of immense help in establishing the cause of death in those snake bite cases where other circumstantial shreds of evidence are lacking.
Results
An autopsy-based prospective study was conducted on fatal cases of snake bite reported at a tertiary care center in south India over a period of 2 years. A total of 38 fatal snake bite cases were included in the study. Epidemiological data were collected and analyzed. Histopathological findings of the kidneys, heart, and endocrine glands (pituitary, adrenals, thyroid, and pancreas) were analyzed. The significant findings of the kidneys were distinct corticomedullary demarcation on the gross surface (65.8%) and congestion and acute tubular necrosis (55.3%) on histology. On the other hand, in the set of endocrine glands, adrenals and pituitary showed predominantly hemorrhagic infarction on the histological analysis (18.4% and 52.6%) respectively.
Conclusion
The results of the current study enlighten the findings such as distinct corticomedullary demarcation and acute tubular necrosis in the kidneys and hemorrhagic infarction in the endocrine glands in a case of snake bite. It highlights the need for histopathological analysis in the cases of a fatal snake bite when other circumstantial and gross features become indecisive. This can aid immensely in a medico-legal investigation of snake bite cases.
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Tchaou BA, de Tové KMS, N'Vènonfon CFT, Mfin PK, Aguemon AR, Chobli M, Chippaux JP. Acute kidney failure following severe viper envenomation: clinical, biological and ultrasonographic aspects. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200059. [PMID: 33335542 PMCID: PMC7724935 DOI: 10.1590/1678-9199-jvatitd-2020-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Acute kidney injury (AKI) is a frequent complication of snakebite envenomation, which is still little known in sub-Saharan Africa. This study aims to describe the clinical, biological and ultrasonographic aspects of AKI following severe snakebite envenomation managed in the intensive care unit. Method: A prospective observational survey was performed in Benin over a period of 18 months. All patients suffering severe snakebite envenomation (SBE) were included. The diagnosis of AKI was made using the KDIGO criteria. Kidney ultrasound exam was performed in all patients to assess internal bleeding and morphological and structural abnormalities of the kidneys. Results: Fifty-one cases of severe SBE were included. All patients presented inflammatory syndrome and showed abnormal WBCT whereas bleeding was found in 46 of them (90%). The median time to hospital presentation was three days. The majority of patients were male (M/F sex ratio = 1.55) and the median age was 26. Sixteen patients (31%) showed AKI according to the KDIGO criteria. Severe AKI (KDIGO stage 2 and 3) was observed in three patients, including one stage 2 and two stage 3. Kidney ultrasound revealed three cases of kidney capsular hematoma (6%), two cases of kidney hypertrophy (3%), three cases of kidney injury (4%), two stage 1 KDIGO and one stage 2 KDIGO. Only one patient benefited from hemodialysis. All patients showing AKI recovered without sequels. The median duration of hospital stays was four days. Seven patients died (14%) including four among the 16 AKI patients. Antivenom has been administered to 41 patients (80%). The comparison between patients without and with AKI did not show any significant difference except gender (p = 10-2). Conclusion: AKI is a common complication of severe snakebite envenomation. Resulting from inflammatory and hemorrhagic disorders, AKI may prove to be a short-term life-threatening factor.
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Affiliation(s)
- Blaise Adelin Tchaou
- Department of Anesthesia-Resuscitation and Emergency, Borgou-Alibori University Hospital Center, Parakou, Bénin
| | - Kofi-Mensa Savi de Tové
- Department of Radiology and Medical Imaging, Borgou-Alibori University Hospital Center, Parakou, Bénin
| | | | - Patrick Kouomboua Mfin
- Department of Anesthesia-Resuscitation and Emergency, Borgou-Alibori University Hospital Center, Parakou, Bénin
| | - Abdou-Rahman Aguemon
- Department of Anesthesia-Resuscitation and Emergency, Borgou-Alibori University Hospital Center, Parakou, Bénin
| | - Martin Chobli
- Department of Anesthesia-Resuscitation and Emergency, Borgou-Alibori University Hospital Center, Parakou, Bénin
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Vikrant S, Jaryal A, Parashar A. Clinicopathological spectrum of snake bite-induced acute kidney injury from India. World J Nephrol 2017; 6:150-161. [PMID: 28540205 PMCID: PMC5424437 DOI: 10.5527/wjn.v6.i3.150] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/10/2016] [Accepted: 03/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study the clinico-pathological spectrum of snake bite-induced acute kidney injury (AKI).
METHODS A retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla with snake bite-induced AKI from July 2003 to June 2016. Medical records were evaluated for patient’s information on demographic, clinical characteristics, complications and outcome. Outcomes of duration of hospital stay, requirement for intensive care unit support, treatment with dialysis, survival and mortality were analyzed. The survival and non survival groups were compared to see the difference in the demographic factors, clinical characteristics, laboratory results, and complications. In patients subjected to kidney biopsy, the findings of histopathological examination of the kidney biopsies were also analyzed.
RESULTS One hundred and twenty-one patients were diagnosed with snake bite-induced AKI. Mean age was 42.2 ± 15.1 years and majority (58%) were women. Clinical details were available in 88 patients. The mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to 30 d. Eighty percent had oliguria and 55% had history of having passed red or brown colored urine. Coagulation defect was seen in 89% patients. The hematological and biochemical laboratory abnormalities were: Anemia (80.7%), leukocytosis (75%), thrombocytopenia (47.7%), hyperkalemia (25%), severe metabolic acidosis (39.8%), hepatic dysfunction (40.9%), hemolysis (85.2%) and rhabdomyolysis (68.2%). Main complications were: Gastrointestinal bleed (12.5%), seizure/encephalopathy (10.2%), hypertension, pneumonia/acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (9.1% each), hypotension and multi organ failure (MOF) (4.5% each). Eighty-two percent patients required renal replacement therapy. One hundred and ten (90.9%) patient survived and 11 (9.1%) patients died. As compared to the survival group, the white blood cell count (P = 0.023) and bilirubin levels (P = 0.006) were significant higher and albumin levels were significantly lower (0.005) in patients who died. The proportion of patients with pneumonia/ARDS (P = 0.001), seizure/encephalopathy (P = 0.005), MOF (P = 0.05) and need for intensive care unit support (0.001) was significantly higher and duration of hospital stay was significantly shorter (P = 0.012) in patients who died. Kidney biopsy was done in total of 22 patients. Predominant lesion on kidney biopsy was acute tubular necrosis (ATN) in 20 (91%) cases. In 11 cases had severe ATN and in other nine (41%) cases kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). One patient only had moderate AIN and one had patchy renal cortical necrosis (RCN).
CONCLUSION AKI due to snake bite is severe and a high proportion requires renal replacement therapy. On renal histology ATN and AIN are common, RCN is rare.
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