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Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022; 26:1259-1266. [PMID: 36755629 PMCID: PMC9886021 DOI: 10.5005/jp-journals-10071-24362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Snakebites are a common cause of morbidity and mortality, especially in tropical countries. Snakebites in any community are managed based on the clinical features and intravenous administration of antisnake venom (ASV). The administration of ASV is either deficient or given in excess based on clinical decisions and whole blood clotting test results. The present study is designed to analyze the level of snake venom component in the blood of snakebite in association with the clinical features. Patients and methods Blood samples were collected from the patients admitted to Karnataka Institute of Medical (KIMS) hospital with a history of snakebite considering the inclusion criteria. Serum was collected from the blood of snakebite patients before and after ASV and used to assess the level of venom-specific phospholipase A2 (PLA2) enzyme using the enzyme-linked immunosorbent assay (ELISA) method. Results Quantitative ELISA results revealed that the snake venom-specific PLA2 in the victim's blood was in the range of 0.3-1.27 mg/mL before the administration of ASV. However, the concentration of PLA2 after 24 hours of ASV administration was decreased in most of the patients. Further, it was observed that envenomation complications were directly proportional to the amount of snake venom-specific PLA2 found in the blood of the snakebite patient. Conclusion The study concludes that snake venom-specific PLA2 in the blood of snakebite patients could be used as a reliable venom marker, which helps in determination of appropriate ASV dosage in snakebite patients. How to cite this article Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022;26(12):1259-1266.
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Affiliation(s)
- Ram S Kaulgud
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Tousif Hasan
- Department of General Medicine, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Gulamnabi L Vanti
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - S Veeresh
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Amruta P Uppar
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Mahantesh M Kurjogi
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India,Mahantesh M Kurjogi, Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, e-mail:
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Alcoba G, Potet J, Vatrinet R, Singh S, Nanclares C, Kruse A, Den Boer M, Molfino L, Ritmeijer K. Snakebite envenoming in humanitarian crises and migration: A scoping review and the Médecins Sans Frontières experience. Toxicon X 2022; 13:100089. [PMID: 35005609 PMCID: PMC8718667 DOI: 10.1016/j.toxcx.2021.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 10/25/2022] Open
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Ramana LN, Mathapati SS, Salvi N, Khadilkar MV, Malhotra A, Santra V, Sharma TK. A paper microfluidic device based colorimetric sensor for the detection and discrimination of elapid versus viper envenomation. Analyst 2022; 147:685-694. [PMID: 35072182 DOI: 10.1039/d1an01698a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Snake bites are a neglected tropical disease, causing mortality and severe damage to various vital organs like the nervous system, kidneys and heart. There is increasing interest in designing new antivenom treatments that are more specific to particular groups (either taxonomic or regional) of species, given the increasing evidence that current polyvalent Indian antivenom is ineffective in many situations. Under these circumstances, being able to detect the species, or a group of species, responsible for the envenomation becomes important. Unfortunately, no such diagnostic tool is available in the Indian market. Such a tool will need to be rapid, sensitive and affordable. To address this need, we have combined the power of nanotechnology and paper microfluidics and herein report a device that has the ability to detect and differentiate viper venom from elapid and scorpion venom. In principle, this assay is based on the release of the dye from the stimuli-responsive glutaraldehyde cross-linked methylene blue-loaded gelatin (GMG) nanoparticles in the presence of snake venom metalloproteases and serine proteases. The developed equipment-free assay can detect and discriminate viper venom from that of elapids and scorpions. The low-end detection limit of the sensor is ∼3.0 ng for the saw-scaled viper Echis carinatus, while the same for Russell's viper Daboia russelii is ∼6.0 ng. The performance of the sensor remains unaltered for different batches of GMG nanoparticles. Altogether, this finding establishes the role of nanotechnology and paper microfluidics in the rapid and accurate detection of viper venom.
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Affiliation(s)
- Lakshmi Narashimhan Ramana
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India.
| | - Santosh S Mathapati
- Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
| | - Nitin Salvi
- Premium Serums and Vaccines Pvt. Ltd, Maharashtra, 410504, India
| | - M V Khadilkar
- Premium Serums and Vaccines Pvt. Ltd, Maharashtra, 410504, India
| | - Anita Malhotra
- School of Natural sciences, College of Environment sciences and Engineering, Bangor University, Bangor LL57 2UW, UK
| | - Vishal Santra
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, 712407, West Bengal, India
- Captive and Field Herpetology, 13 Hirfron, Anglesey, LL65 1YU, Wales, UK
| | - Tarun Kumar Sharma
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India.
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Darshani S, Gnanathasan A, Arambepola C, Chang T. Knowledge on prevention, diagnosis and treatment of snakebite envenoming among doctors in snakebite-dense regions in Sri Lanka. Trans R Soc Trop Med Hyg 2021; 115:984-991. [PMID: 34323280 DOI: 10.1093/trstmh/trab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sri Lanka is one of the highest envenoming reporting countries globally with >80 000 snakebites per year. Among other factors, knowledge of snakebite among doctors predominantly determines patient outcomes. METHODS Using a pretested 72-item self-administered questionnaire, we assessed knowledge on identifying common snake species, signs of envenoming and management of venomous snakebites among 280 doctors working in eight state hospitals in regions where snakebite prevalence is highest in Sri Lanka. RESULTS Visually, 92.1% correctly identified a cobra and 74.3% identified a Russell's viper, but only 30% could identify a hump-nosed viper (HNV). Syndromic identification of snakes was best for the krait (71.8%) followed by the cobra (59.6%), but poor for the HNV (30%). The median knowledge scores of pictorial and syndromic snake identification, indoor preventive measures and indications of antivenom were <75% of the maximum score. Apart from 62.5% who expected the victim to bring the snake along to the hospital, most doctors selected the correct options of pre-hospital care. The duration of work experience did not influence the competency of syndromic identification. Utilisation of local guidelines was associated with better knowledge in antivenom usage (odds ratio 2.22 [95% confidence interval 1.04 to 5.36]; p=0.03). CONCLUSIONS Specific deficiencies of core knowledge in snakebite management exist among doctors working in snakebite prevalent regions.
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Affiliation(s)
| | | | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 00800, Sri Lanka
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Current research into snake antivenoms, their mechanisms of action and applications. Biochem Soc Trans 2021; 48:537-546. [PMID: 32196542 DOI: 10.1042/bst20190739] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/11/2023]
Abstract
Snakebite is a major public health issue in the rural tropics. Antivenom is the only specific treatment currently available. We review the history, mechanism of action and current developments in snake antivenoms. In the late nineteenth century, snake antivenoms were first developed by raising hyperimmune serum in animals, such as horses, against snake venoms. Hyperimmune serum was then purified to produce whole immunoglobulin G (IgG) antivenoms. IgG was then fractionated to produce F(ab) and F(ab')2 antivenoms to reduce adverse reactions and increase efficacy. Current commercial antivenoms are polyclonal mixtures of antibodies or their fractions raised against all toxin antigens in a venom(s), irrespective of clinical importance. Over the last few decades there have been small incremental improvements in antivenoms, to make them safer and more effective. A number of recent developments in biotechnology and toxinology have contributed to this. Proteomics and transcriptomics have been applied to venom toxin composition (venomics), improving our understanding of medically important toxins. In addition, it has become possible to identify toxins that contain epitopes recognized by antivenom molecules (antivenomics). Integration of the toxinological profile of a venom and its composition to identify medically relevant toxins improved this. Furthermore, camelid, humanized and fully human monoclonal antibodies and their fractions, as well as enzyme inhibitors have been experimentally developed against venom toxins. Translation of such technology into commercial antivenoms requires overcoming the high costs, limited knowledge of venom and antivenom pharmacology, and lack of reliable animal models. Addressing such should be the focus of antivenom research.
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Musah Y, Ameade EPK, Attuquayefio DK, Holbech LH. Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana. PLoS Negl Trop Dis 2019; 13:e0007221. [PMID: 31369551 PMCID: PMC6692043 DOI: 10.1371/journal.pntd.0007221] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/13/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Worldwide, snakebite envenomations total ~2.7 million reported cases annually with ~100,000 fatalities. Since 2009, snakebite envenomation has intermittently been classified as a very important 'neglected tropical disease' by the World Health Organisation. Despite this emerging awareness, limited efforts have been geared towards addressing the serious public health implications of snakebites, particularly in sub-Saharan Africa, where baseline epidemiological and ecological data remain incomplete. Due to poverty as well as limited infrastructure and public health facilities, people in rural Africa, including Ghana, often have no other choice than to seek treatment from traditional medical practitioners (TMPs). The African 'snakebite crisis' is highlighted here using regionally representative complementary data from a community-based epidemiological and ecological study in the savanna zone of northern Ghana. METHODOLOGY AND FINDINGS Our baseline study involved two data collection methods in the Savelugu-Nanton District (in 2019 the district was separated into Savelugu and Nanton districts) in northern Ghana, comprising a cross-sectional study of 1,000 residents and 24 TMPs between December 2008 and May 2009. Semi-structured interviews, as well as collection of retrospective snakebite and concurrent rainfall records from the Savelugu-Nanton District Hospital and Ghana Meteorological Authority respectively over 10-years (1999-2008) were used in the study. Variables tested included demography, human activity patterns, seasonality, snake ecology and clinical reports. Complementary data showed higher snakebite prevalence during the rainy season, and a hump-shaped correlation between rainfall intensity and snakebite incidences. Almost 6% of respondents had experienced a personal snakebite, whereas ~60% of respondents had witnessed a total of 799 snakebite cases. Out of a total of 857 reported snakebite cases, 24 (~2.8%) died. The highest snakebite prevalence was recorded for males in the age group 15-44 years during farming activities, with most bites occurring in the leg/foot region. The highest snakebite rate was within farmlands, most severe bites frequently caused by the Carpet viper (Echis ocellatus). CONCLUSION The relatively high community-based prevalence of ~6%, and case fatality ratio of ~3%, indicate that snakebites represent an important public health risk in northern Ghana. Based on the high number of respondents and long recording period, we believe these data truly reflect the general situation in the rural northern savanna zone of Ghana and West Africa at large. We recommend increased efforts from both local and international health authorities to address the current snakebite health crisis generally compromising livelihoods and productivity of rural farming communities in West Africa.
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Affiliation(s)
- Yahaya Musah
- Department of Animal Biology and Conservation Science, University of Ghana, Accra, Ghana
| | - Evans P. K. Ameade
- Department of Animal Biology and Conservation Science, University of Ghana, Accra, Ghana
- Department of Pharmacology, University for Development Studies, Tamale, Ghana
| | - Daniel K. Attuquayefio
- Department of Animal Biology and Conservation Science, University of Ghana, Accra, Ghana
| | - Lars H. Holbech
- Department of Animal Biology and Conservation Science, University of Ghana, Accra, Ghana
- * E-mail:
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Helden DFV, Dosen PJ, O'Leary MA, Isbister GK. Two pathways for venom toxin entry consequent to injection of an Australian elapid snake venom. Sci Rep 2019; 9:8595. [PMID: 31197231 PMCID: PMC6565734 DOI: 10.1038/s41598-019-45022-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022] Open
Abstract
Here we test and refute the hypothesis that venom toxins from an Australian elapid, the Eastern Brown snake (Pseudonaja textilis, PTx), solely require lymphatic transport to enter the circulation. Studies were made using anaesthetised non-recovery rats in which a marker dye (India ink) or highly potent PTx venom was injected into the hind paw. The studies required a means of inhibiting lymphatic function, as achieved by cooling of the test hind limb to low temperatures (~3 °C). Maintained entry of a non-lethal dose (0.15 mg/kg) and respiratory arrest consequent to injection of a lethal dose (1 mg/kg) of PTx venom at these low temperatures indicate that venom including toxin components enter the circulation directly via the vascular system, a process facilitated by, but not dependent on, lymphatic transport. Notably, the venom had a direct effect on vascular permeability markedly increasing this to allow extravasation of plasma albumin (MWt ~60 kDa).
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Affiliation(s)
- Dirk F van Helden
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Peter J Dosen
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Margaret A O'Leary
- Clinical Toxicology Research Group, University of Newcastle, Callaghan, New South Wales, Australia
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Callaghan, New South Wales, Australia
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Ralph R, Sharma SK, Faiz MA, Ribeiro I, Rijal S, Chappuis F, Kuch U. The timing is right to end snakebite deaths in South Asia. BMJ 2019; 364:k5317. [PMID: 30670457 PMCID: PMC6340368 DOI: 10.1136/bmj.k5317] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ravikar Ralph
- Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | | | - Isabela Ribeiro
- Dynamic Portfolio, Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ulrich Kuch
- Department of Tropical Medicine and Public Health, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
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Pawade BS, Salvi NC, Shaikh IK, Waghmare AB, Jadhav ND, Wagh VB, Pawade AS, Waykar IG, Potnis-Lele M. Rapid and selective detection of experimental snake envenomation - Use of gold nanoparticle based lateral flow assay. Toxicon 2016; 119:299-306. [PMID: 27377230 DOI: 10.1016/j.toxicon.2016.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
In this study, we have developed a gold nanoparticle based simple, rapid lateral flow assay (LFA) for detection of Indian Cobra venom (CV) and Russell's viper venom (RV). Presently, there is no rapid, reliable, and field diagnostic test available in India, where snake bite cases are rampant. Therefore, this test has an immense potential from the public health point of view. The test is based on the principle of the paper immunochromatography assay for detection of two snake venom species using polyvalent antisnake venom antibodies (ASVA) raised in equines and species-specific antibodies (SSAbs) against venoms raised in rabbits for conjugation and impregnation respectively. The developed, snake envenomation detection immunoassay (SEDIA) was rapid, selective, and sensitive to detect venom concentrations up to 0.1 ng/ml. The functionality of SEDIA strips was confirmed by experimental envenomation in mice and the results obtained were specific for the corresponding venom. The SEDIA has a potential to be a field diagnostic test to detect snake envenomation and assist in saving lives of snakebite victims.
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Affiliation(s)
- Balasaheb S Pawade
- Department of Antitoxins & Sera, Haffkine Biopharmaceutical Corporation Ltd., Pune, India.
| | - Nitin C Salvi
- Department of Antitoxins & Sera, Haffkine Biopharmaceutical Corporation Ltd., Pune, India
| | - Innus K Shaikh
- Department of Antitoxins & Sera, Haffkine Biopharmaceutical Corporation Ltd., Pune, India
| | - Arun B Waghmare
- Department of Antitoxins & Sera, Haffkine Biopharmaceutical Corporation Ltd., Pune, India
| | - Nitin D Jadhav
- Department of Antitoxins & Sera, Haffkine Biopharmaceutical Corporation Ltd., Pune, India
| | - Vishal B Wagh
- Department of Microbiology, MGM Medical College, Navi Mumbai, India
| | - Abhilasha S Pawade
- Department of Pharmacognosy, Marathwada Mitra Mandal's College of Pharmacy, Pune, India
| | - Indrasen G Waykar
- Department of Antitoxins & Sera, Haffkine Biopharmaceutical Corporation Ltd., Pune, India
| | - Mugdha Potnis-Lele
- Entrepreneurship Development Centre, 100 NCL Innovation Park Campus, Pashan, Pune, India
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Antivenom Costs Show Need for Education and Collaborative Efforts. Am J Med 2016; 129:e29. [PMID: 27215992 DOI: 10.1016/j.amjmed.2015.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022]
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Lewin MR, Bickler P, Heier T, Feiner J, Montauk L, Mensh B. Reversal of experimental paralysis in a human by intranasal neostigmine aerosol suggests a novel approach to the early treatment of neurotoxic envenomation. Clin Case Rep 2013; 1:7-15. [PMID: 25356201 PMCID: PMC4184533 DOI: 10.1002/ccr3.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/03/2013] [Accepted: 06/25/2013] [Indexed: 12/19/2022] Open
Abstract
Key Clinical Message Neurotoxic snake envenomation can result in respiratory failure and death. Early treatment is considered important to survival. Inexpensive, heat-stable, needle-free, antiparalytics could facilitate early treatment of snakebite and save lives, but none have been developed. An experiment using aerosolized neostigmine to reverse paralysis suggests how early interventions could be developed.
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Affiliation(s)
- Matthew R Lewin
- Center for Exploration and Travel Health, California Academy of Sciences San Francisco, California, USA
| | - Philip Bickler
- Department of Anesthesia, University of California San Francisco, California, USA
| | - Tom Heier
- Department of Anesthesia, University of California San Francisco, California, USA
| | - John Feiner
- Department of Anesthesia, University of California San Francisco, California, USA
| | - Lance Montauk
- U.S. State Department (Ret) Berkeley, California, USA
| | - Brett Mensh
- Janelia Farm Research Campus Ashburn, Virginia, USA
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Chippaux JP. Estimate of the burden of snakebites in sub-Saharan Africa: A meta-analytic approach. Toxicon 2011; 57:586-99. [DOI: 10.1016/j.toxicon.2010.12.022] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 08/24/2010] [Accepted: 12/24/2010] [Indexed: 11/28/2022]
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Abstract
Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders.
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Affiliation(s)
- Emilie Alirol
- Division of International and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Hayes WK, Mackessy SP. Sensationalistic journalism and tales of snakebite: are rattlesnakes rapidly evolving more toxic venom? Wilderness Environ Med 2010; 21:35-45. [PMID: 20591352 DOI: 10.1016/j.wem.2010.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent reports in the lay press have suggested that bites by rattlesnakes in the last several years have been more severe than those in the past. The explanation, often citing physicians, is that rattlesnakes are evolving more toxic venom, perhaps in response to anthropogenic causes. We suggest that other explanations are more parsimonious, including factors dependent on the snake and factors associated with the bite victim's response to envenomation. Although bites could become more severe from an increased proportion of bites from larger or more provoked snakes (ie, more venom injected), the venom itself evolves much too slowly to explain the severe symptoms occasionally seen. Increased snakebite severity could also result from a number of demographic changes in the victim profile, including age and body size, behavior toward the snake (provocation), anatomical site of bite, clothing, and general health including asthma prevalence and sensitivity to foreign antigens. Clinical management of bites also changes perpetually, rendering comparisons of snakebite severity over time tenuous. Clearly, careful study taking into consideration many factors will be essential to document temporal changes in snakebite severity or venom toxicity. Presently, no published evidence for these changes exists. The sensationalistic coverage of these atypical bites and accompanying speculation is highly misleading and can produce many detrimental results, such as inappropriate fear of the outdoors and snakes, and distraction from proven snakebite management needs, including a consistent supply of antivenom, adequate health care, and training. We urge healthcare providers to avoid propagating misinformation about snakes and snakebites.
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Affiliation(s)
- William K Hayes
- Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, USA.
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Simpson ID, Jacobsen IM. Antisnake Venom Production Crisis—Who Told Us It Was Uneconomic and Unsustainable? Wilderness Environ Med 2009; 20:144-55. [DOI: 10.1580/08-weme-con-273r1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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