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Kallel H, Pujo JM, Resiere D. Antibiotic Therapy and Prophylaxis for Snake-Bitten Patients. Am J Trop Med Hyg 2024; 110:845-846. [PMID: 38507806 PMCID: PMC11066363 DOI: 10.4269/ajtmh.24-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, French Guiana
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
| | - Jean Marc Pujo
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
- Emergency Department, Cayenne General Hospital, French Guiana
| | - Dabor Resiere
- Intensive Care Unit, Martinique University Hospital, Martinique, France
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Hung YL, Chen YC, Tsai TS, Chang YI, Chuang PC. Incidence and Risk Factors for Wound Infections after Trimeresurus stejnegeri Snakebites in Taiwan. Am J Trop Med Hyg 2024; 110:295-302. [PMID: 38109772 PMCID: PMC10859800 DOI: 10.4269/ajtmh.23-0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/30/2023] [Indexed: 12/20/2023] Open
Abstract
Snakebite envenomation is a neglected tropical disease. Taiwan, with its subtropical and Southeast Asian environment, provides suitable habitat for several venomous snake species. Trimeresurus stejnegeri, an arboreal pit viper, is the most common cause of venomous snakebite in Taiwan. Trimeresurus stejnegeri envenomation can cause local swelling, occasional ecchymosis, and wound infection. The primary treatment of T. stejnegeri envenomation is the binary antivenom, vacuum freeze-dried F(ab')2 fragments of equine antibodies, against T. stejnegeri and Protobothrops mucrosquamatus. This study aimed to analyze the incidence of post-envenomation wound infections caused by T. stejnegeri based on data collected over a decade from institutions affiliated with the Chang Gung Memorial Hospital in Taiwan. A total of 254 patients were enrolled in this study. Clinical and laboratory data, treatment information, and patient outcomes were extracted from electronic medical records. Wound infection was associated with delay in antivenom initiation (adjusted odds ratio: 3.987; 95% CI: 1.406-11.302). The infection rates were 20.5%, 12.5%, 31.3%, and 48.1% for antivenom administration within 2 hours, 2-4 hours, 4-6 hours, and > 6 hours, respectively. Therefore, early initiation of antivenom treatment (within 6 hours) is recommended. Morganella morganii was cultured from wounds of the patients, whereas Enterobacter cloacae and Enterococcus faecalis were cultured from both the oral cavity of snakes and the wounds of the patients. For post-envenomation patients who develop a local infection, empiric antibiotics such as third-generation cephalosporins, quinolones, and piperacillin/tazobactam are recommended because snakebite wound infections are often polymicrobial in nature.
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Affiliation(s)
- Yu-Lun Hung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tein-Shun Tsai
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Ye-In Chang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
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Brenes-Chacon H, Gutiérrez JM, Avila-Aguero ML. Use of Antibiotics following Snakebite in the Era of Antimicrobial Stewardship. Toxins (Basel) 2024; 16:37. [PMID: 38251253 PMCID: PMC10820409 DOI: 10.3390/toxins16010037] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Even though there are guidelines for the management of snakebite envenoming (SBE), the use of antibiotics in this pathology remains controversial. The aim of this study is to provide a narrative review of the literature and recommendations based on the best available evidence regarding antibiotic use in SBE. We performed a narrative review of relevant literature regarding SBE and antibiotic use as prophylaxis or treatment. A total of 26 articles were included. There is wide use of antibiotics in SBE; nevertheless, infection was not necessarily documented. The antibiotics used varied according to the study, from beta lactams to lincosamide and nitroimidazoles, and from monotherapy to combined antimicrobials. The most common recommendations were to manage skin and soft tissue infections and avoid infectious complications, but these suggestions are not necessarily based on bacteriological findings. Prophylactic use of antibiotics in SBE is discouraged in most studies. Antibiotic prescription in SBE should be based on the susceptibility of microorganisms isolated from the affected tissue or identified in snakes' oral cavities. Antibiotics should be reserved only for patients with a demonstrated infection, or those at a high risk of developing an infection, i.e., presenting severe local envenoming, local signs of infection, or those with incorrect manipulation of wounds. Prospective studies are needed to correlate microbiological findings at the wound site and the response to antibiotic use.
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Affiliation(s)
- Helena Brenes-Chacon
- Pediatric Infectious Diseases Division, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José 10103, Costa Rica;
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501, Costa Rica;
| | - María L. Avila-Aguero
- Pediatric Infectious Diseases Division, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José 10103, Costa Rica;
- Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED), San José 10108, Costa Rica
- Affiliated Researcher, Center for Infectious Disease Modeling and Analysis (CIDMA), Yale University New Haven, New Haven, CT 06520, USA
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Cavalcante TTA, de Souza MBS, Neves JCF, Ibiapina HNS, Barbosa FBA, Bentes KO, Alves EC, Marques HO, Colombini M, Sampaio SV, Pucca MB, da Silva IM, Ferreira LCDL, Sampaio VDS, Moura-da-Silva AM, Costa AG, Monteiro WM, Sachett JAG, Sartim MA. Inflammatory Profile Associated with Secondary Infection from Bothrops atrox Snakebites in the Brazilian Amazon. Toxins (Basel) 2023; 15:524. [PMID: 37755950 PMCID: PMC10537699 DOI: 10.3390/toxins15090524] [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: 07/17/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
Bothrops snakebite envenomation (SBE) is consider an important health problem in Brazil, where Bothrops atrox is mainly responsible in the Brazilian Amazon. Local effects represent a relevant clinical issue, in which inflammatory signs and symptoms in the bite site represent a potential risk for short and long-term disabilities. Among local complications, secondary infections (SIs) are a common clinical finding during Bothrops atrox SBE and are described by the appearance of signs such as abscess, cellulitis or necrotizing fasciitis in the affected site. However, the influence of SI in the local events is still poorly understood. Therefore, the present study describes for the first time the impact of SBE wound infection on local manifestations and inflammatory response from patients of Bothrops atrox SBE in the Brazilian Amazon. This was an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (Brazil), involving victims of Bothrops SBE. Clinical and laboratorial data were collected along with blood samples for the quantification of circulating cytokines and chemokines before antivenom administrations (T0) and 24 h (T1), 48 h (T2), 72 h (T3) and 7 days after (T4). From the 94 patients included in this study, 42 presented SI (44.7%) and 52 were without SI (NSI, 55.3%). Patients classified as moderate envenoming presented an increased risk of developing SI (OR = 2.69; CI 95% = 1.08-6.66, p = 0.033), while patients with bites in hands showed a lower risk (OR = 0.20; CI 95% = 0.04-0.96, p = 0.045). During follow-up, SI patients presented a worsening of local temperature along with a sustained profile of edema and pain, while NSI patients showed a tendency to restore and were highlighted in patients where SI was diagnosed at T2. As for laboratorial parameters, leukocytes, erythrocyte sedimentation ratio, fibrinogen and C-reactive protein were found increased in patients with SI and more frequently in patients diagnosed with SI at T3. Higher levels of circulating IL-2, IL-10, IL-6, TNF, INF-γ and CXCL-10 were observed in SI patients along with marked correlations between these mediators and IL-4 and IL-17, showing a plurality in the profile with a mix of Th1/Th2/Th17 response. The present study reports for the first time the synergistic effects of local infection and envenoming on the inflammatory response represented by local manifestations, which reflected on laboratorial parameters and inflammatory mediators and thus help improve the clinical management of SI associated to Bothrops SBE.
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Affiliation(s)
- Távila Tatiane Amorim Cavalcante
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
| | | | - Juliana Costa Ferreira Neves
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
| | | | | | - Karolaine Oliveira Bentes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
| | - Eliane Campos Alves
- Instituto Federal de Educação, Ciência e Tecnologia do Amazonas-IFAM, Manaus 69025-010, Brazil
| | - Hedylamar Oliveira Marques
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas-HEMOAM, Manaus 69050-001, Brazil
| | - Monica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, Brazil
| | - Suely Vilela Sampaio
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo-USP, Ribeirão Preto 14040-903, Brazil
| | - Manuela Berto Pucca
- Curso de Medicina, Universidade Federal de Roraima-UFRR, Boa Vista 69310-000, Brazil
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidaed Estadual Paulista-UNESP, Araraquara 14800-903, Brazil
| | - Iran Mendonça da Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | | | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas-HEMOAM, Manaus 69050-001, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Pró-Reitoria de Pesquisa e Pós-Graduação, Universidade Nilton Lins, Manaus 69058-030, Brazil
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Lee JM, Park MK, Lee GP, Song JH, Song KH. Snake envenomation in three cats in South Korea. JFMS Open Rep 2023; 9:20551169231173582. [PMID: 37492185 PMCID: PMC10363879 DOI: 10.1177/20551169231173582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Case series summary Three cats in South Korea were diagnosed with snake envenomation based on the appearance and location of bite wounds. Two cats were envenomed by the Gloydius species and one by an unidentified species. Clinical signs were detected, including local bite-site swelling, haemorrhagic discharge and necrosis. All three cats were given supportive treatment. An antivenom was administered to one cat, and the cat showed no adverse reactions. All cats survived, but skin necrosis remained a complication of the snake envenomation. This was observed during the 1-year follow-up period. Relevance and novel information Cats with snake envenomation are extremely rare in South Korea, and information regarding clinical details are limited. This study is the first to describe the clinical details and prognosis of feline snake envenomation in South Korea.
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Affiliation(s)
- Jeong-Min Lee
- College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
- Korea Animal Medical Center, Cheongju, South Korea
| | - Mi-Kyung Park
- College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Gi-Ppeum Lee
- Korea Animal Medical Center, Cheongju, South Korea
| | - Joong-Hyun Song
- College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Kun-Ho Song
- College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
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Lertsakulbunlue S, Suebtuam R, Eamchotchawalit T, Chantkran W, Chaisakul J. Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand. Trop Med Infect Dis 2023; 8:346. [PMID: 37505642 PMCID: PMC10383512 DOI: 10.3390/tropicalmed8070346] [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: 06/14/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Snakebite envenoming is an occupational hazard in remote rural areas of South Thailand, where the highest incidence of snakebites is reported. In this work, a hospital-based retrospective study of snakebite patients from 2012 to 2022 at Fort Wachirawut Hospital and Fort Thepsatrisrisunthon Hospital, located in Nakhon Si Thammarat province, Thailand was conducted. Data from the laboratory investigation, physical examinations of snakebite victims, and clinical management, including pharmacological and non-pharmacological treatments, were evaluated. A total of 54 snakebite victims were included. The median age of patients was 49 years (IQR, 28 to 63). Males accounted for 74.1% of all participants. The majority of patients were bitten by Malayan pit vipers (68.5%), followed by unidentified snakes (18.5%), other non-venomous snakes (7.4%), and cobras (5.6%). The most common clinical manifestations were swelling (90.2%) and local pain (73.2%). One patient experienced respiratory failure following an envenoming by an unidentified venomous snake. No deaths were observed in this study. In total, 24 patients received antivenom administration (44.4%), most of whom were from Fort Wachirawut Hospital. Patients who were administered antivenom showed a median admission duration of three days (IQR, 3 to 4), compared with two days (IQR, one to three) for those who did not receive antivenom treatment (p < 0.001). In addition, paracetamol and prophylactic antibiotics, namely, amoxicillin-clavulanate and dicloxacillin, were the most common pharmacotherapies following snakebites. Overall, it was observed that these two community hospitals undertook appropriate clinical management under the standard guidelines for snakebite patients. This might be due to the effective emergency management, facilities, and clinical consultations. Finally, the management process in the medical teams also plays a crucial role in minimizing the severity of snakebite outcomes.
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Affiliation(s)
| | | | | | - Wittawat Chantkran
- Department of Pathology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Janeyuth Chaisakul
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
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Epelboin L, Abboud P, Abdelmoumen K, About F, Adenis A, Blaise T, Blaizot R, Bonifay T, Bourne-Watrin M, Boutrou M, Carles G, Carlier PY, Carod JF, Carvalho L, Couppié P, De Toffol B, Delon F, Demar M, Destoop J, Douine M, Droz JP, Elenga N, Enfissi A, Franck YK, Fremery A, Gaillet M, Kallel H, Kpangon AA, Lavergne A, Le Turnier P, Maisonobe L, Michaud C, Mutricy R, Nacher M, Naldjinan-Kodbaye R, Oberlis M, Odonne G, Osei L, Pujo J, Rabier S, Roman-Laverdure B, Rousseau C, Rousset D, Sabbah N, Sainte-Rose V, Schaub R, Sylla K, Tareau MA, Tertre V, Thorey C, Vialette V, Walter G, Zappa M, Djossou F, Vignier N. [Overview of infectious and non-infectious diseases in French Guiana in 2022]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i1.2023.308. [PMID: 37389381 PMCID: PMC10300792 DOI: 10.48327/mtsi.v3i1.2023.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 07/01/2023]
Abstract
Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.
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Affiliation(s)
- Loïc Epelboin
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Philippe Abboud
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Karim Abdelmoumen
- Département des maladies infectieuses, Centre hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Frédégonde About
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Antoine Adenis
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Théo Blaise
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Romain Blaizot
- Unité carcérale de soins ambulatoires, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Timothée Bonifay
- Unité carcérale de soins ambulatoires, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Mathilde Boutrou
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- Département des maladies infectieuses, Centre hospitalier de Mayotte, Mamoudzou, Mayotte
- Unité carcérale de soins ambulatoires, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de gynécologie-obstétrique, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
- Laboratoire de biologie médicale, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
- Agence régionale de santé de Guyane, Cayenne, Guyane
- Santé publique France, Cayenne, Guyane
- Service de neurologie, Centre hospitalier de Cayenne, Cayenne, Guyane
- TBIP (Tropical Biome and ImmunoPhysiopathology), Université de Guyane, Cayenne, Guyane
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
- Université Claude Bernard Lyon 1 et Centre Léon Bérard, Lyon, France
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane
- Laboratoire de virologie, Institut Pasteur de la Guyane
- Service de cardiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de réanimation, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de médecine, Centre hospitalier de Kourou, Kourou, Guyane
- Laboratoire des interactions virus-hôtes, Institut Pasteur de la Guyane, Cayenne, Guyane
- Croix-Rouge française de Guyane, Cayenne, Guyane
- Laboratoire Écologie, évolution, interactions des systèmes amazoniens (LEEISA), CNRS, Université de Guyane, IFREMER, Cayenne, Guyane
- COREVIH (Comité de coordination de la lutte contre les infections sexuellement transmissibles et le virus de l'immunodéficience humaine), Centre hospitalier de Cayenne, Cayenne, Guyane
- Service d'endocrinologie-diabétologie et maladies métaboliques, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de médecine, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
- Direction interarmées du service de santé (DIASS)
- Laboratoire Eurofins Guyane, site de Kourou, Centre hospitalier de Kourou, Guyane
- Service de radiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Gabriel Carles
- Service de gynécologie-obstétrique, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | | | - Jean-François Carod
- Laboratoire de biologie médicale, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | | | - Pierre Couppié
- Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Bertrand De Toffol
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de neurologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - François Delon
- Laboratoire Eurofins Guyane, site de Kourou, Centre hospitalier de Kourou, Guyane
| | - Magalie Demar
- TBIP (Tropical Biome and ImmunoPhysiopathology), Université de Guyane, Cayenne, Guyane
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
| | - Justin Destoop
- Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Maylis Douine
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Jean-Pierre Droz
- Université Claude Bernard Lyon 1 et Centre Léon Bérard, Lyon, France
| | - Narcisse Elenga
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Yves-Kénol Franck
- Service de cardiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Alexis Fremery
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Mélanie Gaillet
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Hatem Kallel
- Service de réanimation, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Anne Lavergne
- Laboratoire des interactions virus-hôtes, Institut Pasteur de la Guyane, Cayenne, Guyane
| | - Paul Le Turnier
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Lucas Maisonobe
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Céline Michaud
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Rémi Mutricy
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Mathieu Nacher
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | | | - Guillaume Odonne
- Laboratoire Écologie, évolution, interactions des systèmes amazoniens (LEEISA), CNRS, Université de Guyane, IFREMER, Cayenne, Guyane
| | - Lindsay Osei
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Jean Pujo
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Sébastien Rabier
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- COREVIH (Comité de coordination de la lutte contre les infections sexuellement transmissibles et le virus de l'immunodéficience humaine), Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Cyril Rousseau
- Santé publique France, Cayenne, Guyane
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Dominique Rousset
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
| | - Nadia Sabbah
- Service d'endocrinologie-diabétologie et maladies métaboliques, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Vincent Sainte-Rose
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
| | - Roxane Schaub
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Karamba Sylla
- Service de médecine, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | - Marc-Alexandre Tareau
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- Laboratoire Écologie, évolution, interactions des systèmes amazoniens (LEEISA), CNRS, Université de Guyane, IFREMER, Cayenne, Guyane
| | | | - Camille Thorey
- Service de médecine, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | - Véronique Vialette
- Laboratoire Eurofins Guyane, site de Kourou, Centre hospitalier de Kourou, Guyane
| | - Gaëlle Walter
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Magaly Zappa
- Service de radiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Félix Djossou
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Nicolas Vignier
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- COREVIH (Comité de coordination de la lutte contre les infections sexuellement transmissibles et le virus de l'immunodéficience humaine), Centre hospitalier de Cayenne, Cayenne, Guyane
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8
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Senthilkumaran S, Salim A, Almeida JR, Williams J, Vijayakumar P, Thirunavukarasu A, Christopoulos MA, Williams HF, Thirumalaikolundusubramanian P, Patel K, Vaiyapuri S. The Effectiveness of Antibiotics in Managing Bacterial Infections on Bite Sites following Snakebite Envenomation. Toxins (Basel) 2023; 15:190. [PMID: 36977081 PMCID: PMC10057039 DOI: 10.3390/toxins15030190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Snakebite envenomation (SBE) is a life-threatening medical emergency with a high mortality rate. Common secondary complications following SBE, such as wound infections, are significant due to their impact on worsening local tissue damage and causing systemic infection. Antivenoms are not effective to treat wound infections following SBE. Moreover, in several rural clinical settings, broad-spectrum antibiotics are often used without clear guidelines or based on limited laboratory data, resulting in undesirable side effects and exacerbated treatment costs. Therefore, robust antibiotic strategies should be developed to tackle this critical issue. Currently, there is limited information available on the bacterial profiles of SBE-induced infections and antibiotic susceptibility. Hence, it is essential to improve the knowledge of bacterial profiles and their antibiotic sensitivity in SBE victims to develop better treatment strategies. This study aimed to address this issue by examining the bacterial profiles of SBE victims with a specific focus on Russell's viper envenomation. The most frequently found bacteria in the bites of SBE victims were Staphylococcus aureus, Klebsiella sp., Escherichia coli, and Pseudomonas aeruginosa. Linezolid, clindamycin, colistin, meropenem, and amikacin were some of the most effective antibiotics for commonly grown bacteria in SBE victims. Similarly, ciprofloxacin, ampicillin, amoxiclave, cefixime, and tetracyclin were the least effective antibiotics for common bacteria found in the wound swabs of SBE victims. These data provide robust guidance for infection management following SBE and offer useful insights to aid in designing effective treatment protocols for SBE with serious wound infections in rural areas where laboratory facilities may not be readily available.
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Affiliation(s)
| | - Anika Salim
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK
| | - José R Almeida
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK
| | | | | | | | - Harry F Williams
- Toxiven Biotech Private Limited, Coimbatore 641042, Tamil Nadu, India
| | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading RG6 6UB, UK
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9
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Patiño RSP, Salazar-Valenzuela D, Robles-Loaiza AA, Santacruz-Ortega P, Almeida JR. A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon. Trans R Soc Trop Med Hyg 2023; 117:118-127. [PMID: 35917814 DOI: 10.1093/trstmh/trac071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. METHODS This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. RESULTS Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. CONCLUSIONS The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.
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Affiliation(s)
- Ricardo S P Patiño
- Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo 150150, Ecuador.,Escuela Superior Politécnica del Litoral (ESPOL), Centro Nacional de Acuicultura e Investigaciones Marinas (CENAIM), Guayaquil 090211, Ecuador
| | - David Salazar-Valenzuela
- Centro de Investigación de la Biodiversidad y Cambio Climático (BioCamb) e Ingeniería en Biodiversidad y Recursos Genéticos, Facultad de Ciencias de Medio Ambiente, Universidad Tecnológica Indoamérica, Quito 170103, Ecuador
| | | | - Paola Santacruz-Ortega
- Escola de Educação Permanente, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403010, Brasil
| | - José R Almeida
- Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo 150150, Ecuador
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10
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Yeh H, Gao SY, Lin CC. Wound Infection of Snakebite from Venomous Protobothrops mucrosquamatus, Viridovipera stejnegeri and Naja atra in Taiwan: Validation of BITE and Cobra BITE Scoring Systems and their Bacteriological Differences in Wound Cultures. Toxins (Basel) 2023; 15:78. [PMID: 36668897 PMCID: PMC9861491 DOI: 10.3390/toxins15010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Patients bitten by Protobothrops mucrosquamatus, Viridovipera stejnegeri, and Naja atra develop different degrees of wound infection. This study validated BITE and Cobra BITE scoring systems that we established previously. Bacteriological studies of patients with wound infection were conducted. The operating characteristic curves and area under the curve (AUC) and wound infection rates were compared between the derivation set (our previous study patient population) and the validation set (new patient cohorts enrolled between June 2017 and May 2021). No significant differences in the AUC for both the BITE (0.84 vs. 0.78, p = 0.27) and Cobra BITE (0.88 vs. 0.75, p = 0.21) scoring systems were observed between the derivation and validation sets. Morganella morganii and Enterococcus faecalis were the two most commonly detected bacteria in the microbiological study. More bacterial species were cultured from N. atra-infected wounds. Antibiotics such as amoxicillin with clavulanic acid, oxacillin, and ampicillin may not be suitable for treating patients with P. mucrosquamatus, V. stejnegeri, and N. atra bites in Taiwan. Carbapenem, third-generation cephalosporins, and fluoroquinolone may be superior alternatives.
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Affiliation(s)
- Heng Yeh
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shi-Ying Gao
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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11
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Bhaumik S, Gopalakrishnan M, Kirubakaran R, Jagnoor J. Antibiotics for preventing wound infections after snakebite. Hippokratia 2022. [DOI: 10.1002/14651858.cd015114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, Faculty of Medicine; University of New South Wales; Sydney Australia
- Meta-research and Evidence Synthesis Unit; The George Institute for Global Health; New Delhi India
| | - Maya Gopalakrishnan
- Department of Internal Medicine; All India Institute of Medical Sciences, Jodhpur; Jodhpur India
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy; Christian Medical College; Vellore India
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine; University of New South Wales; Sydney Australia
- Injury Division; The George Institute for Global Health; New Delhi India
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12
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Characteristics of Snakebite-Related Infection in French Guiana. Toxins (Basel) 2022; 14:toxins14020089. [PMID: 35202117 PMCID: PMC8878173 DOI: 10.3390/toxins14020089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Wound infection is frequently reported following snakebite (SB). This study is retrospective. It was conducted in the emergency department and the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 July 2021. We included 172 consecutive patients hospitalized for SB envenoming. All patients were monitored for wound infection. Sixty-three patients received antibiotics at admission (36.6%). The main antibiotic used was amoxicillin–clavulanate (92.1%). Wound infection was recorded in 55 cases (32%). It was 19% in grade 1, 35% in grade 2, and 53% in grade 3. It included abscess (69.1%), necrotizing fasciitis (16.4%), and cellulitis (21.8%). The time from SB to wound infection was 6 days (IQR: 3–8). The main isolated microorganisms were A. hydrophila and M. morganii (37.5% and 18.8% of isolated organisms). Surgery was required in 48 patients (28.1%), and a necrosectomy was performed on 16 of them (33.3%). The independent factors associated with snakebite-associated infection were necrosis (p < 0.001, OR 13.15, 95% CI: 4.04–42.84), thrombocytopenia (p = 0.002, OR: 3.37, 95% CI: 1.59–7.16), and rhabdomyolysis (p = 0.046, OR: 2.29, 95% CI: 1.02–5.19). In conclusion, wound infection following SB is frequent, mainly in grade 2 and 3 envenomed patients, especially those with necrosis, thrombocytopenia, and rhabdomyolysis. The main involved bacteria are A. hydrophila and M. morganii.
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13
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Mendes VKDG, Pereira HDS, Elias IC, Soares GS, Santos M, Talhari C, Cordeiro-Santos M, Monteiro WM, Sachett JDAG. Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon. Rev Soc Bras Med Trop 2022; 55:e0244. [PMID: 35239899 PMCID: PMC8909433 DOI: 10.1590/0037-8682-0244-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Gean Souza Soares
- Universidade do Estado do Amazonas, Brasil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil
| | - Monica Santos
- Universidade do Estado do Amazonas, Brasil; Fundação Alfredo da Matta, Brasil; Universidade do Estado do Amazonas, Brasil
| | - Carolina Talhari
- Universidade do Estado do Amazonas, Brasil; Fundação Alfredo da Matta, Brasil; Universidade do Estado do Amazonas, Brasil
| | - Marcelo Cordeiro-Santos
- Universidade do Estado do Amazonas, Brasil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Brasil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil
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14
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Pujo JM, Houcke S, Fremery A, Lontsi-Ngoula G, Burin A, Mutricy R, Hommel D, Resiere D, Kallel H. Les envenimations vipérines en Guyane française. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’OMS classe l’envenimation vipérine comme pathologie négligée. Elle représente un problème de santé publique associé à des taux de mortalité et de morbidité importants. Notre objectif est de faire une mise au point sur les données récentes de la littérature sur l’épidémiologie et la prise en charge de l’envenimation vipérine en Guyane française. La Guyane est un département français presque entièrement recouvert par une forêt tropicale. Elle abrite une herpétofaune très riche comportant notamment les espèces du genre Bothrops (famille des Viperidae) qui provoquent le plus grand nombre de morsures et d’envenimations. La gestion des envenimations vipérines représente un défi de santé publique. En effet, la plupart des envenimations se produisent dans des zones rurales éloignées où l’accès aux soins est le plus compliqué, avec la présence d’un personnel médical peu formé à la prise en charge et l’indisponibilité de l’antivenin, ce qui constitue une véritable perte de chance pour les patients. En conclusion, dans un contexte d’efforts mondiaux visant à réduire l’impact des envenimations vipérines, la coopération internationale et l’engagement des autorités locales de santé et de la société civile sont nécessaires. En Guyane, la mise en place d’une véritable filière de soins et la mise à disposition de l’antivenin dans les structures sanitaires les plus isolées constitueraient un réel progrès sanitaire.
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15
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Sasa M, Segura Cano SE. New insights into snakebite epidemiology in Costa Rica: A retrospective evaluation of medical records. Toxicon X 2020; 7:100055. [PMID: 32776004 PMCID: PMC7398977 DOI: 10.1016/j.toxcx.2020.100055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022] Open
Abstract
Continuous monitoring of the snakebite envenoming allows elucidating factors that affect its incidence at spatial and temporal scales, and is a great tool to evaluate the proper management of snakebite in health centers. To determine if there have been changes over time in snakebite epidemiology in Costa Rica, we conducted a retrospective study using medical records from six hospitals for the years 2012-2013. A total of 475 snakebite patients were treated at the selected hospital during this period. Most bites occurred during the rainy season and primarily affected young men, mainly farm workers and schoolchildren. About 55% of bites occur in peri-domiciliary environments, although its prevalence varies geographically. Bothrops asper generates the vast majority of envenoming in the country, which is why the main local symptoms registered are edema, pain, and bleeding disorders. The time elapsed until treatment did not explain the degree of severity at admission. However, complications were observed more frequently in patients who took longer to receive treatment. The primary complications were bacterial infections, whereas kidney failure and compartment syndrome documented at very low frequencies. Only one death was recorded, reflecting the low fatality rate exhibited in the country. Hospital treatment included the rapid administration of antivenom and complementary treatment of antibiotics, analgesics, and antihistamines. The application of the latter as prophylactic does not seem to prevent the appearance of mild early adverse reactions, registered in 22.5% of the cases. Morbidity and mortality rates from snakebite have continued to decrease in the country, as a result of the efforts that Costa Rica has made to improve its public health system. Among those efforts, the creation of primary care centers (EBAIS) has reduced the time to treatment in many regions of the country. The Costa Rican experience of using antivenom in primary health care centers and maintaining good medical records could be considered for application in other countries where snakebite is a major health problem.
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Affiliation(s)
- Mahmood Sasa
- Instituto Clodomiro Picado, Universidad de Costa Rica, San José, Costa Rica
- Museo de Zoología, Escuela de Biología, Universidad de Costa Rica, San José, Costa Rica
| | - Sofía E. Segura Cano
- Departamento de Farmacología y Toxicología, Escuela de Medicina, Universidad de Costa Rica, San José, Costa Rica
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16
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Xie C, Albulescu LO, Bittenbinder MA, Somsen GW, Vonk FJ, Casewell NR, Kool J. Neutralizing Effects of Small Molecule Inhibitors and Metal Chelators on Coagulopathic Viperinae Snake Venom Toxins. Biomedicines 2020; 8:E297. [PMID: 32825484 PMCID: PMC7555180 DOI: 10.3390/biomedicines8090297] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/27/2022] Open
Abstract
Animal-derived antivenoms are the only specific therapies currently available for the treatment of snake envenoming, but these products have a number of limitations associated with their efficacy, safety and affordability for use in tropical snakebite victims. Small molecule drugs and drug candidates are regarded as promising alternatives for filling the critical therapeutic gap between snake envenoming and effective treatment. In this study, by using an advanced analytical technique that combines chromatography, mass spectrometry and bioassaying, we investigated the effect of several small molecule inhibitors that target phospholipase A2 (varespladib) and snake venom metalloproteinase (marimastat, dimercaprol and DMPS) toxin families on inhibiting the activities of coagulopathic toxins found in Viperinae snake venoms. The venoms of Echis carinatus, Echis ocellatus, Daboia russelii and Bitis arietans, which are known for their potent haemotoxicities, were fractionated in high resolution onto 384-well plates using liquid chromatography followed by coagulopathic bioassaying of the obtained fractions. Bioassay activities were correlated to parallel recorded mass spectrometric and proteomics data to assign the venom toxins responsible for coagulopathic activity and assess which of these toxins could be neutralized by the inhibitors under investigation. Our results showed that the phospholipase A2-inhibitor varespladib neutralized the vast majority of anticoagulation activities found across all of the tested snake venoms. Of the snake venom metalloproteinase inhibitors, marimastat demonstrated impressive neutralization of the procoagulation activities detected in all of the tested venoms, whereas dimercaprol and DMPS could only partially neutralize these activities at the doses tested. Our results provide additional support for the concept that combinations of small molecules, particularly the combination of varespladib with marimastat, serve as a drug-repurposing opportunity to develop new broad-spectrum inhibitor-based therapies for snakebite envenoming.
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Affiliation(s)
- Chunfang Xie
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, The Netherlands; (C.X.); (M.A.B.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Laura-Oana Albulescu
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; (L.-O.A.); (N.R.C.)
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Mátyás A. Bittenbinder
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, The Netherlands; (C.X.); (M.A.B.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
- Naturalis Biodiversity Center, 2333 CR Leiden, The Netherlands
| | - Govert W. Somsen
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, The Netherlands; (C.X.); (M.A.B.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Freek J. Vonk
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, The Netherlands; (C.X.); (M.A.B.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Nicholas R. Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; (L.-O.A.); (N.R.C.)
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Jeroen Kool
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, The Netherlands; (C.X.); (M.A.B.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
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17
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Letter to the Editor: Acute-phase response fever in Viperidae as a potential and additional clinical sign. Toxicon 2020; 184:229-230. [PMID: 32681849 DOI: 10.1016/j.toxicon.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 11/23/2022]
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18
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Xie C, Albulescu LO, Still KBM, Slagboom J, Zhao Y, Jiang Z, Somsen GW, Vonk FJ, Casewell NR, Kool J. Varespladib Inhibits the Phospholipase A 2 and Coagulopathic Activities of Venom Components from Hemotoxic Snakes. Biomedicines 2020; 8:E165. [PMID: 32560391 PMCID: PMC7345350 DOI: 10.3390/biomedicines8060165] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Phospholipase A2 (PLA2) enzymes are important toxins found in many snake venoms, and they can exhibit a variety of toxic activities including causing hemolysis and/or anticoagulation. In this study, the inhibiting effects of the small molecule PLA2 inhibitor varespladib on snake venom PLA2s was investigated by nanofractionation analytics, which combined chromatography, mass spectrometry (MS), and bioassays. The venoms of the medically important snake species Bothrops asper, Calloselasma rhodostoma, Deinagkistrodon acutus, Daboia russelii, Echis carinatus, Echis ocellatus, and Oxyuranus scutellatus were separated by liquid chromatography (LC) followed by nanofractionation and interrogation of the fractions by a coagulation assay and a PLA2 assay. Next, we assessed the ability of varespladib to inhibit the activity of enzymatic PLA2s and the coagulopathic toxicities induced by fractionated snake venom toxins, and identified these bioactive venom toxins and those inhibited by varespladib by using parallel recorded LC-MS data and proteomics analysis. We demonstrated here that varespladib was not only capable of inhibiting the PLA2 activities of hemotoxic snake venoms, but can also effectively neutralize the coagulopathic toxicities (most profoundly anticoagulation) induced by venom toxins. While varespladib effectively inhibited PLA2 toxins responsible for anticoagulant effects, we also found some evidence that this inhibitory molecule can partially abrogate procoagulant venom effects caused by different toxin families. These findings further emphasize the potential clinical utility of varespladib in mitigating the toxic effects of certain snakebites.
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Affiliation(s)
- Chunfang Xie
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (C.X.); (K.B.M.S.); (J.S.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Laura-Oana Albulescu
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; (L.-O.A.); (N.R.C.)
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Kristina B. M. Still
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (C.X.); (K.B.M.S.); (J.S.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Julien Slagboom
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (C.X.); (K.B.M.S.); (J.S.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Yumei Zhao
- Institute of Pharmaceutical Analysis, College of Pharmacy, Jinan University, Huangpu Avenue West 601, Guangzhou 510632, China; (Y.Z.); (Z.J.)
| | - Zhengjin Jiang
- Institute of Pharmaceutical Analysis, College of Pharmacy, Jinan University, Huangpu Avenue West 601, Guangzhou 510632, China; (Y.Z.); (Z.J.)
| | - Govert W. Somsen
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (C.X.); (K.B.M.S.); (J.S.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
| | - Freek J. Vonk
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (C.X.); (K.B.M.S.); (J.S.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
- Naturalis Biodiversity Center, Darwinweg 2, 2333 CR Leiden, The Netherlands
| | - Nicholas R. Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; (L.-O.A.); (N.R.C.)
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Jeroen Kool
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (C.X.); (K.B.M.S.); (J.S.); (G.W.S.); (F.J.V.)
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH Amsterdam, The Netherlands
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Resiere D, Monteiro W, Houcke S, Pujo JM, Mathien C, Mayence C, Neviere R, Hommel D, de Almeida Gonçalves Sachett J, Mehdaoui H, Gutiérrez JM, Kallel H. Bothrops Snakebite Envenomings in the Amazon Region. CURRENT TROPICAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40475-020-00203-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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