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Hsu JY, Chiang SO, Yang CC, Mao YC. A Nationwide Study on the Risks of Complications and Healthcare Costs of Snakebite Envenomation in Taiwan. Am J Trop Med Hyg 2024; 111:205-215. [PMID: 38714189 PMCID: PMC11229656 DOI: 10.4269/ajtmh.24-0030] [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: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
In Taiwan, six medically important venomous snakes, Trimeresurus stejnegeri stejnegeri, Protobothrops mucrosquamatus, Deinagkistrodon acutus, Daboia siamensis, Naja atra, and Bungarus multicinctus, are found. However, comprehensive research on the complications and associated healthcare costs of snakebite envenomation (SBE) is lacking. We retrospectively analyzed pertinent information from the Taiwan National Health Insurance Research Database dated January 2002 to December 2014. We investigated the risk factors for complications and their impact on healthcare costs. Among the 12,542 patients with SBE, those from N. atra or B. multicinctus were more likely to experience wound infections and neurological complications than were those from T. s. stejnegeri or P. mucrosquamatus. In addition, being female, being elderly, and having a Charlson Comorbidity Index equal to or greater than 3 points were associated with an increased likelihood of wound infections and psychological complications. The annual national economic burden averaged US$1,083,624, with an average healthcare cost of US$1,129 per SBE. Snakebite envenomations from N. atra or B. multicinctus, as well as various complications, resulted in significantly higher costs. It is crucial to comprehend the risk factors for complications and their role in increasing expenses to provide insight for tailored healthcare interventions, mitigate complications, and reduce the economic burdens associated with SBEs.
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Affiliation(s)
- Jen-Yu Hsu
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-O Chiang
- ESTAT Statistical Consulting Co., Ltd, Taipei, Taiwan
| | - Chen-Chang Yang
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yan-Chiao Mao
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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2
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Smith LK, Vardanega J, Smith S, White J, Little M, Hanson J. The Incidence of Infection Complicating Snakebites in Tropical Australia: Implications for Clinical Management and Antimicrobial Prophylaxis. J Trop Med 2023; 2023:5812766. [PMID: 37868739 PMCID: PMC10586896 DOI: 10.1155/2023/5812766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/24/2023] Open
Abstract
Objective To define the incidence of infection following snakebite in tropical Australia and the resulting implications for the routine prescription of prophylactic antibiotics. Methods A retrospective study of all individuals presenting to Cairns Hospital, a tertiary referral hospital in tropical Australia, after a snakebite between December 2013 and October 2020. Results There were 732 hospitalisations, 720 (98.4%) patients presented within 8 hours of the snakebite, and 29/732 (4.0%) were envenomated. Envenomated patients were more likely to receive empirical antibiotics than nonenvenomated patients (8/29 (27.6%) versus 14/703 (2.0%), p < 0.001), although this was frequently as a bundle of care for critically ill individuals. Superficial skin infection was diagnosed by clinicians in 6/732 (0.8%) patients during their hospitalisation; infection was diagnosed more commonly in envenomated than in nonenvenomated patients (3/29 (10.3%) versus 3/703 (0.4%), p = 0.001). All 3 envenomated individuals diagnosed with infection were believed to have taipan (genus Oxyuranus) bites. Five (83%) of the six patients diagnosed with infection had received empirical antibiotics at presentation; only 1/710 (0.1%) patients who received no antibiotics developed a (superficial) infection. Conclusion Infection is a very uncommon complication of snakebite in tropical Australia. Individuals bitten by snakes in tropical Australia should not routinely receive antibiotic prophylaxis.
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Affiliation(s)
| | - John Vardanega
- Cairns Hospital, Cairns, Queensland, Australia
- QML Pathology, Murarrie, Queensland, Australia
| | - Simon Smith
- Cairns Hospital, Cairns, Queensland, Australia
| | - Julian White
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mark Little
- Cairns Hospital, Cairns, Queensland, Australia
- NSW Poisons Information Service, Sydney NSW, Australia
| | - Josh Hanson
- Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, UNSW, Sydney, NSW, Australia
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3
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Hu S, Lou Z, Shen Y, Tu M. Bacteriological Studies of Venomous Snakebite Wounds in Hangzhou, Southeast China. Am J Trop Med Hyg 2022; 107:925-929. [PMID: 36067984 PMCID: PMC9651534 DOI: 10.4269/ajtmh.21-1314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022] Open
Abstract
Snakebite is a common occurrence in Hangzhou, and identifying bacteria in wounds is very important for snakebite treatment. To define the pattern of wound bacterial flora of venomous snakebites and their susceptibility to common antibiotics, we reviewed the medical charts of patients admitted with snakebite at Hangzhou TCM Hospital from January 2019 to December 2020. A total of 311 patients were enrolled in this study. Among them, bacteria culture was positive in 40 patients, and 80 organisms were isolated. The most frequent pathogens were Morganella morganii and Staphylococcus aureus. According to the results of susceptibility testing, a majority of the isolates were resistant to some common first-line antibiotics, such as ampicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, cefoxitin, and cephazolin. Quinolones, however, have shown a better antibacterial effect. In conclusion, snakebite wounds involve a wide range of bacteria. Fluoroquinolones, such as levofloxacin and ciprofloxacin, could be an alternative for empirical treatment in patients with snakebite when the effect of other antibiotics is poor.
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Affiliation(s)
- Sipin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhengqing Lou
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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4
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Esmaeilishirazifard E, Usher L, Trim C, Denise H, Sangal V, Tyson GH, Barlow A, Redway KF, Taylor JD, Kremyda-Vlachou M, Davies S, Loftus TD, Lock MMG, Wright K, Dalby A, Snyder LAS, Wuster W, Trim S, Moschos SA. Bacterial Adaptation to Venom in Snakes and Arachnida. Microbiol Spectr 2022; 10:e0240821. [PMID: 35604233 PMCID: PMC9248900 DOI: 10.1128/spectrum.02408-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Animal venoms are considered sterile sources of antimicrobial compounds with strong membrane-disrupting activity against multidrug-resistant bacteria. However, venomous bite wound infections are common in developing nations. Investigating the envenomation organ and venom microbiota of five snake and two spider species, we observed venom community structures that depend on the host venomous animal species and evidenced recovery of viable microorganisms from black-necked spitting cobra (Naja nigricollis) and Indian ornamental tarantula (Poecilotheria regalis) venoms. Among the bacterial isolates recovered from N. nigricollis, we identified two venom-resistant, novel sequence types of Enterococcus faecalis whose genomes feature 16 virulence genes, indicating infectious potential, and 45 additional genes, nearly half of which improve bacterial membrane integrity. Our findings challenge the dogma of venom sterility and indicate an increased primary infection risk in the clinical management of venomous animal bite wounds. IMPORTANCE Notwithstanding their 3 to 5% mortality, the 2.7 million envenomation-related injuries occurring annually-predominantly across Africa, Asia, and Latin America-are also major causes of morbidity. Venom toxin-damaged tissue will develop infections in some 75% of envenomation victims, with E. faecalis being a common culprit of disease; however, such infections are generally considered to be independent of envenomation. Here, we provide evidence on venom microbiota across snakes and arachnida and report on the convergent evolution mechanisms that can facilitate adaptation to black-necked cobra venom in two independent E. faecalis strains, easily misidentified by biochemical diagnostics. Therefore, since inoculation with viable and virulence gene-harboring bacteria can occur during envenomation, acute infection risk management following envenomation is warranted, particularly for immunocompromised and malnourished victims in resource-limited settings. These results shed light on how bacteria evolve for survival in one of the most extreme environments on Earth and how venomous bites must be also treated for infections.
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Affiliation(s)
- Elham Esmaeilishirazifard
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
- Westminster Genomic Services, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Louise Usher
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
- Westminster Genomic Services, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Carol Trim
- School of Psychology and Life Sciences, Faculty of Science, Engineering and Social Sciences, Canterbury Christ Church University, Canterbury, Kent, United Kingdom
| | - Hubert Denise
- EMBL-EBI European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Vartul Sangal
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear, United Kingdom
| | - Gregory H. Tyson
- Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Laurel, Maryland, USA
| | - Axel Barlow
- Institute for Biochemistry and Biology, University of Potsdam, Potsdam, Germany
| | - Keith F. Redway
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - John D. Taylor
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
- Westminster Genomic Services, Faculty of Science and Technology, University of Westminster, London, United Kingdom
- School of Environment and Life Sciences, University of Salford, Salford, Greater Manchester, United Kingdom
| | - Myrto Kremyda-Vlachou
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Sam Davies
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear, United Kingdom
| | | | | | - Kstir Wright
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Andrew Dalby
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Lori A. S. Snyder
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, London, United Kingdom
| | - Wolfgang Wuster
- Molecular Ecology and Evolution at Bangor, School of Biological Sciences, College of Natural Sciences, Bangor University, Bangor, Wales, United Kingdom
| | - Steve Trim
- Venomtech, Ltd., Sandwich, Kent, United Kingdom
| | - Sterghios A. Moschos
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
- Westminster Genomic Services, Faculty of Science and Technology, University of Westminster, London, United Kingdom
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear, United Kingdom
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Snake Bite Management: A Scoping Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3506. [PMID: 33936914 PMCID: PMC8084039 DOI: 10.1097/gox.0000000000003506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/20/2023]
Abstract
Background: Around the world, snake bite envenomation remains an underreported human health hazard. Envenomation can cause local and systemic complications, especially when there is a lack of antivenom availability. Although there are established guidelines regarding snake bite management acute care, there is a paucity of data regarding surgical intervention and the plastic surgeon’s role treating this unique patient population. Methods: A review was conducted identifying relevant published articles involving snake bite management and treatment in PubMed and EMBASE. Results: One hundred ten articles were identified and 77 met inclusion criteria. Snake bite envenomation can result in complications that are dependent upon a variety of variables. The literature has shown the best field treatment to be timely transportation to the nearest medical facility, along with antivenom administration. The cytotoxic, hemotoxic, and neurotoxic effects of venom can cause a variety of local soft tissue and systemic complications. Surgical interventions such as fasciotomies, wound debridements, skin grafts, and tissue flaps may be necessary in these patients to optimize functional and aesthetic outcomes. Disparities in access to care in resource limited settings are discussed. Conclusions: Global health disparities and insufficient antivenom distribution create an inequality of care in snake bite patients. Plastic surgeons have an important role in managing acute and chronic complications of snake bite envenomations that can lead to improved patient outcomes.
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Pirasath S, Gajan D, Guruparan M, Murugananthan A, Gnanathasan A. Saw-scaled viper envenoming complicated with acute myocardial infarction. SAGE Open Med Case Rep 2021; 9:2050313X211007705. [PMID: 33953917 PMCID: PMC8042544 DOI: 10.1177/2050313x211007705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
The saw-scaled viper (Echis carinatus) is considered to be a venomous snake which is especially seen in Northern Sri Lanka. Systemic manifestations are rare and reported complications include coagulopathy and renal impairment. The cardiac toxicity following snakebites is rare and cardiac involvement following the saw-scaled viper bites is extremely rare. Here, we describe a patient with acute myocardial infarction following systemic envenoming by saw-scaled viper in Northern Sri Lanka, which was successfully managed per ward protocol following national guidelines.
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Affiliation(s)
| | - Dilani Gajan
- District General Hospital, Kilinochchi, Sri Lanka
| | | | - Arumugam Murugananthan
- Department of Parasitology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Ariaranee Gnanathasan
- National Hospital of Sri Lanka and Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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7
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Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, Begum R, Sati P, Piyasena K, Bhatia M, Brown P, Jha P. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife 2020; 9:e54076. [PMID: 32633232 PMCID: PMC7340498 DOI: 10.7554/elife.54076] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/04/2020] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization call to halve global snakebite deaths by 2030 will require substantial progress in India. We analyzed 2833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001 to 2014, and conducted a systematic literature review from 2000 to 2019 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000 to 2019. Nearly half occurred at ages 30-69 years and over a quarter in children < 15 years. Most occurred at home in the rural areas. About 70% occurred in eight higher burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11-1.77 million bites in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.
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Affiliation(s)
- Wilson Suraweera
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - David Warrell
- Nuffield Department of Clinical Medicine, University of OxfordOxfordUnited Kingdom
| | - Romulus Whitaker
- Centre for Herpetology/Madras Crocodile Bank, Vadanemmeli VillageChennaiIndia
| | - Geetha Menon
- Indian Council of Medical Research, Ansari NagarNew DelhiIndia
| | - Rashmi Rodrigues
- Department of Community Health, St. John's Medical College, St. John's National Academy of Health SciencesBangaloreIndia
| | - Sze Hang Fu
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Rehana Begum
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Prabha Sati
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Kapila Piyasena
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Mehak Bhatia
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Patrick Brown
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
- Department of Statistical Sciences, University of TorontoTorontoCanada
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
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Sørensen CV, Knudsen C, auf dem Keller U, Kalogeropoulos K, Gutiérrez-Jiménez C, Pucca MB, Arantes EC, Bordon KCF, Laustsen AH. Do Antibiotics Potentiate Proteases in Hemotoxic Snake Venoms? Toxins (Basel) 2020; 12:toxins12040240. [PMID: 32283690 PMCID: PMC7232225 DOI: 10.3390/toxins12040240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/02/2022] Open
Abstract
Antibiotics are often administered with antivenom following snakebite envenomings in order to avoid secondary bacterial infections. However, to this date, no studies have evaluated whether antibiotics may have undesirable potentiating effects on snake venom. Herein, we demonstrate that four commonly used antibiotics affect the enzymatic activities of proteolytic snake venom toxins in two different in vitro assays. Similar findings in vivo could have clinical implications for snakebite management and require further examination.
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Affiliation(s)
- Christoffer V. Sørensen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
| | - Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
- BioPorto Diagnostics A/S, DK-2900 Hellerup, Denmark
| | - Ulrich auf dem Keller
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
| | - Konstantinos Kalogeropoulos
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
| | - Cristina Gutiérrez-Jiménez
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
| | - Manuela B. Pucca
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
- Medical School, Federal University of Roraima, Boa Vista BR-69310-000, Brazil
| | - Eliane C. Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto BR-14040-903, Brazil; (E.C.A.); (K.C.F.B.)
| | - Karla C. F. Bordon
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto BR-14040-903, Brazil; (E.C.A.); (K.C.F.B.)
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.V.S.); (C.K.); (U.a.d.K.); (K.K.); (C.G.-J.); (M.B.P.)
- Correspondence:
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Bammigatti C, Reddy PA, Hanumanthappa N, Harichandrakumar KT, Swaminathan RP. Serum Procalcitonin Concentration and Its Relationship with Local Manifestations after Snakebites. Am J Trop Med Hyg 2019; 100:146-149. [PMID: 30457093 DOI: 10.4269/ajtmh.17-0892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The local signs and symptoms following snakebites are similar to those of cellulitis caused by bacterial infections. This leads to empirical treatment with antibiotics, which however is not supported by evidence. Procalcitonin (PCT) is a biomarker with good diagnostic accuracy for bacterial infection. We studied serum PCT concentration in 100 patients aged 13 years or more, presenting to the hospital with significant local manifestations (crossing the joint proximal to the bitten wound) within 24 hours after snakebite. The extent and progression of local manifestations were monitored 12 hourly. Baseline PCT measurement was carried out for all patients and measurement was repeated 12 hourly only in those patients with progressive local manifestations. The median interqartile range PCT concentration did not differ significantly by the severity of local manifestation at presentation (Grade 2 = 0.28 [0.26-0.30]; Grade 3 = 0.28 [0.26-0.32]; Grade 4 = 0.27 [0.26-0.32] ng/mL; P = 0.15). Furthermore, we did not observe an increase in PCT concentration on serial estimation in those with progressive local manifestation (0.28, 0.29, and 0.29 ng/mL) over 36 hours. These observations suggest that the local manifestations following snakebites were not caused by bacterial infection.
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Affiliation(s)
- Chanaveerappa Bammigatti
- Departments of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Preetham A Reddy
- Departments of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nandeesha Hanumanthappa
- Departments of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K T Harichandrakumar
- Departments of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Rathinam Palamalai Swaminathan
- Departments of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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10
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TAKEUCHI IKUTO, ISHIKAWA KOUHEI, NAGASAWA HIROKI, JITSUIKI KEI, KONDO AKIHIKO, OHSAKA HIROMICHI, OMORI KAZUHIKO, YANAGAWA YOUICHI. The Clinical Significance of C-Reactive Protein in Patients with <i>Gloydius blomhoffii</i> Bite. JUNTENDO MEDICAL JOURNAL 2019. [DOI: 10.14789/jmj.2019.65.jmj19-oa11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- IKUTO TAKEUCHI
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - KOUHEI ISHIKAWA
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - HIROKI NAGASAWA
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - KEI JITSUIKI
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - AKIHIKO KONDO
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - HIROMICHI OHSAKA
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - KAZUHIKO OMORI
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
| | - YOUICHI YANAGAWA
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital
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11
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Félix-Silva J, Silva-Junior AA, Zucolotto SM, Fernandes-Pedrosa MDF. Medicinal Plants for the Treatment of Local Tissue Damage Induced by Snake Venoms: An Overview from Traditional Use to Pharmacological Evidence. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:5748256. [PMID: 28904556 PMCID: PMC5585606 DOI: 10.1155/2017/5748256] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/09/2017] [Indexed: 01/21/2023]
Abstract
Snakebites are a serious problem in public health due to their high morbimortality. Most of snake venoms produce intense local tissue damage, which could lead to temporary or permanent disability in victims. The available specific treatment is the antivenom serum therapy, whose effectiveness is reduced against these effects. Thus, the search for complementary alternatives for snakebite treatment is relevant. There are several reports of the popular use of medicinal plants against snakebites worldwide. In recent years, many studies have been published giving pharmacological evidence of benefits of several vegetal species against local effects induced by a broad range of snake venoms, including inhibitory potential against hyaluronidase, phospholipase, proteolytic, hemorrhagic, myotoxic, and edematogenic activities. In this context, this review aimed to provide an updated overview of medicinal plants used popularly as antiophidic agents and discuss the main species with pharmacological studies supporting the uses, with emphasis on plants inhibiting local effects of snake envenomation. The present review provides an updated scenario and insights into future research aiming at validation of medicinal plants as antiophidic agents and strengthens the potentiality of ethnopharmacology as a tool for design of potent inhibitors and/or development of herbal medicines against venom toxins, especially local tissue damage.
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Affiliation(s)
- Juliana Félix-Silva
- Laboratório de Tecnologia & Biotecnologia Farmacêutica (TecBioFar), Faculdade de Farmácia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Arnóbio Antônio Silva-Junior
- Laboratório de Tecnologia & Biotecnologia Farmacêutica (TecBioFar), Faculdade de Farmácia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Silvana Maria Zucolotto
- Grupo de Pesquisa em Produtos Naturais Bioativos (PNBio), Laboratório de Farmacognosia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Matheus de Freitas Fernandes-Pedrosa
- Laboratório de Tecnologia & Biotecnologia Farmacêutica (TecBioFar), Faculdade de Farmácia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Assessment of Cultivable Oral Bacterial Flora from Important Venomous Snakes of India and Their Antibiotic Susceptibilities. Curr Microbiol 2017; 74:1278-1286. [PMID: 28733908 DOI: 10.1007/s00284-017-1313-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
Abstract
Snakebite is a common, frequently devastating, occupational, socio-economic hazard, and it has a great impact on the rural population of India. Snakebite is a major cause of the human morbidity and mortality since ancient times, as it not only affects the victim by systemic envenomation but also by wound infections originating from deadly pathogenic microorganisms from the oral cavity of the offending snake. The pathogens from the oral cavity of the snake tend to initiate an infection, resulting in gas gangrene, soft tissue necrosis, and permanent physical disabilities. In light of this, the present study is designed to evaluate the oral microbiota of venomous snakes commonly found in India and assessment of their antibiotic susceptibilities. Oral cavity swabs of twenty snakes representing the Indian cobra, Russell's viper, Saw-scaled viper, and Common krait were selected for the study. These materials were enriched using microbiological media to facilitate the growth of bacteria and their subsequent isolation to assess the antibiotic susceptibilities. A total 205 strains were isolated from the oropharyngeal cavity of snakes, which represent the common pathogens, especially Morganella morganii, Escherichia coli, Aeromonas hydrophila, Pseudomonas aeruginosa, coagulase-negative Staphylococcus aureus, Bacillus species, Micrococcus species, and some anaerobes including Clostridium perfringens. The study can conclude that the oral cavity of the snakes has a diversity of Gram-positive and Gram-negative bacteria are susceptible to several antibiotics. The Gram-negative microorganisms showed 100% susceptibility to imipenem and levofloxacin, whereas Gram-positive microorganisms to azithromycin and amoxicillin/clavulanic acid.
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