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Zhao W, Liu J, Wang S, Tao Q, Lei Q, Huang C. Varespladib mitigates acute liver injury via suppression of excessive mitophagy on Naja atra envenomed mice by inhibiting PLA 2. Toxicon 2024; 242:107694. [PMID: 38556061 DOI: 10.1016/j.toxicon.2024.107694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
Snakebite envenomation often leads to severe visceral injuries, including acute liver injury (ALI). However, the toxicity mechanism remains unclear. Moreover, varespladib can directly inhibit phospholipase A2 (PLA2) in snake venom, but its protective effect on snakebite-induced ALI and the mechanism have not been clarified. Previous studies have shown that snake venom PLA2 leads to neuron cell death via reactive oxygen species (ROS), one of the initial factors related to the mitophagy pathway. The present study group also found that ROS accumulation occurred after Naja atra envenoming. Hematoxylin and eosin (H/E) staining and immunohistochemistry (IHC) were performed to identify the expression of inflammatory factors in the liver tissue, and flow cytometry and immunofluorescence were used to detect ROS levels and mitochondrial function. Immunofluorescence and western blotting were also used for detecting mitophagy pathway-related proteins. The results showed that N. atra bite induced ALI by activating mitophagy and inducing inflammation and that varespladib had a protective effect. Collectively, these results showed the pathological mechanism of ALI caused by N. atra bite and revealed the protective effect of varespladib.
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Affiliation(s)
- Wenjie Zhao
- School of Basic Medicine Sciences, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Jiahao Liu
- School of Basic Medicine Sciences, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Sidan Wang
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Qinqin Tao
- School of Basic Medicine Sciences, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Qiongqiong Lei
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China.
| | - Chunhong Huang
- School of Basic Medicine Sciences, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China.
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Sassoè-Pognetto M, Cavalcante R, Paonessa M. Acute compartment syndrome and fasciotomy after a viper bite in Italy: a case report. Ital J Pediatr 2024; 50:70. [PMID: 38627836 PMCID: PMC11020867 DOI: 10.1186/s13052-024-01638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Bites caused by European vipers are rare medical emergencies but can occasionally cause life-threatening complications. Viper venom causes local symptoms, which can be accompanied by systemic manifestations in severe cases. The local effects of snakebites include edema and, more rarely, necrosis and compartment syndrome. The consequences of envenomation are often more pronounced in children due to their smaller body size. CASE PRESENTATION We present the case of a 6-year-old girl who experienced multiple viper bites in the lower limb in northwest Italy. The girl received supportive care but progressed to develop compartment syndrome that required emergency fasciotomy. The patient's condition improved promptly after surgical decompression and administration of antivenom, but full recovery required prolonged hospitalization and rehabilitation. CONCLUSIONS This case highlights the importance of obtaining a timely assessment of the severity of viper envenomation without delaying the administration of antivenom in most serious cases. The presence of multiple bite marks on the patient is one factor that may help to predict the clinical severity of snakebites and anticipate symptom progression.
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Affiliation(s)
- Marco Sassoè-Pognetto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, C.so Massimo d'Azeglio, 52, 10126, Torino, Italy.
| | - Riccardo Cavalcante
- Centro Emys Piemonte, ELEADE Società Cooperativa a.r.l, Chiaverano, TO, Italy
| | - Matteo Paonessa
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Torino, Italy
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Shen Y, Hu S, Bao S, Tu M. Clinical characteristics of snakebite patients attending a tertiary hospital in Hangzhou, southeast China. Trans R Soc Trop Med Hyg 2024; 118:287-292. [PMID: 38073610 DOI: 10.1093/trstmh/trad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 11/24/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Venomous snakebite is a neglected yet an important public health problem in China, and few studies have focused on them so far. The aim of this study is to investigate clinical characteristics of snakebites patients in a tertiary hospital in Hangzhou, southeast China. METHODS A total of 416 snakebite cases were included in this retrospective study. The data were collected from the medical records including demographics, clinical manifestations, management and outcomes. RESULTS Of the 416 patients with venomous snakebites, 248 were male, and the average age was 54.6 years. The majority of cases occurred in rural in May to September. Out of all the venomous bites, Gloydius brevicaudus accounted for the highest percentage (55.3%). Hands were the most vulnerable site to snakebites (47.4%). Patients had clinical manifestations of pain (100%), swelling (100%), wound necrosis (25.7%), hemorrhagic blister (18.3%), and blister (8.7%). Three hundred and ninety-two patients received antivenom administration, and most were treated within six hours after bites. Twenty-six patients received surgical treatments, and 90 patients developed venom-induced consumption coagulopathy. No deaths have occurred in this study. CONCLUSION Hangzhou is one of the regions with high affecting of snakebites in China. The results of this study will increase the understanding of the clinical characteristics of venomous snakebites in Hangzhou area.
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Affiliation(s)
- Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Sipin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Shuhua Bao
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
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Abstract
Snakebite envenomation (SBE) in horses can have devastating outcomes. Tissue damage, cardiotoxicity, coagulopathy, and neurotoxicity can be concerns with SBE. Understanding the actions of venom components is important in developing a successful treatment plan. Antivenom is the mainstay of treatment. Long-term deleterious effects can occur including cardiac dysfunction and lameness.
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Affiliation(s)
- Lyndi L Gilliam
- College of Veterinary Medicine, Oklahoma State University, 2065 West Farm Road, Stillwater, OK 74078, USA.
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Blessmann J, Kreuels B. Urgent administration of antivenom following proven krait bites in Southeast Asia irrespective of neurotoxic symptoms. PLoS Negl Trop Dis 2024; 18:e0012079. [PMID: 38603643 PMCID: PMC11008851 DOI: 10.1371/journal.pntd.0012079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Affiliation(s)
- Joerg Blessmann
- Research Group Snakebite envenoming, Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benno Kreuels
- Research Group Snakebite envenoming, Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Section for Tropical Medicine, I. Department of Medicine, University Medical Center, Hamburg, Germany
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Thibodeaux LA, Kent M, Vernier ME, Barber RM, Brainard BM. Diffuse lower motor neuron dysfunction secondary to timber rattlesnake (Crotalus horridus) envenomation. J Am Vet Med Assoc 2024; 262:1-4. [PMID: 38237268 DOI: 10.2460/javma.23.11.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
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Nachshon A, Bazer R, Dagan G, Firman S. Peripheral Nerve Block to Treat Pain Caused by Daboia palaestinae Envenomation. A A Pract 2024; 18:e01744. [PMID: 38557929 DOI: 10.1213/xaa.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Snakebite pain can be challenging to control. We describe our experience managing intolerable pain after conventional treatment failed. A 35-year-old man, presented after a viper snakebite, suffering from intolerable pain in the affected extremity. He had no significant past medical history. All attempts to control the pain conventionally were unsuccessful. Treatment with a supraclavicular nerve block resulted in immediate relief. After the block receded, only a dull pain remained, which later disappeared without recurrence. This experience illustrates the need for personalized pain treatment to avoid subsequent complications.
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Affiliation(s)
- Akiva Nachshon
- From the General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rashit Bazer
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gil Dagan
- Department of Cardiology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shimon Firman
- From the General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Cao R, He J, Yu Z, Chen Y, Zhu L. Moderately severe acute pancreatitis after snake bite: a case report from Southern China. Z Gastroenterol 2024; 62:508-511. [PMID: 37729941 DOI: 10.1055/a-2150-2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Venomous snakebites are not rare worldwide, and this is also the situation in the mountainous regions of southern China, where they pose a serious health risk to the local population. Snake venom usually causes a variety of clinical symptoms, such as local pain and swelling, systemic coagulation system abnormalities, and shock, but rarely leads to acute pancreatitis. In this report, we presented a rare case of moderately severe acute pancreatitis caused by snake venom even after prompt antivenom treatment. The patient was relieved, obviously, with effective treatment of acute pancreatitis and was discharged without severe complications. Although acute pancreatitis after snake bite is a rarity, its serious complications and lethality still deserve our utmost attention, and timely and standardized treatment of acute pancreatitis is needed in addition to antivenom treatment.
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Affiliation(s)
- Ronglai Cao
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinli He
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhengping Yu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Youxiang Chen
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Liang Zhu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
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Meena P, Bhargava V, Gupta P, Panda S, Bhaumik S. The kidney histopathological spectrum of patients with kidney injury following snakebite envenomation in India: scoping review of five decades. BMC Nephrol 2024; 25:112. [PMID: 38515042 PMCID: PMC10958888 DOI: 10.1186/s12882-024-03508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Snakebite is a public health problem leading to about 58,000 deaths every year in India. Kidney injury subsequent to snakebite envenomation is common with a reported prevalence of up to 32%. The current study aims to elucidate the spectrum of kidney histopathology in acute kidney injury (AKI) cases associated with snake bites. METHODS We searched seven electronic database studies to identify studies describing the histopathological findings in the kidney with snakebite envenomation. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for the final inclusion decision. Data were extracted as per the standardized form. We conducted narrative synthesis. Studies done exclusively on autopsy findings, in vitro studies, and case reports were excluded. RESULTS We retrieved 1464 studies and finally included 28 studies which met the eligibility criteria in the analysis. Most studies were single-centre and the majority were cross-sectional. Overall we included a total of 534 renal biopsies. Russell's viper bite was the most common cause related to AKI. Acute tubular necrosis was the most common finding followed by acute interstitial nephritis, acute cortical necrosis (ACN), and thrombotic microangiopathy (TMA). Vasculitis changes in vessels were rarely reported. Lesions such as ACN and TMA were associated with poor outcomes. CONCLUSION This analysis supports the notion that renal biopsies are important to guide prognosis and increase our knowledge about post-snake bite AKI pathophysiology.
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Affiliation(s)
- Priti Meena
- Department of Nephrology, All India Institute Medical Sciences, Bhubaneswar, India.
| | - Vinant Bhargava
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Pallav Gupta
- Department of Pathology, Sir Gangaram Hospital, New Delhi, India
| | - Sandip Panda
- Department of Nephrology, All India Institute Medical Sciences, Bhubaneswar, India
| | - Soumyadeep Bhaumik
- Meta-research and evidence synthesis unit, The George Institute for Global Health, New Delhi, India
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Fouad MM, Zawilla NH, Abdelsamie AA, Manawil M, Shehata RSA, Mohammed RS, Khalifa EM, Abdallah Ramadan M, Mourad BH. Successful Management of Severe Unresponsive Snake Bite Envenomation Using Plasmapheresis and Corticosteroid at Egyptian National Environmental and Clinical Toxicology Research Center: A Case Report. Wilderness Environ Med 2024; 35:82-87. [PMID: 38379491 DOI: 10.1177/10806032231225102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient's general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.
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Affiliation(s)
- Marwa Mohammed Fouad
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermin Hamdy Zawilla
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
- Head of National Environmental and Clinical Toxicological Research Centre (NECTR), Cairo University, Cairo, Egypt
| | - Aiesha Ashraf Abdelsamie
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marie Manawil
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Rateba Said Mohammed
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Mahmoud Khalifa
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Abdallah Ramadan
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Basma Hussein Mourad
- Department of Occupational and Environmental Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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11
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Brasileiro-Martins LM, Cavalcante SA, Nascimento TP, Silva-Neto AV, Mariano Santos MD, Camillo-Andrade AC, da Gama Fischer JDS, Ferreira CC, Oliveira LB, Sartim MA, Costa AG, Pucca MB, Wen FH, Moura-da-Silva AM, Sachett J, Carvalho PC, de Aquino PF, Monteiro WM. Urinary proteomics reveals biological processes related to acute kidney injury in Bothrops atrox envenomings. PLoS Negl Trop Dis 2024; 18:e0012072. [PMID: 38536893 PMCID: PMC11020875 DOI: 10.1371/journal.pntd.0012072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/16/2024] [Accepted: 03/14/2024] [Indexed: 04/18/2024] Open
Abstract
Acute kidney injury (AKI) is a critical systemic complication caused by Bothrops envenoming, a neglected health problem in the Brazilian Amazon. Understanding the underlying mechanisms leading to AKI is crucial for effectively mitigating the burden of this complication. This study aimed to characterize the urinary protein profile of Bothrops atrox snakebite victims who developed AKI. We analyzed three groups of samples collected on admission: healthy subjects (controls, n = 10), snakebite victims who developed AKI (AKI, n = 10), and those who did not evolve to AKI (No-AKI, n = 10). Using liquid-chromatography tandem mass spectrometry, we identified and quantified (label-free) 1190 proteins. A panel of 65 proteins was identified exclusively in the urine of snakebite victims, with 32 exclusives to the AKI condition. Proteins more abundant or exclusive in AKI's urine were associated with acute phase response, endopeptidase inhibition, complement cascade, and inflammation. Notable proteins include serotransferrin, SERPINA-1, alpha-1B-glycoprotein, and NHL repeat-containing protein 3. Furthermore, evaluating previously reported biomarkers candidates for AKI and renal injury, we found retinol-binding protein, beta-2-microglobulin, cystatin-C, and hepcidin to be significant in cases of AKI induced by Bothrops envenoming. This work sheds light on physiological disturbances caused by Bothrops envenoming, highlighting potential biological processes contributing to AKI. Such insights may aid in better understanding and managing this life-threatening complication.
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Affiliation(s)
- Lisele Maria Brasileiro-Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
| | | | - Thaís Pinto Nascimento
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
- Leonidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Brazil
| | - Alexandre Vilhena Silva-Neto
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Marlon Dias Mariano Santos
- Structural and Computational Proteomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
| | - Amanda C. Camillo-Andrade
- Structural and Computational Proteomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
| | | | | | | | - Marco Aurelio Sartim
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Research, Nilton Lins University, Manaus, Brazil
| | - Allyson Guimarães Costa
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
- Nursing School, Amazonas Federal University, Manaus, Brazil
| | - Manuela B. Pucca
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
| | - Fan Hui Wen
- Immunopathology Laboratory, Butantan Institute, São Paulo, Brazil
| | | | - Jacqueline Sachett
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Immunopathology Laboratory, Butantan Institute, São Paulo, Brazil
| | - Paulo Costa Carvalho
- Structural and Computational Proteomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
| | | | - Wuelton M. Monteiro
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
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Lindquist DG, Valente JH, Hack JB. A Pilot Study Testing the Novel Use of a Snake Bite Compression Device for Field Hemostasis and Wound Repair in an Animal Model. Mil Med 2024; 189:461-465. [PMID: 35861270 DOI: 10.1093/milmed/usac223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/18/2022] [Accepted: 07/14/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A commercially available snake bite device was pilot tested for novel use as a method of hemostasis and wound repair at a noncompressible site in a live swine model. The device is light, is plastic, uses a hook-and-loop strap attachment, and is easily deployed. The device could offer a method for the field repair of an actively bleeding laceration at a noncompressible site in an austere environment. MATERIALS AND METHODS This was an interventional, prospective, controlled study in a large animal model. The study was approved by the Rhode Island Hospital Institutional Review Board (IRB) and the Animal Welfare Committee/Institutional Animal Care and Use Committee and the Lifespan Research Conflict of Interest Committee. Each animal acted as its own control. Blood loss was measured and compared between repairs of standardized incisions with and without the device's application. The lacerations were sutured closed. Two proceduralists alternated tasks of wound repair versus blood collection. Blood loss was measured by using gauze sponges to capture the blood during a 30-second free-bleeding period and during the repair itself. Using a one sample t-test (the expected difference in blood loss between the two incision repair methods = 0 if the null hypothesis were true), we calculated the mean difference in the deltas between the repair methods. RESULTS The mean delta difference was 3.1 g (SE ± 0.97). The t-test demonstrated that there was a significantly greater blood loss during the standard repair method, t(9) = 3.11, P < 0.01 than during the repair with the device in place (see Fig. 2). A statistical power analysis conducted showed that with a sample size of 10 animals, there was sufficient statistical power to detect this significant effect (β = 0.82, α < 0.05, one-tailed). CONCLUSIONS There was statistically significantly less blood loss during the repairs with the device's application. This feasibility experiment demonstrates that a commercially available snakebite device may be useful for hemostasis during laceration repair at anatomic sites not amenable to application of tourniquets or compressive dressings. Strengths of the study include the prospective controlled design, including the use of each animal as its own control; alternating proceduralists to account for any variability in suturing efficiency; and the statistical significance of the results despite the small number of subjects. One weakness is that the time required for each repair was not measured. The device's portability and reusability suggest applicability in austere medical environments. Future studies could include timing the repairs, using a skin stapler or wound adhesive instead of sutures, applying a hemostatic agent before the repair, and sequentially applying the device to wounds longer than the device.
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Affiliation(s)
- David G Lindquist
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Jonathan H Valente
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Department of Pediatrics, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI 02903, USA
| | - Jason B Hack
- Department of Emergency Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
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Sharif M, Amin MR, Barshan AD, Hasan MJ, Faiz MA. Optimizing survival in Russell's viper bite cases in low-resource setting: two case reports. J Med Case Rep 2024; 18:56. [PMID: 38355606 PMCID: PMC10868078 DOI: 10.1186/s13256-024-04354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Snakebite envenomation poses a significant health risk, particularly in low-resource settings where access to proper treatment is limited. CASE PRESENTATION This study reports two cases of Russell's viper bites in rural Bangladesh, involving 48 and 35-year-old Bangladesh males, respectively, and highlights the difficulties in providing adequate medical care and in treating any complications that may arise. Both cases involved delayed access to healthcare, initial visit to traditional healers, and the development of severe complications such as coagulopathy, renal failure. After the intervention both cases survived which is scarce in low resource settings. CONCLUSION The cases underscore the importance of early recognition, appropriate management, and improved healthcare infrastructure to optimize survival outcomes in snakebite cases in resource-limited settings. These cases will contribute valuable insights to the field of snakebite management and provide guidance for improving survival rates and outcomes among snakebite victims in Bangladesh.
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Affiliation(s)
| | - Mohammad Robed Amin
- Noncommunicable Disease, Directorate General of Health Services, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Mohammad Jahid Hasan
- Tropical Disease and Health Research Center, Dhaka, 1100, Bangladesh.
- Pi Research Development Center, Dhaka, 1100, Bangladesh.
| | - M A Faiz
- Chittagong Medical College & Hospital, Chittagong, 4203, Bangladesh
- Director General of Health Services, Mohakhali, Dhaka, 1212, Bangladesh
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Sun I, Lee ST, Chen YG, Mao YC, Chen FC, Chen YH, Tsai SH, Ho CH. Thromboembolic events following a pit viper bite from Protobothrops mucrosquamatus (Taiwan Habu): A report of two cases. Toxicon 2024; 238:107572. [PMID: 38145881 DOI: 10.1016/j.toxicon.2023.107572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
Protobothrops mucrosquamatus, also known as the Taiwan Habu, is a venomous snake prevalent in Taiwan. It is accountable for most snakebites in the region. The toxin of the Taiwan Habu has significant hemorrhagic potential. However, patients bitten by this snake often suffer more local injuries than systemic ones. This report presents two cases of individuals bitten by the Taiwan Habu who subsequently experienced thromboembolism. In the first case, an 88-year-old male, bitten on his fourth toe, suffered a cerebral infarction 32 hours post-bite. In the second case, an 82-year-old female, bitten on her ankle, experienced cardiac arrest 19 hours later. Both patients promptly received antivenom and showed no signs of coagulopathy either before or after the snakebite. However, elevated coagulation factor VIII levels were observed in the first case. Our aim is to understand the mechanism behind these thromboembolic events. This report emphasizes the unusually high level of coagulation factor VIIIa and highlights the need for further investigation into the mechanisms involved. Consequently, physicians should assess the risk of thromboembolic events in snakebite patients by evaluating coagulation factors during treatment.
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Affiliation(s)
- I Sun
- Department of Emergency Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, 80284, Taiwan; Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan
| | - Siou-Ting Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan; Department of Obstetrics and Gynecology, Taoyuan Armed Forces General Hospital, Taoyuan City, 32551, Taiwan
| | - Yu-Guang Chen
- The Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan
| | - Yan-Chiao Mao
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City, 40705, Taiwan
| | - Feng-Chen Chen
- Department of Emergency Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, 80284, Taiwan; Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan
| | - Yen-Hsiu Chen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan
| | - Cheng-Hsuan Ho
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, 114202, Taiwan; Institute of Toxicology, College of Medicine, National Taiwan University, Taipei City, 100233, Taiwan.
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Fai KN, Moustafa H, Esso L, Boum Y. Case 1-2024: A 25-Year-Old Pregnant Woman with Bleeding after a Snakebite. N Engl J Med 2024; 390:166-173. [PMID: 38197820 DOI: 10.1056/nejmcpc2301033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Karl Njuwa Fai
- From Homegrown Solutions for Health (K.N.F., L.E., Y.B.), Faculty of Medicine and Biomedical Sciences, University of Yaoundé I (L.E., Y.B.), and the Ministry of Public Health (L.E.), Yaoundé, and Poli District Hospital, Poli (H.M.) - all in Cameroon; Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia (K.N.F.); and Institut Pasteur de Bangui, Bangui, Central African Republic (Y.B.)
| | - Hamdja Moustafa
- From Homegrown Solutions for Health (K.N.F., L.E., Y.B.), Faculty of Medicine and Biomedical Sciences, University of Yaoundé I (L.E., Y.B.), and the Ministry of Public Health (L.E.), Yaoundé, and Poli District Hospital, Poli (H.M.) - all in Cameroon; Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia (K.N.F.); and Institut Pasteur de Bangui, Bangui, Central African Republic (Y.B.)
| | - Linda Esso
- From Homegrown Solutions for Health (K.N.F., L.E., Y.B.), Faculty of Medicine and Biomedical Sciences, University of Yaoundé I (L.E., Y.B.), and the Ministry of Public Health (L.E.), Yaoundé, and Poli District Hospital, Poli (H.M.) - all in Cameroon; Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia (K.N.F.); and Institut Pasteur de Bangui, Bangui, Central African Republic (Y.B.)
| | - Yap Boum
- From Homegrown Solutions for Health (K.N.F., L.E., Y.B.), Faculty of Medicine and Biomedical Sciences, University of Yaoundé I (L.E., Y.B.), and the Ministry of Public Health (L.E.), Yaoundé, and Poli District Hospital, Poli (H.M.) - all in Cameroon; Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia (K.N.F.); and Institut Pasteur de Bangui, Bangui, Central African Republic (Y.B.)
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16
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Jeenwal P, Gupta J, Choudhary R, Meena P, Sehra RN, Devpura K. Acute-Onset Neuromuscular Paralysis in Children- Do not forget to Rule Out Snake Bite. Neurol India 2024; 72:189-190. [PMID: 38443034 DOI: 10.4103/neurol-india.neurol-india-d-24-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Pragati Jeenwal
- Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India
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17
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Carvalho ÉDS, Souza ARDN, Melo DFC, de Farias AS, Macedo BBDO, Sartim MA, Caggy MC, Rodrigues BDA, Ribeiro GS, Reis HN, Araújo FQ, da Silva IM, Sachett A, Sampaio VDS, Balieiro AADS, Zamuner SR, Vissoci JRN, Cabral LN, Monteiro WM, Sachett JDAG. Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:70-80. [PMID: 38048090 PMCID: PMC10696517 DOI: 10.1001/jamainternmed.2023.6538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/08/2023] [Indexed: 12/05/2023]
Abstract
Importance Bothrops venom acts almost immediately at the bite site and causes tissue damage. Objective To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. Design, Setting, and Participants This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. Intervention The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Main Outcomes and Measures Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. Results A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. Conclusions and Relevance The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Trial Registration Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.
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Affiliation(s)
- Érica da Silva Carvalho
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Andrea Renata do Nascimento Souza
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Dessana Francis Chehuan Melo
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- School of Medicine, Universidade Federal do Amazonas, Manaus, Brazil
| | - Altair Seabra de Farias
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marco Aurélio Sartim
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade Nilton Lins, Manaus, Brazil
| | - Mariela Costa Caggy
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | | | - Heloísa Nunes Reis
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Iran Mendonça da Silva
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - André Sachett
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson de Souza Sampaio
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | - Lioney Nobre Cabral
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Department of Teaching and Research, Fundação Alfredo da Matta, Manaus, Brazil
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18
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Kono IS, Pandolfi VCF, Marchi MNAD, Freitas N, Freire RL. Unveiling the secrets of snakes: Analysis of environmental, socioeconomic, and spatial factors associated with snakebite risk in Paraná, Southern Brazil. Toxicon 2024; 237:107552. [PMID: 38065257 DOI: 10.1016/j.toxicon.2023.107552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
The state of Paraná is home to three out of the five medically significant snake genera in Brazil and lacks of snakebite epidemiology studies. This study aimed to ascertain the spatial, environmental, and socioeconomic factors associated with snakebite risk by analyzing notification data of cases in the state of Paraná. Notification and socioeconomic data were gathered from the online platforms of the National System of Notifiable Diseases (SINAN) and the Brazilian Institute of Geography and Statistics (IBGE). Land cover and land use maps were obtained from the Mapbiomas platform in raster format and subsequently converted into vectors using QGis software. The proportions of land use and land cover in square kilometers (km2) were then calculated. All acquired data were tabulated using Microsoft Excel 365 software. For spatial analysis, GeoDa software version 1.20 was utilized to calculate the Global and Local Moran indices, assessing spatial correlations. Between 2007 and 2021, 12,877 notifications were recorded, with an average incidence of 8.22/100,000 inhabitants in the state, 8166 (63.41%) caused by Bothrops, 1534 (11.91%) caused by Crotalus, 56 (0.43%) caused by Micrurus. 1703 (13.22%) caused by non-venomous snake species, and the remaining cases did not have the identified causative species. The incidents caused by Bothrops and Crotalus showed different distribution patterns. Spatial analysis revealed that key factors contributing to snakebite risk included the presence of native forests, mangroves, apicuns, and monospecific planted forests. The population group at the highest risk comprised rural residents and workers. Furthermore, the absence of basic sanitation and proper garbage collection and disposal exhibited positive correlations with snakebites. Conversely, intensive farming practices with substantial mechanization and pastures demonstrated negative spatial correlations. This study has enabled the identification of the primary factors associated with snakebite risk, facilitating more targeted efforts to prevent snakebite accidents among vulnerable populations.
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Affiliation(s)
- Isabelli Sayuri Kono
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
| | | | - Melca Niceia Altoé de Marchi
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz, Ilhéus, 45662900, Bahia, Brazil.
| | - Nicolas Freitas
- Departamento de Geociências, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
| | - Roberta Lemos Freire
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
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19
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Abad Ribeiro AB, Santoro ML, Duarte MR, Virgulino CC, de Oliveira GSS, França FODS. Hemoperitoneum after a Bothrops snakebite: Case report. Toxicon 2024; 237:107350. [PMID: 38016581 DOI: 10.1016/j.toxicon.2023.107350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.
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Affiliation(s)
| | - Marcelo Larami Santoro
- Biotério Central and Escola Superior do Instituto Butantan (ESIB), Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Marcelo Ribeiro Duarte
- Laboratório de Coleções Zoológicas, Instituto Butantan, Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Cristiana Cruz Virgulino
- Hospital Vital Brazil, Instituto Butantan, Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Gerson Sobrinho Salvador de Oliveira
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Oscar de Siqueira França
- Núcleo de Medicina Tropical, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Laboratório de Imunologia (LIM48), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
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20
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D’Este G, Fabris F, Stazi M, Baggio C, Simonato M, Megighian A, Rigoni M, Negro S, Montecucco C. Agonists of melatonin receptors strongly promote the functional recovery from the neuroparalysis induced by neurotoxic snakes. PLoS Negl Trop Dis 2024; 18:e0011825. [PMID: 38190386 PMCID: PMC10798625 DOI: 10.1371/journal.pntd.0011825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/19/2024] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
Snake envenoming is a major, but neglected, tropical disease. Among venomous snakes, those inducing neurotoxicity such as kraits (Bungarus genus) cause a potentially lethal peripheral neuroparalysis with respiratory deficit in a large number of people each year. In order to prevent the development of a deadly respiratory paralysis, hospitalization with pulmonary ventilation and use of antivenoms are the primary therapies currently employed. However, hospitals are frequently out of reach for envenomated patients and there is a general consensus that additional, non-expensive treatments, deliverable even long after the snake bite, are needed. Traumatic or toxic degenerations of peripheral motor neurons cause a neuroparalysis that activates a pro-regenerative intercellular signaling program taking place at the neuromuscular junction (NMJ). We recently reported that the intercellular signaling axis melatonin-melatonin receptor 1 (MT1) plays a major role in the recovery of function of the NMJs after degeneration of motor axon terminals caused by massive Ca2+ influx. Here we show that the small chemical MT1 agonists: Ramelteon and Agomelatine, already licensed for the treatment of insomnia and depression, respectively, are strong promoters of the neuroregeneration after paralysis induced by krait venoms in mice, which is also Ca2+ mediated. The venom from a Bungarus species representative of the large class of neurotoxic snakes (including taipans, coral snakes, some Alpine vipers in addition to other kraits) was chosen. The functional recovery of the NMJ was demonstrated using electrophysiological, imaging and lung ventilation detection methods. According to the present results, we propose that Ramelteon and Agomelatine should be tested in human patients bitten by neurotoxic snakes acting presynaptically to promote their recovery of health. Noticeably, these drugs are commercially available, safe, non-expensive, have a long bench life and can be administered long after a snakebite even in places far away from health facilities.
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Affiliation(s)
- Giorgia D’Este
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Federico Fabris
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marco Stazi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Chiara Baggio
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | - Aram Megighian
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Padua Neuroscience Center, University of Padova, Padova, Italy
| | - Michela Rigoni
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Myology Center (CIR-Myo), University of Padova, Padova, Italy
| | - Samuele Negro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- U.O.C. Clinica Neurologica, Azienda Ospedale-Università Padova, Padova, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CNR Institute of Neuroscience, Padova, Italy
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21
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Srinath KM, Sethi M, Madhu B, Prasad MC, Sangappa SB. Serpent strikes, sapien sways: A rare case of bilateral cerebellar infarct following viper bite. Ann Afr Med 2024; 23:104-106. [PMID: 38358180 PMCID: PMC10922187 DOI: 10.4103/aam.aam_44_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 02/16/2024] Open
Abstract
Ischemic stroke following snake bite is rare. We report a posterior circulation infarct involving bilateral cerebellum and occipital lobe following Russell's viper bite in a previously healthy individual. A 50 years old healthy individual, soon after being bitten by the Russel viper on the left foot he developed pain and swelling followed by drooping of eyelids, slurring of speech and giddiness with multiple episodes of vomiting. The patient was administered ASV as well as neostigmine and atropine injections. Following this, the neurological manifestations resolved except dysarthria. CT brain study done was normal. On day 2 of hospitalization, he developed left cerebellar signs (positive finger nose finger test, rebound phenomenon, dysdiadochokinesia, a positive heel shin test). Subsequently, an MRI with MR angiogram was done which showed acute infarcts in bilateral cerebellar hemispheres, with the left superior cerebellar peduncle showing restricted diffusion and low ADC values. Ischemic infarction following viper envenomation has been described by only few authors. In majority of the cases reported, ischemic infarction involved the anterior circulation. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favourable outcome.
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Affiliation(s)
- K. M. Srinath
- Department of General Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
| | - Mahim Sethi
- Department of General Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
| | - B. Madhu
- Department of Community Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
| | - M. C. Prasad
- Department of General Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
| | - Sunila B. Sangappa
- Department of Prosthodontics, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
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22
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Zhang Z, Yang J, Fang J, Zhang J, Zeng L, Li J. Case Report: Snake Venom Ophthalmia Caused by Cobra Exposure: A Report of 26 Cases. Am J Trop Med Hyg 2023; 109:1393-1396. [PMID: 37931316 DOI: 10.4269/ajtmh.23-0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/14/2023] [Indexed: 11/08/2023] Open
Abstract
We report 26 cases of eye injuries resulting from cobra venom sprayed by Naja atra. This accounts for 14.5% of patients (26/173) treated for cobra injuries who presented to the emergency department of a snakebite treatment center in Guangzhou, South China. Pain, blurred vision, lacrimation, photophobia, and foreign body sensation were the most common symptoms, found in 24 patients. Ophthalmic examination revealed eyelid swelling and conjunctival congestion. Eye slit lamp examination showed obvious punctate corneal epithelial defects in four patients. Five patients received an intravenous infusion of antivenom. All patients' eyes were rinsed completely with normal saline after their arrival at the hospital. Prophylactic topical antibiotics were given to all patients. All eyes were cured without long-term sequelae.
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Affiliation(s)
- Zehan Zhang
- Department of Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jieyi Yang
- Department of Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jing Fang
- Department of Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jiasheng Zhang
- Department of Ophthalmology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liangbo Zeng
- Department of Emergency Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianjing Li
- Department of Ophthalmology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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23
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Panda R, Singh S, Radhakrishnan RV, Mohanty CR, Shaji IM, Prusty AV, Rajput A. A Case of Cobra Bite in a Term Pregnant Woman: The Obstetric and Wound Management Challenges. Wilderness Environ Med 2023; 34:571-575. [PMID: 37923681 DOI: 10.1016/j.wem.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/13/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Snake envenomation is a rare incident during pregnancy and potentially challenging to manage. Snakebites in pregnancy may lead to several complications such as teratogenicity, miscarriage, antepartum hemorrhage, and even intrauterine fetal death. Here, we report a case of a pregnant woman who presented to our emergency department with signs of systemic envenomation following an Indian cobra bite on her foot, highlighting the key obstetric and wound management challenges. She complained of severe pain at the site of the bite and progressive swelling, abdominal pain, and multiple episodes of vomiting, which started 45 min after the bite. She received 10 vials of polyvalent antivenom from a primary hospital and was then referred to our center. The patient underwent emergency cesarean section and later fasciotomy with free-flap reconstruction at the bitten site due to local tissue necrosis. The case was successfully managed by a multidisciplinary team consisting of an emergency physician, obstetrician, and plastic surgeon, saving 2 lives and the limb of the patient.
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Affiliation(s)
- Ritesh Panda
- Department of Trauma and Emergency (Plastic Surgery), All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sweta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Aditya Vikram Prusty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Akanksha Rajput
- Department of Burn and Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Menzies SK, Arinto-Garcia R, Amorim FG, Cardoso IA, Abada C, Crasset T, Durbesson F, Edge RJ, El-Kazzi P, Hall S, Redureau D, Stenner R, Boldrini-França J, Sun H, Roldão A, Alves PM, Harrison RA, Vincentelli R, Berger I, Quinton L, Casewell NR, Schaffitzel C. ADDovenom: Thermostable Protein-Based ADDomer Nanoparticles as New Therapeutics for Snakebite Envenoming. Toxins (Basel) 2023; 15:673. [PMID: 38133177 PMCID: PMC10747859 DOI: 10.3390/toxins15120673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Snakebite envenoming can be a life-threatening medical emergency that requires prompt medical intervention to neutralise the effects of venom toxins. Each year up to 138,000 people die from snakebites and threefold more victims suffer life-altering disabilities. The current treatment of snakebite relies solely on antivenom-polyclonal antibodies isolated from the plasma of hyperimmunised animals-which is associated with numerous deficiencies. The ADDovenom project seeks to deliver a novel snakebite therapy, through the use of an innovative protein-based scaffold as a next-generation antivenom. The ADDomer is a megadalton-sized, thermostable synthetic nanoparticle derived from the adenovirus penton base protein; it has 60 high-avidity binding sites to neutralise venom toxins. Here, we outline our experimental strategies to achieve this goal using state-of-the-art protein engineering, expression technology and mass spectrometry, as well as in vitro and in vivo venom neutralisation assays. We anticipate that the approaches described here will produce antivenom with unparalleled efficacy, safety and affordability.
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Affiliation(s)
- Stefanie K. Menzies
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Raquel Arinto-Garcia
- iBET, Instituto de Biologia Experimental e Technológica, Apartado 12, 2781-901 Oeiras, Portugal
- ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157 Oeiras, Portugal
| | - Fernanda Gobbi Amorim
- Mass Spectrometry Laboratory, MolSys Research Unit, Allée du six Aout 11, Quartier Agora, Liège Université, 4000 Liège, Belgium
| | - Iara Aimê Cardoso
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Camille Abada
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Thomas Crasset
- Mass Spectrometry Laboratory, MolSys Research Unit, Allée du six Aout 11, Quartier Agora, Liège Université, 4000 Liège, Belgium
| | - Fabien Durbesson
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille Université, 13009 Marseille, France
| | - Rebecca J. Edge
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Priscila El-Kazzi
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille Université, 13009 Marseille, France
| | - Sophie Hall
- School of Biochemistry, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
- Max Planck Bristol Centre for Minimal Biology, Cantock’s Close, Bristol BS8 1TS, UK
| | - Damien Redureau
- Mass Spectrometry Laboratory, MolSys Research Unit, Allée du six Aout 11, Quartier Agora, Liège Université, 4000 Liège, Belgium
| | - Richard Stenner
- School of Biochemistry, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
- Max Planck Bristol Centre for Minimal Biology, Cantock’s Close, Bristol BS8 1TS, UK
| | - Johara Boldrini-França
- School of Biochemistry, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
- Max Planck Bristol Centre for Minimal Biology, Cantock’s Close, Bristol BS8 1TS, UK
| | - Huan Sun
- School of Biochemistry, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
- Max Planck Bristol Centre for Minimal Biology, Cantock’s Close, Bristol BS8 1TS, UK
| | - António Roldão
- iBET, Instituto de Biologia Experimental e Technológica, Apartado 12, 2781-901 Oeiras, Portugal
- ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157 Oeiras, Portugal
| | - Paula M. Alves
- iBET, Instituto de Biologia Experimental e Technológica, Apartado 12, 2781-901 Oeiras, Portugal
- ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157 Oeiras, Portugal
| | - Robert A. Harrison
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Renaud Vincentelli
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille Université, 13009 Marseille, France
| | - Imre Berger
- School of Biochemistry, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
- Max Planck Bristol Centre for Minimal Biology, Cantock’s Close, Bristol BS8 1TS, UK
| | - Loïc Quinton
- Mass Spectrometry Laboratory, MolSys Research Unit, Allée du six Aout 11, Quartier Agora, Liège Université, 4000 Liège, Belgium
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Christiane Schaffitzel
- School of Biochemistry, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
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Almeida JS, Possas FC, de Andrade A, Sauzen SDO, Sugino RG. Early-Onset Respiratory Muscle Paralysis in Crotalic Envenomation: A Case Study. Rev Soc Bras Med Trop 2023; 56:e03742023. [PMID: 37970880 PMCID: PMC10637731 DOI: 10.1590/0037-8682-0374-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
Crotalic envenomation is responsible for approximately 8%-13% of ophidism cases in Brazil, yet it is associated with the highest mortality among snakes. We describe the case of a patient bitten by a rattlesnake who developed ventilatory muscle paralysis within hours after envenomation. While diaphragmatic paralysis is a rare late neurotoxic event following crotalic envenomation, in this case, paralysis occurred early but was rapidly reversed after antivenom administration. This report discusses potential contributing factors based on a comprehensive literature review.
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Affiliation(s)
- Juliana Sartorelo Almeida
- Hospital João XXIII, Centro de Informação e Assistência Toxicológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Felipe Carvalhaes Possas
- Hospital João XXIII, Centro de Informação e Assistência Toxicológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Adebal de Andrade
- Hospital João XXIII, Centro de Informação e Assistência Toxicológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Samir de Oliveira Sauzen
- Hospital João XXIII, Centro de Informação e Assistência Toxicológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
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Larréché S, Chevillard L, Jourdi G, Mathé S, Servonnet A, Joly BS, Siguret V, Chippaux JP, Mégarbane B. Bothrops venom-induced hemostasis disorders in the rat: Between Scylla and Charybdis. PLoS Negl Trop Dis 2023; 17:e0011786. [PMID: 38011218 PMCID: PMC10703418 DOI: 10.1371/journal.pntd.0011786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
Hemostasis impairment represents the most threatening consequence of Viperidae envenoming, notably with Bothrops genus. In the French departments of America, B. atrox envenomation in French Guiana may lead to bleeding while B. lanceolatus envenomation in Martinique to thrombosis. Bleeding related to B. atrox envenomation is attributed to vascular damage mediated by venom metalloproteinases and blood uncoagulable state resulting from thrombocytopenia and consumptive coagulopathy. Thrombosis related to B. lanceolatus envenomation are poorly understood. We aimed to compare the effects of B. atrox and B. lanceolatus venoms in the rat to identify the determinants of the hemorrhagic versus thrombotic complications. Viscoelastometry (ROTEM), platelet count, plasma fibrinogen, thrombin generation assay, fibrinography, endothelial (von Willebrand factor, ADAMTS13 activity, ICAM-1, and soluble E-selectin), and inflammatory biomarkers (IL-1β, IL-6, TNF-α, MCP-1, and PAI-1) were determined in blood samples obtained at H3, H6, and H24 after the subcutaneous venom versus saline injection. In comparison to the control, initial fibrinogen consumption was observed with the two venoms while thrombocytopenia and reduction in the clot amplitude only with B. atrox venom. Moreover, we showed an increase in thrombin generation at H3 with the two venoms, an increase in fibrin generation accompanied with hyperfibrinogenemia at H24 and an increase in inflammatory biomarkers with B. lanceolatus venom. No endothelial damage was found with the two venoms. To conclude, our data support two-sided hemostasis complications in Bothrops envenoming with an initial risk of hemorrhage related to platelet consumption and hypocoagulability followed by an increased risk of thrombosis promoted by the activated inflammatory response and rapid-onset fibrinogen restoration.
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Affiliation(s)
- Sébastien Larréché
- Université Paris Cité, Inserm UMRS-1144, Paris, France
- Department of Medical Biology, Bégin Military Teaching Hospital, Saint-Mandé, France
| | | | - Georges Jourdi
- Université Paris Cité, Inserm UMRS-1140, Innovative Therapies in Hemostasis, Paris, France
- Department of Biological Hematology, Lariboisière Hospital, APHP, Paris, France
| | - Simon Mathé
- Université Paris Cité, Inserm UMRS-1144, Paris, France
| | - Aurélie Servonnet
- Unité analyses biologiques, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Bérangère S. Joly
- Université Paris Cité, Inserm UMRS-1140, Innovative Therapies in Hemostasis, Paris, France
- Université Paris Cité, EA3518, Institut de Recherche Saint-Louis, Paris, France
| | - Virginie Siguret
- Université Paris Cité, Inserm UMRS-1140, Innovative Therapies in Hemostasis, Paris, France
- Department of Biological Hematology, Lariboisière Hospital, APHP, Paris, France
| | - Jean-Philippe Chippaux
- Université Paris Cité, Research Institute for Development, Mother, and Child in Tropical Environment: Pathogens, Health system and Epidemiological transition, Paris, France
| | - Bruno Mégarbane
- Université Paris Cité, Inserm UMRS-1144, Paris, France
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Federation of Toxicology, APHP, Paris, France
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Chippaux JP, Ntone R, Benhammou D, Madec Y, Noël G, Perilhou A, Karl F, Amta P, Sanchez M, Matchim L, Clauteaux P, Eteki L, Ndifon M, Boum Y, Nkwescheu AS, Taieb F. Real life condition evaluation of Inoserp PAN-AFRICA antivenom effectiveness in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011707. [PMID: 37939111 PMCID: PMC10659212 DOI: 10.1371/journal.pntd.0011707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/20/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Snakebites is a serious public health issue but remains a neglected tropical disease. Data on antivenom effectiveness are urgently needed in Africa. We assessed effectiveness of Inoserp PAN-AFRICA (IPA), the recommended antivenom available in Cameroon. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 447 patients presenting with snakebite in 14 health facilities across Cameroon. At presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. We administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. We renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. We defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. Medium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. After hospital discharge, a home visit was planned to assess long-term outcomes. Between October 2019 and May 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. The median [IQR] age was 25 [14-40]. Envenomation was diagnosed in 369 (82.6%) participants. The antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. Among these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. Two hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. Complete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. Sequelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection. CONCLUSIONS/SIGNIFICANCE We confirmed good effectiveness of the IPA and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. Sequential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom. TRIAL REGISTRATION NCT03326492.
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Affiliation(s)
- Jean-Philippe Chippaux
- Université Paris Cité, Institut de Recherche pour le développement, MERIT, Paris, France
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | - David Benhammou
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Yoann Madec
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Gaëlle Noël
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Anais Perilhou
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Fai Karl
- Epicentre Yaoundé, Yaoundé, Cameroon
| | | | - Marie Sanchez
- Institut Pasteur, Université Paris Cité, Data management core facility, Paris, France
| | | | - Pedro Clauteaux
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | | | - Yap Boum
- Epicentre Yaoundé, Yaoundé, Cameroon
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Sugimoto R, Kenzaka T, Nishisaki H. Hyponatremia due to adrenal insufficiency after a Mamushi bite: a case report. BMC Endocr Disord 2023; 23:219. [PMID: 37821844 PMCID: PMC10566049 DOI: 10.1186/s12902-023-01466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Mamushi bites are the most common venomous snake bites in Japan, with known complications including rhabdomyolysis and acute kidney injury; however, adrenal insufficiency as a result of snake bites has not been previously reported. We report a case of empty sella with transient adrenal insufficiency during hospitalization for a Mamushi bite. CASE PRESENTATION An 84-year-old man was admitted to our hospital with a Mamushi bite on the right fifth finger. Serum sodium (Na) level remained in the normal range. On the ninth day of admission, he developed hyponatremia, with a serum Na level of 114 mEq/L and serum cortisol level of 4.0 μg/dL (reference value 4.5-21.1 μg/dL). His serum Na level was restored within the normal range after administration of corticosteroids with 3% NaCl solution. Both rapid adrenocorticotrophin and corticotropin-releasing hormone loading tests showed low cortisol response. Based on the results of the hormone loading tests, a diagnosis of pituitary adrenal insufficiency was made. Contrast-enhanced pituitary magnetic resonance imaging (MRI) showed primary empty sella. After discontinuation of corticosteroids, the hyponatremia did not recur, and the patient was discharged on the 24th day of hospitalization. After discharge, the patient visited an outpatient clinic, but hyponatremia recurrence was not observed. CONCLUSIONS This is the first report of hyponatremia due to pituitary adrenal insufficiency during hospitalization for a Mamushi bite in a patient with empty sella. When hyponatremia occurs during hospitalization for a Mamushi bite, cortisol measurement, hormone loading test, and head MRI should be performed to search for pituitary lesions because of the possibility of adrenal insufficiency caused by snake venom.
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Affiliation(s)
- Ryu Sugimoto
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-Cho, Tamba, 669-3495, Japan.
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-Cho, Tamba, 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hogara Nishisaki
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-Cho, Tamba, 669-3495, Japan
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Zinenko O, Durkin DM, Carter RW, Ritter B, Lewin MR. Cold Finger: Raynaud Phenomenon Following Snakebite Envenoming by Nikolsky's Viper ( Vipera berus nikolskii). Toxins (Basel) 2023; 15:598. [PMID: 37888629 PMCID: PMC10610580 DOI: 10.3390/toxins15100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
A field biologist was bitten by a female Nikolsky's viper (Vipera berus nikolskii) in Kharkiv Oblast, Ukraine. Two months later, the patient began to experience cold-induced vasospasm of the affected digit diagnosed as acquired Raynaud phenomenon. The patient had more than 30 occurrences during the single winter following the bite, but the signs and symptoms of Raynaud phenomenon disappeared with the end of winter. This report describes the case and puts it into context with the literature on the topic of toxin-induced peripheral vasospastic disorders and their potential importance in snakebite envenoming.
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Affiliation(s)
- Oleksandr Zinenko
- V. N. Karazin Kharkiv University, 61058 Kharkiv, Ukraine;
- California Academy of Sciences, San Francisco, CA 94118, USA;
| | | | | | - Brandi Ritter
- Ophirex, Inc., Corte Madera, CA 94925, USA; (R.W.C.); (B.R.)
| | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, CA 94118, USA;
- Ophirex, Inc., Corte Madera, CA 94925, USA; (R.W.C.); (B.R.)
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30
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Seltzer JA, Winkler GA, Friedman NA, Galust H, Hardin J, Srihari P, Ontiveros S, Corbett B, Clark RF. Pediatric Rattlesnake Envenomations Treated With Crotalidae Equine Immune F(Ab') 2 Antivenom : A 3-Year Retrospective Observational Analysis. Pediatr Emerg Care 2023; 39:776-779. [PMID: 37725768 DOI: 10.1097/pec.0000000000003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab') 2 antivenom (F(ab') 2 AV; trade name ANAVIP) was introduced in 2018, no pediatric specific studies of F(ab') 2 AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab') 2 AV in children. METHODS A single-center, retrospective chart review was performed on patients with rattlesnake envenomation presenting to a children's hospital between October 2018 and August 2022. Inclusion criteria were age younger than 18 years and F(ab') 2 AV use. Exclusion criteria were other antivenom use at any time and presentation beyond 24 hours postenvenomation.Demographic characteristics, hemoglobin, platelet count, fibrinogen, international normalized ratio, number of F(ab') 2 AV vials used, infusion-related complications, and clinical outcomes were collected. RESULTS Twenty-six patients, 19 males and 7 females, with a mean age of 7.7 years (0.67 to 16 years) met inclusion criteria. Fourteen (54%) were treated with only the initial 10 vial F(ab') 2 AV doses. Twelve patients were given additional doses with a median additional vials of 10 (4-34 vials; interquartile range, 8.75-12 vials). The median total vials given for all patients was 10 (10-44 vials; interquartile range, 10-20 vials).Two patients developed acute infusion reactions. Both were treated by slowing the infusion rate and with medications (diphenhydramine, corticosteroids). No delayed reactions were noted. No patients required blood products or surgical interventions.After discharge, no complications, recurrent symptoms, return visits, or readmissions were reported. Follow-up by chart review or phone was obtained for 18 patients, and no postdischarge complications were noted. Seven patients had postdischarge hematologic laboratory evaluations and all were normal. CONCLUSIONS Although limited by small sample size and postdischarge follow-up, F(ab') 2 AV was well tolerated in our series of pediatric patients, consistent with prior studies of all age groups.
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Affiliation(s)
| | | | | | | | | | - Priya Srihari
- Department of Emergency Medicine, Keck Medicine of USC, Los Angeles, CA
| | - Sam Ontiveros
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
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31
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Das K, Das S, Mohakud NK, Pradhan SK, Sahu SK. Risk factors and outcome of acute kidney injury in children with snake envenomation. Trop Doct 2023; 53:441-443. [PMID: 37545383 DOI: 10.1177/00494755231192684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Our study evaluates the risk factors of acute kidney injury (AKI) in children with snake envenomation. Out of 145 cases, 54 (37%) developed AKI. Unsurprisingly, the mortality increased with oliguria and higher levels of creatinine. Bleeding manifestations were also more common among the AKI group.
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Affiliation(s)
- Kedarnath Das
- Department of Pediatrics, Sri Ram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Siddhanta Das
- Department of Pediatrics, Sri Ram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Nirmal Kumar Mohakud
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, Odisha, India
| | - Subal Kumar Pradhan
- Department of Pediatrics, Sri Ram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Sanjay Kumar Sahu
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, Odisha, India
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32
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Chen CC, Yang PJ, Wang PH, Chen SC. Risk of stroke following antivenom use after venomous snakebite: correspondence. QJM 2023; 116:723-724. [PMID: 37099702 DOI: 10.1093/qjmed/hcad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Chun-Chieh Chen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Po-Jen Yang
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Po-Hui Wang
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Shiuan-Chih Chen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
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33
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Spyres MB, Maker G, Aldy K, Wolk BJ, Meadors KE, Christian M, Ruha AM. Compartment Syndrome after Crotalid Envenomation in the United States: A Review of the North American Snakebite Registry from 2013 to 2021 on Behalf of the ToxIC Snakebite Study Group. Wilderness Environ Med 2023; 34:322-327. [PMID: 37474357 DOI: 10.1016/j.wem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome. This study aims to describe presentation and management of suspected CS cases after native snakebite reported to the North American Snakebite Registry (NASBR). METHODS This is an analysis of snakebite cases reported to the Toxicology Investigators Consortium NASBR between January 1, 2013 and December 31, 2021. Cases of native snakebite with documented concern for CS were included. RESULTS Over an 8-y period, 22 cases of suspected CS were identified, representing 1% of all cases reported to the NASBR. Fasciotomies were performed in 41% (n=9) of these cases, most commonly to the upper extremity (67%, n=6). In cases of suspected CS, intracompartmental pressures (ICPs) were rarely measured (23%, n=5) and fasciotomies were performed without measurement of ICPs frequently (56%, n=5). In 1 case, ICPs were measured and found to be low (8 mm Hg) and fasciotomy was avoided. CONCLUSIONS Measurement of compartment pressures in cases of suspected CS was uncommon in cases reported to the NASBR. Fasciotomy was commonly performed without measurement of compartment pressures.
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Affiliation(s)
- Meghan B Spyres
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ.
| | - Greg Maker
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ; Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX
| | - Brian J Wolk
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA
| | - Kevan E Meadors
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Christian
- Department of Emergency Medicine, University of Missouri‒Kansas City School of Medicine, Kansas City, MO
| | - Anne-Michelle Ruha
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM. Long-term health manifestations of hump-nosed pit viper (Genus: Hypnale) bites. Clin Toxicol (Phila) 2023; 61:680-686. [PMID: 37882639 DOI: 10.1080/15563650.2023.2265549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION The hump-nosed pit viper (Genus: Hypnale) is a highly medically significant snake in Sri Lanka, responsible for the majority of venomous snakebites (22-77%). They are found throughout Sri Lanka and the Western Ghats region of India. The venom can lead to two types of effects: acute and long-term. Acutely, bites often result in local symptoms, with less common systemic effects such as acute kidney injury, venom-induced consumption coagulopathy, and thrombotic microangiopathy. METHODS We conducted a prospective observational study at Teaching Hospital Ratnapura, Sri Lanka, spanning six years, starting in June 2015. Patients bitten by hump-nosed pit vipers were followed up for two years, with assessments every three months to identify long-term effects. Data was gathered through interviewer-administered questionnaires. RESULTS Out of 728 patients bitten by hump-nosed pit vipers, 22 (3%) were lost to follow-up. Forty-four (6.2%) experienced long-term effects, including chronic kidney disease (24; 3.4%), chronic wounds (five; 0.7%), amputations (five; 0.7%), fasciotomy-related wounds (four; 0.6%), and psychological illnesses (four; 0.6%). There were nine (1.3%) deaths in this group. Among those with chronic effects, 27 (61%) were males, and 17 (39%) were females, with ages ranging from 29 to 82 years (mean 57.6 years). The time it took to diagnose acute kidney injury from the snakebite was 18 h (interquartile range: 15-23.5 h), while the time to diagnose chronic kidney disease was 69 days (interquartile range: 64-74.75 days). In these patients, the estimated glomerular filtration rate was 29.3 mL/min/1.73 m2 (interquartile range: 14-50.75 mL/min/1.73 m2). Among the patients who did not develop long-term complications (662; 91%) 660 (90.7%) experienced local effects, and 82 (11.3%) developed systemic manifestations, including acute kidney injury in 60 (8%) and coagulopathy in 35 (5%). CONCLUSION Following hump-nosed pit viper bites, a subset of patients may experience long-term health complications, including chronic kidney disease, chronic ulcers, amputations, fasciotomy-related wounds, and psychological illnesses, with chronic kidney disease being the most frequently observed among these manifestations.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
- Intensive care unit, Teaching Hospital, Ratnapura, Sri Lanka
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Kachhwaha A, Kumar A, Garg P, Sharma A, Garg MK, Gopalakrishnan M. Delayed Compression Paralysis Following an Iliopsoas Hematoma 30 Days After Saw-Scaled Viper (Echis carinatus sochureki) Envenoming: A Case Report. Wilderness Environ Med 2023; 34:366-371. [PMID: 37179190 DOI: 10.1016/j.wem.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 05/15/2023]
Abstract
Snakebite envenoming is a neglected tropical disease disproportionately affecting the rural and marginalized population in low-middle-income countries. The saw-scaled viper (Echis carinatus) is a clinically important snake that causes serious morbidity and mortality in the Indian subcontinent. Even though it is within the so-called big-four snakes against which polyvalent antivenom is available throughout India, reports of antivenom ineffectiveness are emerging in saw-scaled viper envenoming, especially around Jodhpur, Rajasthan, India. This case report highlights a patient with saw-scaled viper envenoming with an ineffective antivenom response complicated by acute kidney injury as well as local and systemic bleeding complications, which subsequently resulted in a pelvic hematoma that compressed the lumbosacral nerves, causing lower-limb weakness and sensory deficits. He was successfully managed with hematoma aspiration and supportive care. This case brings into focus the challenges of managing saw-scaled viper envenoming in this region with antivenom ineffectiveness, resulting in delayed and significant coagulopathy and its complications leading to prolonged hospital stay and morbidity. Our report spotlights less emphasized aspects of long-term morbidity in snakebite survivors, such as loss of working days and productivity. We also highlight the need for an organized system of long-term follow-up of snakebite survivors to screen for possible complications and manage them early.
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Affiliation(s)
- Arjun Kachhwaha
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Akhilesh Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Pawan Garg
- Department of Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankur Sharma
- Department of Anesthesiology and critical care, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra K Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Maya Gopalakrishnan
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India.
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Ninad N, Andharia N, Schneibel E, Parel R. Snake Envenomation Simulating ST Elevation Myocardial Infarction. Am Surg 2023; 89:3900-3901. [PMID: 37165662 DOI: 10.1177/00031348231173952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Envenomation syndromes following snakebites can include tissue reaction, coagulopathy, nephrotoxicity, and neurotoxicity. Cardiotoxicity is rare but usually presents with dysrhythmias. Myocardial infarction after envenomation has rarely been reported. We discuss a case of snake bite simulating ST-elevation myocardial infarction (STEMI). Our patient is a 49-year-old male who sustained a snake bite in his left hand. Patient had hemodynamic collapse requiring increasing pressor support; EKG and troponin results confirmed STEMI. Cardiac catheterization did not demonstrate any thrombosis, rather severe cardiomyopathy with left ventricular ejection fraction 20-25%. Even though our patient did not require any coronary intervention, an angiogram was warranted given the clinical presentation. Our case demonstrates severe cardiotoxicity following snake bite. Further research is warranted to study the mechanism behind such phenomena.
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Affiliation(s)
- Nehal Ninad
- Department of Surgery, Atrium Health Navicent, Macon, GA, USA
| | - Neil Andharia
- Mercer University School of Medicine, Macon, GA, USA
| | - Erik Schneibel
- Department of Cardiology, Atrium Health Navicent, Macon GA, USA
| | - Robert Parel
- Department of Surgery, Atrium Health Navicent, Macon, GA, USA
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Faulkner JD, Carballo CJ, Acquista E, Baughman SD, Powers WF, Novosel TJ, Yon JR. Thromboelastography Use to Guide Resuscitation and Antivenom Administration after Gaboon Viper Bite. Am Surg 2023; 89:3968-3970. [PMID: 37431298 DOI: 10.1177/00031348221086815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
The Gaboon viper (Bitis gabonica) is an exotic snake native to sub-Saharan Africa. Gaboon viper venom is an extremely toxic hemotoxin, causing severe coagulopathy and local tissue necrosis. These are not aggressive snakes and therefore bites involving humans are rare and there is not a substantial amount of literature documenting how to manage these injuries and resultant coagulopathies. We report a 29-year-old male presenting 3 hours after a Gaboon viper envenomation resulting in coagulopathy requiring massive resuscitation and multiple doses of antivenom. The patient received various blood products based on thromboelastography (TEG) and also underwent early continuous renal replacement therapy (CRRT) to assist in correction of severe acidosis and acute renal failure. The combination of TEG to guide resuscitation, administration of antivenom, and early implementation of CRRT allowed our team to correct venom-induced consumptive coagulopathy and ultimately allow the patient to survive following this extremely deadly Gaboon viper envenomation.
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Affiliation(s)
- Justin D Faulkner
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Christopher J Carballo
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Elizabeth Acquista
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Samuel D Baughman
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - William F Powers
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Timothy J Novosel
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - James R Yon
- Department of General Surgery & Surgical Critical Care, New Hanover Regional Medical Center, Wilmington, NC, USA
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Sonavane M, Almeida JR, Rajan E, Williams HF, Townsend F, Cornish E, Mitchell RD, Patel K, Vaiyapuri S. Intramuscular Bleeding and Formation of Microthrombi during Skeletal Muscle Damage Caused by a Snake Venom Metalloprotease and a Cardiotoxin. Toxins (Basel) 2023; 15:530. [PMID: 37755956 PMCID: PMC10536739 DOI: 10.3390/toxins15090530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
The interactions between specific snake venom toxins and muscle constituents are the major cause of severe muscle damage that often result in amputations and subsequent socioeconomic ramifications for snakebite victims and/or their families. Therefore, improving our understanding of venom-induced muscle damage and determining the underlying mechanisms of muscle degeneration/regeneration following snakebites is critical to developing better strategies to tackle this issue. Here, we analysed intramuscular bleeding and thrombosis in muscle injuries induced by two different snake venom toxins (CAMP-Crotalus atrox metalloprotease (a PIII metalloprotease from the venom of this snake) and a three-finger toxin (CTX, a cardiotoxin from the venom of Naja pallida)). Classically, these toxins represent diverse scenarios characterised by persistent muscle damage (CAMP) and successful regeneration (CTX) following acute damage, as normally observed in envenomation by most vipers and some elapid snakes of Asian, Australasian, and African origin, respectively. Our immunohistochemical analysis confirmed that both CAMP and CTX induced extensive muscle destruction on day 5, although the effects of CTX were reversed over time. We identified the presence of fibrinogen and P-selectin exposure inside the damaged muscle sections, suggesting signs of bleeding and the formation of platelet aggregates/microthrombi in tissues, respectively. Intriguingly, CAMP causes integrin shedding but does not affect any blood clotting parameters, whereas CTX significantly extends the clotting time and has no impact on integrin shedding. The rates of fibrinogen clearance and reduction in microthrombi were greater in CTX-treated muscle compared to CAMP-treated muscle. Together, these findings reveal novel aspects of venom-induced muscle damage and highlight the relevance of haemostatic events such as bleeding and thrombosis for muscle regeneration and provide useful mechanistic insights for developing better therapeutic interventions.
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Affiliation(s)
- Medha Sonavane
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK; (M.S.); (J.R.A.); (E.R.)
| | - José R. Almeida
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK; (M.S.); (J.R.A.); (E.R.)
| | - Elanchezhian Rajan
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK; (M.S.); (J.R.A.); (E.R.)
| | - Harry F. Williams
- Toxiven Biotech Private Limited, Coimbatore 641042, Tamil Nadu, India;
| | - Felix Townsend
- School of Biological Sciences, University of Reading, Reading RG6 6UB, UK; (F.T.); (E.C.); (K.P.)
| | - Elizabeth Cornish
- School of Biological Sciences, University of Reading, Reading RG6 6UB, UK; (F.T.); (E.C.); (K.P.)
| | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading RG6 6UB, UK; (F.T.); (E.C.); (K.P.)
| | - Sakthivel Vaiyapuri
- School of Pharmacy, University of Reading, Reading RG6 6UB, UK; (M.S.); (J.R.A.); (E.R.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Millán-González R, Monge-Morales LF, De La Cruz-Villalobos N, Bonilla-Murillo F, Gutiérrez JM. Bothrops asper bite and post-traumatic stress disorder in Costa Rica: Report of two cases. Toxicon 2023; 231:107199. [PMID: 37328114 DOI: 10.1016/j.toxicon.2023.107199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
Snakebite envenoming (SBE) is a public health problem of high impact worldwide. The psychiatric consequences of SBE have been poorly documented. Here we present in detail the phenomenology of two clinical cases of Bothrops asper snakebite post-traumatic stress disorder (SBPTSD) in Costa Rica. We suggest that there is a characteristic presentation of SBPTSD and hypothesize that main contributors to the development of this disorder are: the systemic inflammatory response, the repetition of events that put the patient's life at risk and the human innate fear of snakes. Protocols for the prevention, detection and treatment of PTSD in patients who suffer a SBE should be implemented, with at least one mental health care consultation during hospitalization and a 3-5 months follow-up after the discharge.
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Affiliation(s)
| | - Luis F Monge-Morales
- Resident in Psychiatry, Escuela de Medicina, Universidad de Costa Rica, Costa Rica
| | | | - Fabián Bonilla-Murillo
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Kalpana S, Ravi S, Muthu T. Acute Demyelination Following Snake Bite - An Unusual Complication. Indian J Pediatr 2023; 90:846. [PMID: 37249832 DOI: 10.1007/s12098-023-04655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Sivasambo Kalpana
- Department of Pediatric Medicine, Government Vellore Medical College, Adukamparai, Tamil Nadu, India.
| | - Suwethaa Ravi
- Department of Pediatric Medicine, Government Vellore Medical College, Adukamparai, Tamil Nadu, India
| | - T Muthu
- Department of Neurology, Government Vellore Medical College, Adukamparai, Tamil Nadu, India
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Saaiman E, Buys C, Theart F. Namibian spitting cobra, Naja nigricincta nigricincta (Zebra snake): Antibiotic profile of bacteria cultured from the oral pharynx, venom and snakebite wounds. S Afr Med J 2023; 113:22-28. [PMID: 37882042 DOI: 10.7196/samj.2023.v113i7.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Indexed: 10/27/2023] Open
Abstract
This was a cross-sectional study with the aim of characterising Naja nigricincta nigricincta's oral bacterial flora as well as accompanying sensitivities and resistance towards antibiotics. Naja nigricincta nigricincta (zebra snake) is a spitting cobra indigenous to Namibia. Nasopharyngeal and venom swabs for bacterial culture and antibiotic sensitivity were taken from 37 native zebra snakes originating from the Khomas region that were captured for removal and relocation. Enterococcus faecalis, Proteus spp., Morganella morganii and Pseudomonas spp. were the organisms most often cultured. The antibiotic sensitivity profiles of these organisms suggest ciprofloxacin or a third-generation cephalosporin plus gentamicin or piperacillin-tazobactam as prophylactic antibiotics in case of Naja nigricincta nigricincta bites.
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Affiliation(s)
- E Saaiman
- Anaesthetist, private practice, Windhoek, Namibia; member of the Namibian Snakebite Interest Group.
| | - C Buys
- Ear, nose and throat surgeon, private practice, Windhoek, Namibia; Namibian snakebite management expert; founding member and head of the Namibian Snakebite Interest Group.
| | - F Theart
- Snake expert and handler; member of the Namibian Snakebite Interest Group.
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Naik SB. Intravenous snake bite: A catastrophic snake envenomation. Ann Afr Med 2023; 22:239-245. [PMID: 37417008 PMCID: PMC10445712 DOI: 10.4103/aam.aam_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 07/08/2023] Open
Abstract
The rapid onset of life-threatening clinical manifestations in venomous snake bite could be due to an intravenous bite. This article seeks to review and consider the clinical implications, pathophysiology, and management of this rare route of snake envenomation broadly by venomous snakes which are little described in the available literature.
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Affiliation(s)
- Sadananda B. Naik
- Senior Physician, Alva's Health Centre, Moodabidri, Karnataka, India
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Sachett JDAG, Vieira SSC, Soares FGS, Alcântara JA, Carvalho HBDS, da Silva EMG, da Silva IM, Monteiro WM. Treatment of a Snakebite Injury With Secondary Bacterial Infection: A Case Study. J Wound Ostomy Continence Nurs 2023; 50:245-249. [PMID: 37146116 DOI: 10.1097/won.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Pit viper snakebites are challenging as they often cause tissue injury and secondary bacterial infection that may impair full recovery of the affected limb. We describe the evolution of a snakebite injury with secondary infection and the use of specialized dressings to achieve tissue repair and complete closure of the wound. CASE Ms E., a 45-year-old woman, was bitten by a pit viper that began as a small lesion and progressed to necrosis, cellulitis, edema, and hyperemia of the perilesional skin, local inflammation, and infection. We implemented a combination of topical hydrogel therapy with calcium alginate and hydrofiber with 1.2% silver to promote autolytic debridement, combat local infection, and provide a moist wound environment. The wound required daily local treatment for 2 months due to extensive tissue damage, combined with the proteolytic action of the bothropic venom. CONCLUSION The care of wounds caused by snakebites is a challenge for the health care team due to tissue loss resulting from the action of the venom and secondary bacterial infection. Close follow-up with the use of systemic antibiotics and topical therapies proved effective in minimizing tissue loss in this case.
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Affiliation(s)
- Jacqueline de Almeida Gonçalves Sachett
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Samara Sousa Carvalho Vieira
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Frandison Gean Souza Soares
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - João Arthur Alcântara
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Hanna Beatriz de Souza Carvalho
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Eliana Marques Gomes da Silva
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Iran Mendonça da Silva
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
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Young R, Little M. Case of small eyed snake envenoming. Emerg Med Australas 2023; 35:359. [PMID: 36574962 DOI: 10.1111/1742-6723.14150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Ruth Young
- Department of Emergency Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Mark Little
- Department of Emergency Medicine, Cairns Hospital, Cairns, Queensland, Australia
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Coelho KF, Neves JCF, Ibiapina HNS, Magalhães-Gama F, Barbosa FBA, Silva FS, Wellmann IAM, Sachett JAG, Tarragô AM, Ferreira LCL, Malheiro A, Monteiro WM, Costa AG. Exploring the Profile of Cell Populations and Soluble Immunological Mediators in Bothrops atrox Envenomations. Toxins (Basel) 2023; 15:196. [PMID: 36977086 PMCID: PMC10051854 DOI: 10.3390/toxins15030196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Bothrops atrox envenomations are common in the Brazilian Amazon. The venom of B. atrox is highly inflammatory, which results in severe local complications, including the formation of blisters. Moreover, there is little information on the immune mechanisms associated with this condition. Thus, a longitudinal study was carried out to characterize the profile of the cell populations and soluble immunological mediators in the peripheral blood and blisters in B. atrox patients s according to their clinical manifestations (mild and severe). A similar response in both B. atrox patient groups (MILD and SEV) was observed, with an increase in inflammatory monocytes, NKT, and T and B cells, as well as CCL2, CCL5, CXCL9, CXCL10, IL-1β and IL-10, when compared with the group of healthy blood donors. After the administration of antivenom, the participation of patrolling monocytes and IL-10 in the MILD group was observed. In the SEV group, the participation of B cells was observed, with high levels of CCL2 and IL-6. In the blister exudate, a hyperinflammatory profile was observed. In conclusion, we revealed the involvement of cell populations and soluble mediators in the immune response to B. atrox envenomation at the local and peripheral level, which is related to the onset and extent of the inflammation/clinical manifestation.
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Affiliation(s)
- Kerolaine Fonseca Coelho
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Juliana Costa Ferreira Neves
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Fábio Magalhães-Gama
- Programa de Pós-Graduação em Ciências da Saúde, Instituto René Rachou-Fundação Oswaldo Cruz (FIOCRUZ Minas), Belo Horizonte 30190-002, MG, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
| | - Fabiane Bianca Albuquerque Barbosa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Flavio Souza Silva
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
| | - Irmgardt Alicia María Wellmann
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
- Departamento de Ensino e Pesquisa, Fundação Alfredo da Matta (FUAM), Manaus 69065-130, AM, Brazil
| | - Andréa Monteiro Tarragô
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69050-001, AM, Brazil
| | - Luiz Carlos Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Adriana Malheiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69050-001, AM, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69050-001, AM, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus 69057-070, AM, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Soares Coriolano Coutinho JV, Fraga Guimarães T, Borges Valente B, Gomes Martins de Moura Tomich L. Epidemiology of secondary infection after snakebites in center-west Brazil. PLoS Negl Trop Dis 2023; 17:e0011167. [PMID: 36877732 PMCID: PMC10019779 DOI: 10.1371/journal.pntd.0011167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/16/2023] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Snakebites represent a significant health problem in tropical countries, with an annual incidence of 2.7 million cases worldwide. The incidence of secondary infections after snake bites is also high and is usually caused by bacteria from the oral cavity of snakes. Morganella morganii has been identified as an important cause of infections and has been guiding antibiotic therapy in several regions of Brazil and the world. METHODOLOGY/PRINCIPAL FINDINGS We performed a retrospective cross-sectional evaluation of snakebites in hospitalized patients between January 2018 and November 2019 and selected those with secondary infection in their medical records. During the period, 326 cases of snakebites were treated, and 155 (47.5%) of them eventually had secondary infections. However, only seven patients underwent culture of soft tissue fragments, in which three cases were negative culture results, while Aeromonas hydrophila was identified in four cases. Of these, 75% were resistant to ampicillin/sulbactam, 50% had intermediate sensitivity to imipenem, and 25% had intermediate sensitivity to piperacillin/tazobactam. Trimethoprim/sulfamethoxazole (TMP-SMX) was not tested on any strain. Of the 155 cases that progressed to secondary infections, 48.4% (75) were empirically treated with amoxicillin/clavulanate, 41.9% (65) with TMP-SMX, and 32 (22%) of these 144 cases required a change to a second regimen, and 10 of these 32 patients required a third therapeutic regimen. CONCLUSION Wild animals act as reservoirs of resistant bacteria because their oral cavity favors biofilm formation, which explains the finding of A. hydrophila with a reduced sensitivity profile in this study. This fact is essential for the appropriate choice of empirical antibiotic therapy.
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Affiliation(s)
- João Victor Soares Coriolano Coutinho
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- State Hospital for Tropical Diseases (HDT), Goiânia, Goiás, Brazil
- Hospital das Clínicas (HC) of the Federal University of Goiás (UFG), Goiânia, Goiás, Brazil
- * E-mail:
| | - Taiguara Fraga Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- State Hospital for Tropical Diseases (HDT), Goiânia, Goiás, Brazil
| | | | - Lísia Gomes Martins de Moura Tomich
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- State Hospital for Tropical Diseases (HDT), Goiânia, Goiás, Brazil
- Hospital das Clínicas (HC) of the Federal University of Goiás (UFG), Goiânia, Goiás, Brazil
- University of Rio Verde, Aparecida de Goiânia campus, Goiânia, Goiás, Brazil
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49
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM. Epidemiological and clinical features of hump-nosed pit viper (Hypnale hypnale and Hypnale zara) envenoming in children. PLoS Negl Trop Dis 2022; 16:e0011013. [PMID: 36548435 PMCID: PMC9822102 DOI: 10.1371/journal.pntd.0011013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/06/2023] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Bites by the hump-nosed pit vipers (HNPV) of the genus Hypnale are the commonest type of venomous snakebites in Sri Lanka. Their bites frequently cause local effects while rarely causing systemic envenoming, that may include acute kidney injury and coagulopathy. There are 3 species of genus Hypnale including H. hypnale, H. zara and H. nepa from which latter two are endemic to Sri Lanka. Virtually all studies on HNPV bites in Sri Lanka are focused on adults except two studies in paediatric group. The aims of this study were to describe the epidemiology and clinical manifestations of HNPV bites in a group of children admitted to a tertiary care hospital in Sri Lanka. METHODOLOGY/PRINCIPAL FINDINGS This was a prospective observational study carried out in Teaching Hospital Ratnapura, Sri Lanka over 27 months commencing from May 2020 including all children aged up to 14 years with the history of HNPV bites. There were 40 (56%) HNPV bites, of them 28 (70%) were males. The age was 84 months (50.2-120 months). Majority (n = 21;52.5%) were bitten during day-time (06:00-17:59) in home gardens (n = 20; 50%) on lower limbs (n = 24;60%). Most children (n = 30;75%) were admitted to the medical facility < 4 hours after the snakebite [90 min (40-210 min)] and the hospital stay was 4 days (3-5 days). Local envenoming was observed in 38 patients (95%) and systemic effects developed in 4 patients (10%) as mild coagulopathy. Local effects include local pain (n = 30; 94%), swelling (n = 38;95%), blistering (n = 11;27.5%), necrosis at the site of bite (n = 11; 27.5%), regional lymph node enlargement (n = 8;20%) and local bleeding (n = 4;10%). For the local effects, surgical interventions were needed in 10 children (25%) and 3 (7.5%) of them developed acute compartment syndrome leading to fasciotomy. Leucocytosis (n = 28;78%) and eosinophilia (n = 9;27%) were the prominent laboratory findings. All got recovered except in patients with fasciotomy who got permanent scar. CONCLUSIONS/SIGNIFICANCE Hump-nosed pit viper bites mostly cause local effects and rarely systemic envenoming in children. Compartment syndrome is common in children following their bites.
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Affiliation(s)
- R. M. M. K. Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka
- Intensive care unit, Teaching Hospital, Ratnapura, Sri Lanka
- * E-mail:
| | | | - S. A. M. Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Suhita R, Begum I, Rashid M, Chandran VP, Shastri SA, Kantamneni R, Rajan AK, Thunga G. Systematic review and meta-analysis of global prevalence of neurotoxic and hemotoxic snakebite envenomation. East Mediterr Health J 2022; 28:909-916. [PMID: 36573572 DOI: 10.26719/emhj.22.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
Background The World Health Organization estimates that there are approximately 5.4 million snakebites and 1.8-2.7 million cases of envenomation, with 81 410-137 880 deaths each year worldwide. Aims To estimate the prevalence of neurotoxic and haemotoxic snakebite envenomation through a comprehensive systematic review and meta-analysis. Methods We searched Medline/PubMed, Scopus and Cochrane Library up to January 2021 using keywords such as snakebite and snake envenomation. Bibliographic and random searches were also performed. Prospective or retrospective observational studies and randomized controlled trials were included for the review. Results We included 271 of 9711 studies published between 1963 and 2020. The pooled prevalence of snakebite from 188 studies with a total of 207 235 participants showed the highest prevalence in North America (69.20%; 95% confidence interval, CI: 57.06-81.34%) and lowest in Africa (28.10%; 95% CI: 22.22-33.98%). There was a pooled prevalence of 24.94% (95% CI: 22.84-27.03%) for haemotoxicity, with a highest prevalence of coagulopathy (43.76%; 95% CI: 33.15-54.37%). The overall prevalence of neurotoxicity was 38.20% (95% CI: 31.88-44.53%), with a highest prevalence of ptosis (53.57%; 95% CI: 38.51-68.62%). Conclusion There was a higher prevalence of snakebites in North America. The most prevalent haemotoxicity and neurotoxicity were coagulopathy and ptosis, respectively. The overall quality of evidence was good with a non-significant publication bias.
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Affiliation(s)
- Ramadugula Suhita
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Izwath Begum
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sanjana Aditya Shastri
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Raveena Kantamneni
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Asha K Rajan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
- Centre for Toxicovigilance and Drug Safety, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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