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Kazemi SM, Hosseinzadeh MS, Weinstein SA. Identifying the geographic distribution pattern of venomous snakes and regions of high snakebite risk in Iran. Toxicon 2023; 231:107197. [PMID: 37321410 DOI: 10.1016/j.toxicon.2023.107197] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
We describe species richness patterns of venomous snakes in Iran in order to produce snakebite risk prediction maps and identify gaps in regional health care centers capable of managing snakebites. We digitized distribution maps from the literature, Global Biodiversity Information Facility (GBIF), and the results of our own field studies of 24 terrestrial venomous snake species (including 4 endemic to Iran). Species richness patterns were associated with eight environmental factors. The variables have been extracted from the WorldClim dataset (bio12 = annual precipitation, bio15 = precipitation seasonality, bio17 = precipitation of the driest quarter, bio2 = mean diurnal range, bio3 = isothermality (bio2/bio7), bio4 = temperature seasonality, bio9 = mean temperature of the driest quarter and slope). Based on spatial analyses, species richness in Iran is highly affected by three environmental variables (bio12, 15, and 17) associated with precipitation. The relationship patterns among these predictors and species richness were strong and linear. The hotspot regions for venomous snakes species are concentrated on the western to southwestern and north to northeastern regions of Iran, which is partially consistent with the known Irano-Anatolian biodiversity hotspot. Because of the high number of endemic species and climatic conditions on the Iranian Plateau, the venoms of snakes distributed in those areas may contain novel properties and components.
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Affiliation(s)
- Seyed Mahdi Kazemi
- Zagros Herpetological Institute, 37156-88415, P. O. No 12, Somayyeh 14 Avenue, Qom, Iran
| | | | - Scott A Weinstein
- Playford Family Medicine, 297 Peachey Rd., Munno Para, South Australia, 5115, Australia; Young Adult Institute, 220 E. 42nd St., 8th Floor, NY, NY, 10017, USA; Premier Health Care, 227 E. 41st St., 8th Floor, NY, NY, 10017, USA.
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Kazemi SM, Jahan-Mahin MH, Mohammadian-Kalat T, Hosseinzadeh MS, Weinstein SA. Local envenoming by the coinsnake or Asian racer, Hemorrhois nummifer and mountain racer or leopard snake, Hemorrhois ravergieri (Serpentes: Colubridae, Colubrinae) in Iran: A reminder of the importance of species identification in the medical management of snakebites. Toxicon 2023; 226:107070. [PMID: 36868482 DOI: 10.1016/j.toxicon.2023.107070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/07/2023] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
In Iran, there are approximately 4500-6500 snakebites per year, but fortunately only 3-9 of these are fatal. However, in some population centers such as Kashan city (Isfahan Province, central Iran), approximately 80% of snakebites are attributed to "non-venomous" snakes that are often comprised of several species of non-front-fanged snakes (NFFS). NFFS comprise a diverse group that constitute approximately 2900 species belonging to an estimated 15 families. We report here two cases of local envenoming from H. ravergieri, and one from H. nummifer that occurred in Iran. The clinical effects consisted of local erythema, mild pain, transient bleeding and edema. Two victims experienced progressive local edema that distressed the victims. The medical team's unfamiliarity with snakebites contributed to the incorrect clinical management of one victim including the contraindicated, ineffective provision of antivenom. These cases provide further documentation about local envenoming caused by these species, and also emphasize the need for regional medical personnel to receive increased training in order to improve familiarity with the local snake fauna and evidence-based snakebite management.
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Affiliation(s)
- Seyed Mahdi Kazemi
- Zagros Herpetological Institute, 37156-88415, P. O. No 12, Somayyeh 14 Avenue, Qom, Iran
| | | | | | | | - Scott A Weinstein
- Playford Family Medicine, 297 Peachey Rd., Munno Para, South Australia, 5115, Australia.
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Weinstein SA. Navigating the Partly Charted Seas of Clinical Toxinology. Wilderness Environ Med 2022; 33:369-370. [DOI: 10.1016/j.wem.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Weinstein SA, Sanders KL, White J. Construction of Accurate Medical Risk Profiles for Venomous Snakes Requires Correct Identification of the Envenoming Species. Am J Forensic Med Pathol 2021; 42:407-408. [PMID: 34793411 DOI: 10.1097/paf.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thein MM, Rogers CA, White J, Mahmood MA, Weinstein SA, Nwe MT, Thwin KT, Zaw A, Thant M, Oo SSL, Gyi KM, Warrell DA, Alfred S, Peh CA. Characteristics and significance of "green snake" bites in Myanmar, especially by the pit vipers Trimeresurus albolabris and Trimeresurus erythrurus. Toxicon 2021; 203:66-73. [PMID: 34562496 DOI: 10.1016/j.toxicon.2021.09.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Snakebite is an important problem in Myanmar. Regionally, bites by Eastern Russell's vipers, Daboia siamensis (Viperidae, Viperinae), and monocled cobras, Naja kaouthia are considered medically important, but those categorised as "green snake" bites are not. However, these may include bites by green pit vipers, Trimeresurus spp. (Viperidae, Crotalinae) for which no antivenom is available in Myanmar. Elsewhere in Southeast Asia, these snakes are reported to cause local and systemic envenoming. As part of the Myanmar Snakebite Project, prospective case data were collected over 3 years from five hospitals in the Mandalay region. These included 3803 snakebite cases reported from Mandalay region. Of these, 355 were listed as bites by a witnessed green-coloured snake. In 22 cases, the snakes responsible were retained and preserved, then expertly identified; 21 were medically important white-lipped pit vipers (Trimeresurus albolabris), and one as an Asian vine snake, Ahaetulla prasina (Colubridae, Ahaetuliinae) which is not of medical importance. Among confirmed Trimeresurus albolabris bites, 15/21 developed swelling of the bitten limb, and 3/21 coagulopathy, defined as a positive 20-min whole blood clotting test (20WBCT). None developed necrosis, blistering, thrombocytopenia or acute kidney injury (AKI). Of the remaining 333 patients bitten by green snakes that were not specifically identified, 241 (72%) developed swelling of the bitten limb, and 62 (19%) coagulopathy. AKI occurred in 21/333 patients, but only one required dialysis. At least 10/21 of the cases with AKI in this study were more likely to represent bites from Trimeresurus spp. than D. siamensis because the snake responsible was brought into the hospital, examined and described by the treating physician as "green-coloured". This study describes a previously unpublished case of AKI from envenoming by T. erythrurus in Yangon, and reviews cases of AKI following bites by this species and T. albolabris in Myanmar. This confirms that, at least on rare occasions, Trimeresurus spp. envenoming can cause AKI. This has important implications for snakebite management in Myanmar as the finding of local swelling, coagulopathy and AKI is generally considered pathognomonic of D. siamensis envenoming. Further collection of confirmed Trimeresurus spp. bites is required in Myanmar in order better to define the syndrome of envenoming and to assess the possible need for antivenom against Trimeresurus spp. in this country.
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Affiliation(s)
- Myat Myat Thein
- Myanmar Snakebite Project, Mandalay Office, Mandalay, Myanmar
| | - Caitlyn A Rogers
- Toxinology Department, Women's and Children's Hospital, North Adelaide, SA, 5006, Australia; University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Julian White
- Toxinology Department, Women's and Children's Hospital, North Adelaide, SA, 5006, Australia; University of Adelaide, Adelaide, SA, 5000, Australia
| | | | - Scott A Weinstein
- Toxinology Department, Women's and Children's Hospital, North Adelaide, SA, 5006, Australia; University of Adelaide, Adelaide, SA, 5000, Australia
| | - Myat Thet Nwe
- Myanmar Snakebite Project, Mandalay Office, Mandalay, Myanmar
| | | | - Aung Zaw
- General Manager, Myanmar Pharmaceutical Industrial Enterprise, Yangon, Myanmar
| | - Myo Thant
- Myanmar Snakebite Project, Mandalay Office, Mandalay, Myanmar
| | - Sai Sein Lin Oo
- Department of Zoology, University of Mandalay, Mandalay, Myanmar
| | - Khin Maung Gyi
- Department of Zoology, University of Mandalay, Mandalay, Myanmar
| | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Sam Alfred
- University of Adelaide, Adelaide, SA, 5000, Australia; Emergency Department, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Chen Au Peh
- University of Adelaide, Adelaide, SA, 5000, Australia; Department of Renal Medicine, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
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Weinstein SA, Warrell DA, Daoues K, Vidal N. The first reported snakebite by an African snake-eater, Polemon spp. (Atractaspididae, Aparallactinae); Local envenoming by Reinhardt's snake-eater, Polemon acanthias (Reinhardt, 1860). Toxicon 2021; 200:92-95. [PMID: 34280410 DOI: 10.1016/j.toxicon.2021.07.006] [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: 06/02/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
The first reported snakebite by an African snake-eater, Polemon spp. (Atractaspididae, Aparallactinae); Local envenoming by Reinhardt's snake-eater, Polemon acanthias (Reinhardt, 1860). Toxicon XX, xxx. A 51-yr-old male herpetologist was bitten on the left index finger by a captive male Polemon acanthias while manually removing fragments of incompletely shed skin from the specimen. The snake sustained its bite for approximately 2 mins, advancing its jaws several times. The victim rapidly developed moderate pain, erythema, progressive edema that ultimately extended to the left wrist; a blister later developed in the wound site, as well as joint stiffness in the bitten and adjacent two fingers that limited flexion and extension. These effects regressed during the week following the bite, but recurred thereafter and were similar to the effects that developed immediately post-envenoming. There were no systemic signs or symptoms. The victim sought medical advice and was treated with broad-spectrum antibiotics, antihistamines and wound care; no laboratory investigations were conducted. He improved during the subsequent month with complete resolution in 5 and one-half weeks. This is the first documented bite by a Polemon spp. and the victim's clinical course suggests the development of local effects from venom components. The phylogenetic relationship of Polemon spp. with the burrowing asps (Atractaspis spp.) and the similarity of some of the features of this local envenoming by P. acanthias with mild/moderate envenoming by some Atractaspis spp., suggests that none of these snakes should be handled; they should be considered capable of inflicting potentially serious envenoming.
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Affiliation(s)
- Scott A Weinstein
- Department of Toxinology, Women's and Children's Hospital, North Adelaide, South Australia, 5006, Australia.
| | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Karim Daoues
- La Ferme Tropicale, 54 rue Jenner, 75013, Paris, France
| | - Nicolas Vidal
- Muséum National d'Histoire Naturelle, UMR 7205, MNHN, CNRS, Sorbonne Université, EPHE, Université des Antilles, Institut de Systématique, Evolution et Biodiversité, CP 30, 57, Rue Cuvier, F-75005, Paris, France
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Ineich I, Girard F, Ping T, Reynes J, Weinstein SA. Two case reports of local envenoming by the Spotted grass snake, Psammophylax rhombeatus (Linnæus, 1758) (Serpentes, Psammophiidae). Toxicon 2021; 195:24-28. [PMID: 33705734 DOI: 10.1016/j.toxicon.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
Two cases of bites by a South African psammophiid snake, Psammophylax rhombeatus, are described and analyzed. These are the first detailed reports of local envenoming by a Psammophylax spp. While handling a wild-collected 1 m P. rhombeatus, the snake inflicted a protracted bite proximal to the metacarpophalangeal joint of digit #5, left hand of a 24-year-old male amateur herpetologist. Local edema persisted for three days, but no pain or other signs or symptoms including non-specific autonomic effects (e.g. headache, nausea) occurred. In a second case, a 28-year-old male herpetologist-photographer was repositioning a 0.58 m female P. rhombeatus in order to photograph the snake and her egg clutch, when the snake bit the metacarpophalangeal joint of digit #5, left hand, and briefly advanced its jaws. The bite caused mild local pain, progressive edema of the left hand, and arthralgia; resolution required almost 1 week. Bites from non-front-fanged snakes such as these by P. rhombeatus are uncommonly reported in comparison with those described for front-fanged snakes (e.g. Viperidae, Elapidae). Therefore, documentation of bites even with minimal effects provides information essential for the construction of an accurate medical risk profile for these less-known species.
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Affiliation(s)
- Ivan Ineich
- Institut de Systématique, Évolution, Biodiversité (ISYEB) Muséum national d'Histoire Naturelle, CNRS, Sorbonne Université, EPHE, Université des Antilles - CP 30, 57 Rue Cuvier, 75005, Paris, France.
| | | | - Tyrone Ping
- 7 Oak Tree Avenue, Glen Anil, KwaZulu-Natal, 4051, South Africa
| | - Jordy Reynes
- 31 Rue des Mouleyres, 11120, Bize Minervois, France
| | - Scott A Weinstein
- Department of Toxinology, Women's and Children's Hospital, 72 King William St., North Adelaide, South Australia, 5000, Australia
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Ineich I, Girard F, Weinstein SA. Local envenoming by the Schokari sand racer, Psammophis schokari Forskål, 1775 (Serpentes, Psammophiidae) and a brief review of reported bites by sand racers (Psammophis spp.). Toxicon 2020; 185:72-75. [DOI: 10.1016/j.toxicon.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022]
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Weinstein SA, Mirtschin PJ, White J. Risks and realities of single vial antivenom recommendations for envenoming by Australian elapid snakes. Med J Aust 2020; 213:46-46.e1. [DOI: 10.5694/mja2.50651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Julian White
- Women's and Children's Hospital Adelaide Adelaide SA
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Weinstein SA, Mirtschin PJ, White J. Risks and realities of single vial antivenom recommendations for envenoming by Australian elapid snakes. Med J Aust 2019; 211:492-493.e1. [PMID: 31441065 DOI: 10.5694/mja2.50314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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White J, Weinstein SA, De Haro L, Bédry R, Schaper A, Rumack BH, Zilker T. Reply to Rzymski and Klimaszyk regarding comment on "Mushroom poisoning: A proposed new clinical classification". Toxicon 2019; 160:59. [PMID: 30794842 DOI: 10.1016/j.toxicon.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/14/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Julian White
- Toxinology Dept., Women's & Children's Hospital, North Adelaide, Australia
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| | - Scott A Weinstein
- Toxinology Dept., Women's & Children's Hospital, North Adelaide, Australia
| | - Luc De Haro
- Marseille Poison Centre, Hopital Sainte Marguerite, Marseille, France
| | - Regis Bédry
- Hospital Secure Unit, Pellegrin University Hospital, Bordeaux, France
| | - Andreas Schaper
- GIZ-Nord Poisons Centre, University Medical Center Göettingen, Göttingen, Germany
| | - Barry H Rumack
- Department of Emergency Medicine and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas Zilker
- Dept. for Clinical Toxicology at II, Med. Klinik, TU, München, Munich, Germany
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White J, Weinstein SA. Challenges in clinical toxinology; Practice, pretence and prematurity. Toxicon 2019. [DOI: 10.1016/j.toxicon.2018.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weinstein SA, Mirtschin PJ, White J. Local morbidity from red-bellied black snake (Pseudechis porphyriacus, elapidae) envenoming: Two cases and a brief review of management. Toxicon 2019. [DOI: 10.1016/j.toxicon.2018.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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White J, Weinstein SA, De Haro L, Bédry R, Schaper A, Rumack BH, Zilker T. Mushroom poisoning: A proposed new clinical classification. Toxicon 2019; 157:53-65. [DOI: 10.1016/j.toxicon.2018.11.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 01/19/2023]
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Weinstein SA, Mirtschin PJ, Tristram H, Lawton L, White J. Local morbidity from red-bellied black snake (Pseudechis porphyriacus, Elapidae) envenoming: Two cases and a brief review of management. Toxicon 2018; 142:34-41. [DOI: 10.1016/j.toxicon.2017.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/16/2022]
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Weinstein SA, Everest E, Purdell-Lewis J, Harrison M, Tavender F, Alfred S, Marrack L, Davenport-Klunder C, Wearn N, White J. Neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan (Oxyuranus microlepidotus, Elapidae) in remote outback South Australia. Toxicon 2017; 137:15-18. [PMID: 28694006 DOI: 10.1016/j.toxicon.2017.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus, is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. CASE REPORT The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling "drowsiness" and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole blood clotting test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury. DISCUSSION Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome.
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Affiliation(s)
- Scott A Weinstein
- Toxinology Department, Women's and Children's Hospital, 72 King William Street, North Adelaide, South Australia, 5006, Australia; Department of Paediatrics and Reproductive Medicine, University of Adelaide School of Medicine, 30 Frome Street, Adelaide, South Australia, 5005, Australia.
| | - Evan Everest
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia; MedSTAR Retrieval Service, South Australian Ambulance Service, 20 James Schofield Drive, Adelaide Airport, South Australia, 5950, Australia
| | - Jeremy Purdell-Lewis
- Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia
| | - Michael Harrison
- Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia
| | - Fiona Tavender
- MedSTAR Retrieval Service, South Australian Ambulance Service, 20 James Schofield Drive, Adelaide Airport, South Australia, 5950, Australia
| | - Sam Alfred
- Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia
| | - Liz Marrack
- Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia
| | - Chris Davenport-Klunder
- Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia
| | - Neralie Wearn
- MedSTAR Retrieval Service, South Australian Ambulance Service, 20 James Schofield Drive, Adelaide Airport, South Australia, 5950, Australia
| | - Julian White
- Toxinology Department, Women's and Children's Hospital, 72 King William Street, North Adelaide, South Australia, 5006, Australia; Department of Paediatrics and Reproductive Medicine, University of Adelaide School of Medicine, 30 Frome Street, Adelaide, South Australia, 5005, Australia
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Keyler DE, Gawarammana I, Villalta M, León G, Sellahewa KH, McWhorter K, Malleappah R, Weinstein SA, Gutiérrez JM. A polyspecific antivenom for Sri Lanka: First to include Hypnale. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kanaan NC, Ray J, Stewart M, Fuller M, Martin Caravati E, Russell KW, Bush SP, Cardwell MD, Norris RL, Weinstein SA. In Reply to Drs Boyer and Ruha. Wilderness Environ Med 2016; 27:342-4. [DOI: 10.1016/j.wem.2015.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
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Keyler DE, Richards DP, Warrell DA, Weinstein SA. Local envenomation from the bite of a juvenile false water cobra (Hydrodynastes gigas; Dipsadidae). Toxicon 2016; 111:58-61. [PMID: 26743113 DOI: 10.1016/j.toxicon.2015.12.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
The false water cobra (Hydrodynastes gigas) is a non-front-fanged colubroid snake frequently exhibited in zoos, and maintained by amateur collectors. Little detailed documentation regarding the time-course of symptoms development and the consequences of their bites to humans has been published. Reported here is a case of envenoming in a 25 yo male that occurred after the bite of a juvenile H. gigas. The victim was bitten on the fourth digit of the left hand while processing the snake for sex determination, and the snake remained attached to the digit for approximately 30 s; there was no jaw advancement. Within 5 min, intense local pain developed, and at 4hr post bite the entire dorsal aspect of the hand was significantly edematous, The local effects progressed and involved the entire forearm, and the local pain referred to the axillary region. Mild paresthesia and local blanching ("pallor") were noted in the affected digit, but resolved within 7 days. The clinical course in the patient showed that moderate localized symptoms may result from the bite of a juvenile H.gigas.
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Affiliation(s)
- D E Keyler
- Animal Venom Research International, Moreno Valley, CA, 92556, USA; Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - D P Richards
- School of Life Sciences, University of Nottingham, United Kingdom
| | - D A Warrell
- Nufield Department of Clinical Medicine, University of Oxford, Oxford, OX3 9DW, UK
| | - S A Weinstein
- Toxinology Department, Women's and Children's Hospital, North Adelaide, 5006, Australia
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Weinstein SA, White J, Ou J, Haiart S, Galluccio S. Reply to Isbister and Page: Further discussion of an illuminated case of presumed brown snake (Pseudonaja spp.) envenoming. Clin Toxicol (Phila) 2015; 53:926-7. [PMID: 26503791 DOI: 10.3109/15563650.2015.1096369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Scott A Weinstein
- a Toxinology Department , Women's and Children's Hospital , North Adelaide , South Australia , Australia
| | - Julian White
- a Toxinology Department , Women's and Children's Hospital , North Adelaide , South Australia , Australia
| | - Judy Ou
- b Departments of Emergency Medicine and Intensive Care , Flinders University Medical Center , Bedford Park , Adelaide , South Australia , Australia
| | - Sebastien Haiart
- b Departments of Emergency Medicine and Intensive Care , Flinders University Medical Center , Bedford Park , Adelaide , South Australia , Australia
| | - Steven Galluccio
- b Departments of Emergency Medicine and Intensive Care , Flinders University Medical Center , Bedford Park , Adelaide , South Australia , Australia
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Kanaan NC, Ray J, Stewart M, Russell KW, Fuller M, Bush SP, Caravati EM, Cardwell MD, Norris RL, Weinstein SA. Wilderness Medical Society Practice Guidelines for the Treatment of Pitviper Envenomations in the United States and Canada. Wilderness Environ Med 2015; 26:472-87. [DOI: 10.1016/j.wem.2015.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 10/22/2022]
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Abstract
CONTEXT Several species of medically important Australian elapid snakes are frequently involved in human envenoming. The brown snake group (Pseudonaja spp., 9 species) is most commonly responsible for envenoming including life-threatening or fatal cases. Several Pseudonaja spp. can inflict human envenoming that features minor local effects, but may cause serious systemic venom disease including defibrination coagulopathy, thrombocytopenia, micro-angiopathic hemolytic anemia (MAHA) and, rarely, paralysis. Pseudonaja envenoming is typically diagnosed by history, clinical assessment including occasional active clinical bleeding noted on physical examination (e.g. from venipuncture sites, recent cuts, etc.), and laboratory detection of coagulopathy (prolonged activated partial thromboplastin time [APTT]/INR, elevated D-dimer, afibrinogenemia and thrombocytopenia). Lack of verified identity of the envenoming snake species is a common problem in Australia and elsewhere. Identification and confirmation of the envenoming Australian snake taxon is often attempted with enzyme sandwich immunoassay venom detection kits (SVDKs). However, the SVDK has limited utility due to unreliable specificity and sensitivity when used to detect venoms of some Australian elapids. Antivenom (AV) remains the cornerstone of treatment, although there is debate concerning the recommended dose (1 vs. 2 or more vials) necessary to treat serious Pseudonaja envenoming. Envenomed patients receiving timely treatment uncommonly succumb, but a proportion of seriously envenomed patients may exhibit clinical or laboratory evidence of myocardial insult. CASE DETAILS An 88-year-old woman presented her dog to a veterinarian after it had sustained a bite by a witnessed snake, reportedly an eastern brown snake (Pseudonaja textilis, Elapidae). The woman became suddenly confused, and lost consciousness at the veterinary office. After transport to hospital, she denied any contact with the snake, but developed large haematomas at intravenous (i.v.) catheter insertion sites; blood tests revealed a severe defibrination coagulopathy, consistent with envenoming by a brown snake. An SVDK-tested urine sample was negative. A non-contrast CT of her head showed a minor subacute infarction of the left corona radiata. A twelve-lead ECG was normal, but her troponins were mildly elevated (39 ng/L). A diagnosis of brown snake envenoming was made and she received 2 vials of brown snake AV i.v., without adverse incident. Thirty min post AV her Glasgow Coma Score (GCS) had improved from 13 to 15 (normal). At 3.5 h post AV all bleeding from i.v. sites ceased, although her troponin T level peaked at 639 ng/L, supporting a diagnosis of non-ST elevated myocardial infarction (NSTEMI). DISCUSSION Severe brown snake envenoming may occur in the absence of a perceived bite, and AV is temporally associated with improvement in clinical findings and coagulopathy. However, severe envenoming by this species can be complicated by cardiovascular events that in the circumstance of incomplete or absent history may confuse the primary diagnosis and affect patient outcome.
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Affiliation(s)
- Judy Ou
- Flinders Medical Centre, Bedford Park , Adelaide, South Australia , Australia
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Weinstein SA, White J. In Response to How Not To Train Your Dragon: A Case of Komodo Dragon Bite, by Borek and Charlton. Wilderness Environ Med 2015; 26:572-3. [PMID: 25998862 DOI: 10.1016/j.wem.2015.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 03/25/2015] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Scott A Weinstein
- Department of Toxinology, Women's and Children's Hospital, 72 King William St., North Adelaide, South Australia, Australia
| | - Julian White
- Department of Toxinology, Women's and Children's Hospital, 72 King William St., North Adelaide, South Australia, Australia
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Affiliation(s)
- Julian White
- Toxinology Department, Women's and Children's Hospital , North Adelaide , South Australia
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White J, Weinstein SA. Latrodectism and Effectiveness of Antivenom. Ann Emerg Med 2015; 65:123-4. [DOI: 10.1016/j.annemergmed.2014.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/27/2022]
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Vetter RS, Swanson DL, Weinstein SA, White J. Do spiders vector bacteria during bites? The evidence indicates otherwise. Toxicon 2015; 93:171-4. [DOI: 10.1016/j.toxicon.2014.11.229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 01/13/2023]
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Weinstein SA. The pharmacotherapy for pit viper envenoming in the United States: A brief retrospective on roots, recurrence, and risk. Clin Toxicol (Phila) 2014; 53:1-4. [DOI: 10.3109/15563650.2014.983240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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White J, Weinstein SA. A phoenix of clinical toxinology: White-tailed spider (Lampona spp.) bites. A case report and review of medical significance. Toxicon 2014; 87:76-80. [DOI: 10.1016/j.toxicon.2014.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/09/2014] [Accepted: 05/29/2014] [Indexed: 01/22/2023]
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Weinstein SA. The shifting role of the primary care physician. Fam Pract Manag 2014; 21:36. [PMID: 25078017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Razavi S, Weinstein SA, Bates DJ, Alfred S, White J. The Australian mulga snake (Pseudechis australis: Elapidae): report of a large case series of bites and review of current knowledge. Toxicon 2014; 85:17-26. [PMID: 24726467 DOI: 10.1016/j.toxicon.2014.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/28/2014] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mulga snake (Pseudechis australis) is the largest terrestrial venomous snake in Australia. It is capable of inflicting severe and occasionally fatal envenoming, but there have been few studies of P. australis bites. OBJECTIVES To highlight and reinforce the main features of P. australis envenoming and to provide a clearer picture of the epidemiology of bites from this species. METHODS Selected case records kept by the Toxinology Dept. (Women's and Children's Hospital, Adelaide, Australia) were reviewed retrospectively to determine definite P. australis bites. INCLUSION CRITERIA definite cases where the snake was identified by a competent person and/or lab specimens (bite site/urine) tested positive for "black snake" using CSL snake venom detection kit in a locality within the known range of P. australis, but without sympatry with other Pseudechis spp. EXCLUSION CRITERIA where the snake could not be clearly identified under criteria above. Epidemiological and clinical information was recorded and analysed for the definite cases. RESULTS A total of 27 cases were identified as definite P. australis bites; there were no fatalities. The median age was 35.5 years (IQR 51-23) and 80% of bites occurred in males. More bites occurred in the warmer months (Dec-March) and in those handling/interfering with snakes. Seven people were bitten whilst asleep at night. 21/27 patients developed systemic envenoming (based on signs, symptoms and laboratory results) and 17 cases received antivenom. Local bite site pain (18) and swelling (17) were common as were non-specific generalised symptoms such as nausea, vomiting and headache. Myotoxicity (11) and anticoagulant coagulopathy (10) occurred frequently; haemolysis was seen in fewer cases (3). Two patients developed local tissue injury around the bite site requiring further treatment. CONCLUSIONS This study confirms previous reports about P. australis bites with respect to high rates of envenoming, commonly associated with pain and swelling and systemic effects of rhabdomyolysis and anticoagulant coagulopathy. Systemic envenoming, even severe cases, responds well to antivenom therapy. Compared to other Australian snakes, a high proportion of bites occur in people asleep at night. Medically significant local tissue injury around the bite site may occur and may be associated with inappropriate first-aid, particularly the vascular occlusive type.
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Affiliation(s)
- Shahab Razavi
- Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia; Medical School, University of Bristol, Bristol BS8 1TH, UK
| | - Scott A Weinstein
- Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia
| | - David J Bates
- Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia.
| | - Sam Alfred
- Emergency Department, Royal Adelaide Hospital, North Tce, Adelaide, SA 5000, Australia
| | - Julian White
- Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia
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Weinstein SA, Griffin R, Ismail AK. Non-front-fanged colubroid ("colubrid") snakebites: three cases of local envenoming by the mangrove or ringed cat-eyed snake (Boiga dendrophila; Colubridae, Colubrinae), the Western beaked snake (Rhamphiophis oxyrhynchus; Lamprophiidae, Psammophinae) and the rain forest cat-eyed snake (Leptodeira frenata; Dipsadidae). Clin Toxicol (Phila) 2014; 52:277-82. [PMID: 24645905 DOI: 10.3109/15563650.2014.897352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Non-front-fanged colubroid snakes (NFFC; formerly and artificially taxonomically assembled as "colubrids") comprise the majority of extant ophidian species. Although the medical risks of bites by a handful of species have been documented, the majority of these snakes have oral products (Duvernoy's secretions, or venoms) with unknown biomedical properties/unverified functions and their potential for causing harm in humans is unknown. CASE DETAILS Described are three cases of local envenoming from NFFC bites inflicted respectively by the mangrove or ringed cat-eyed snake (Boiga dendrophila, Colubridae), the Western beaked snake (Rhamphiophis oxyrhynchus, Lamprophiidae) and the rain forest cat-eyed snake (Leptodeira frenata, Dipsadidae). The effects ranged from mild pain, edema and erythema to severe pain, progressive edema, and blistering with slowly resolving arthralgia; there were no systemic effects. DISCUSSION Although these three taxa occasionally inflict bites with mild to moderate local effects, there is no current evidence of systemic involvement. Two of these cases were reported to one of the authors for medical evaluation, and although verified, thus constitute reliably reported cases, but low-quality evidence. Type-1 local hypersensitivity may contribute to some cases, but most local effects observed or reported in these three cases were consistent with the effects of venom/oral product components.
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Affiliation(s)
- S A Weinstein
- Department of Toxinology, Women's and Children's Hospital , North Adelaide, SA , Australia
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Weinstein SA, White J, Keyler DE, Warrell DA. Non-front-fanged colubroid snakes: a current evidence-based analysis of medical significance. Toxicon 2013; 69:103-13. [PMID: 23462380 DOI: 10.1016/j.toxicon.2013.02.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 11/13/2012] [Revised: 01/16/2013] [Accepted: 02/05/2013] [Indexed: 11/19/2022]
Abstract
Non-front-fanged colubroid snakes (NFFC; formerly and artificially taxonomically assembled as "colubrids") comprise about 70% of extant snake species and include several taxa now known to cause lethal or life threatening envenoming in humans. Although the medical risks of bites by only a handful of species have been documented, a growing number of NFFC are implicated in medically significant bites. The majority of these snakes have oral products (Duvernoy's secretions, or venoms) with unknown biomedical properties and their potential for causing harm in humans is unknown. Increasingly, multiple NFFC species are entering the commercial snake trade posing an uncertain risk. Published case reports describing NFFC bites were assessed for evidence-based value, clinical detail and verified species identification. These data were subjected to meta-analysis and a hazard index was generated for select taxa. Cases on which we consulted or personally treated were included and subjected to the same assessment criteria. Cases involving approximately 120 species met the selection criteria, and a small subset designated Hazard Level 1 (most hazardous), contained 5 species with lethal potential. Recommended management of these cases included antivenom for 3 species, Dispholidus typus, Rhabdophis tiginis, Rhabdophis subminiatus, whereas others in this subset without commercially available antivenoms (Thelotornis spp.) were treated with plasma/erythrocyte replacement therapy and supportive care. Heparin, antifibrinolytics and/or plasmapheresis/exchange transfusion have been used in the management of some Hazard Level 1 envenomings, but evidence-based analysis positively contraindicates the use of any of these interventions. Hazard Level 2/3 species were involved in cases containing mixed quality data that implicated these taxa (e.g. Boiga irregularis, Philodryas olfersii, Malpolon monspessulanus) with bites that caused rare systemic effects. Recommended management may include use of acetylcholinesterase inhibitors (e.g. neostigmine) and wound care on a case-by-case basis. Hazard level 3 species comprised a larger group capable of producing significant local effects only, often associated with a protracted bite (eg Heterodon nasicus, Borikenophis (Alsophis) portoricensis, Platyceps (Coluber) rhodorachis). Management is restricted to wound care. Bites by Hazard level 4 species comprised the majority of surveyed taxa and these showed only minor effects of no clinical importance. This study has produced a comprehensive evidence-based listing of NFFC snakes tabulated against medical significance of bites, together with best-practice management recommendations. This analysis assumes increasing importance, as there is growing exposure to lesser-known NFFC snakes, particularly in captive collections that may uncover further species of significance in the future. Careful and accurate documentation of bites by verified species of NFFC snakes is required to increase the evidence base and establish the best medical management approach for each species.
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Affiliation(s)
- Scott A Weinstein
- Department of Toxinology, Women's and Children's Hospital, 72 King William St., North Adelaide, South Australia, Australia.
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Ismail AK, Weinstein SA. Response to Letter entitled “Cardiac toxicity following cobra envenomation”. Clin Toxicol (Phila) 2012. [DOI: 10.3109/15563650.2012.723216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Weinstein SA, Stiles BG. Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium. Expert Rev Anti Infect Ther 2012; 10:487-99. [PMID: 22512757 DOI: 10.1586/eri.12.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mycoplasma genitalium is a globally important sexually transmitted pathogen. Men infected with M. genitalium frequently present with dysuria, while women may present with or without urogenital symptoms. In some populations, M. genitalium is significantly associated with HIV-1 infection, and is also an etiological agent in pelvic inflammatory disease. However, there is insufficient evidence to establish a causative role of the organism in obstetric complications, including tubal factor infertility. Although several nucleic acid amplification tests offer rapid, sensitive methods for detecting M. genitalium, there is no standardized assay. Available evidence supports treatment of M. genitalium infections with an extended regimen of azithromycin and resistant strains respond to moxifloxacin. Accumulating evidence indicates growing fluoroquinolone resistance, including against moxifloxacin, emphasizing the need for new therapeutic strategies to treat M. genitalium infections.
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Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Abstract
CONTEXT Envenoming by some species of cobras (Naja species) may include cardiotoxic effects including various dysrhythmias. However, dysrhythmias leading specifically to ventricular bigeminy have not been previously documented. We report a case of cardiotoxicity and the development of ventricular bigeminy following a cobra envenomation. CASE DETAILS The patient was a 23-year-old man who presented to an emergency department following an alleged cobra bite. There was transient episode of nausea, vomiting, hypotension and tachycardia. The ECG showed infrequent ventricular ectopics that progressed to ventricular bigeminy and persisted even after the vital signs normalized. Complete resolution and resumption of normal sinus rhythm occurred following an empirical administration of monovalent antivenom against Naja kaouthia venom. The patient was discharged after 24 hours of uneventful observation. DISCUSSION The patient's concomitant local effects, episodic cardiovascular instability and evolution of ventricular bigeminy support the likelihood of a venom-induced disease. Ventricular bigeminy can develop following a cobra envenomation. Thorough clinical evaluation, close serial observation of vital signs and early continuous cardiac monitoring are important in Naja spp. bites.
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Affiliation(s)
- Ahmad Khaldun Ismail
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
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Weinstein SA, Keyler DE, White J. Replies to Fry et al. (Toxicon 2012, 60/4, 434-448). Part A. Analyses of squamate reptile oral glands and their products: A call for caution in formal assignment of terminology designating biological function. Toxicon 2012; 60:954-63. [PMID: 22687284 DOI: 10.1016/j.toxicon.2012.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/17/2012] [Indexed: 11/19/2022]
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Weinstein SA, Stiles BG. A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium. Sex Health 2011; 8:143-58. [PMID: 21592428 DOI: 10.1071/sh10065] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 08/30/2010] [Indexed: 11/23/2022]
Abstract
Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.
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Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5003, Australia.
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Chu ER, Weinstein SA, White J, Warrell DA. Venom ophthalmia caused by venoms of spitting elapid and other snakes: Report of ten cases with review of epidemiology, clinical features, pathophysiology and management. Toxicon 2010; 56:259-72. [DOI: 10.1016/j.toxicon.2010.02.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 02/10/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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Bandara V, Weinstein SA, White J, Eddleston M. A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning. Toxicon 2010; 56:273-81. [DOI: 10.1016/j.toxicon.2010.03.026] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/02/2010] [Accepted: 03/21/2010] [Indexed: 11/28/2022]
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Ismail AK, Weinstein SA, Auliya M, Sabardin DM, Herbosa TJ, Saiboon IM, White J. A bite by the Twin-Barred Tree Snake, Chrysopelea pelias (Linnaeus, 1758). Clin Toxicol (Phila) 2010; 48:222-6. [PMID: 20345298 DOI: 10.3109/15563650903550964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species. CASE REPORT The patient was a 19-year-old female who arrived at the Emergency Department (ED) of an urban teaching hospital 6 h after being bitten by a snake that was later provisionally identified as a C. pelias. Noted on presentation were bite marks on the right middle toe with minimal inflammation and tenderness. There was slight numbness over the dorsum of the right foot and discomforting sensation radiating up the thigh that persisted for several days. There was mild pyrexia, but no evidence of any systemic effects. The full blood count did show neutrophil leucocytosis, and transient hemoglobinuria was noted in an initial urine analysis. DISCUSSION The properties of Duvernoy's secretion of C. pelias remain uncharacterized. In this case, the clinical course featured only the local effects noted above. However, the significant local pain reported by the patient suggests that bites by C. pelias are not necessarily trivial and do require full evaluation and observation in a medical facility. Discussed also is the importance of the establishment of a national registry for animal bites and stings in Malaysia. CONCLUSION Such a facility could expedite safe and appropriate management of envenomed patients.
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Affiliation(s)
- Ahmad Khaldun Ismail
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
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Weinstein SA, Keyler DE. Local envenoming by the Western hognose snake (Heterodon nasicus): A case report and review of medically significant Heterodon bites. Toxicon 2009; 54:354-60. [DOI: 10.1016/j.toxicon.2009.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 04/13/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
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Weinstein SA, Williams V, White J. Preliminary characteristics of the prothrombin converting enzyme from venom of Stephen's banded snake (Hoplocephalus stephensii). Toxicon 2001; 39:1937-9. [PMID: 11600158 DOI: 10.1016/s0041-0101(01)00168-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/23/2022]
Abstract
Stephen's banded snake (Hoplocephalus stephensii) is an infrequently encountered Australian elapid species. The crude venom contains coagulant activity and the component responsible is a prothrombin activator requiring factor V for activity. SDS-PAGE of the isolated native protein revealed two bands at 23 and 36 kDa. These findings indicate that the procoagulant is similar to that found in the Australian tiger snake (Notechis scutatus) and thus resembles factor Xa.
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Affiliation(s)
- S A Weinstein
- Flinders University School of Medicine, Bedford Park, Australia
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McArdle JJ, Lentz TL, Witzemann V, Schwarz H, Weinstein SA, Schmidt JJ. Waglerin-1 selectively blocks the epsilon form of the muscle nicotinic acetylcholine receptor. J Pharmacol Exp Ther 1999; 289:543-50. [PMID: 10087048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Neonatal mice resist the lethal effect of Waglerin-1. Because Waglerin-1 blocks the nicotinic acetylcholine receptor of mature end-plates, the appearance of lethality may result from the epsilon- for gamma-subunit substitution. In support of this hypothesis, adult knockout (KO) mice lacking the gene coding for the epsilon-subunit resist the lethal effect of Waglerin-1. In contrast, heterozygous litter mates respond to Waglerin-1 like adult wild-type mice. In vitro application of 1 microM Waglerin-1 inhibited spontaneous miniature end-plate potentials and evoked end-plate potentials of adult wild-type and heterozygous KO mice. Both miniature end-plate potentials and end-plate potentials of neonatal wild-type and adult homozygous KO mice resisted Waglerin-1. Waglerin-1 decreased the end-plate response of adult wild-type mice to iontophoretically applied acetylcholine (ACh) with an IC50 value of 50 nM; 1 microM Waglerin-1 decreased the ACh response to 4 +/- 1% of control for adult heterozygous KO mice. In contrast, 1 microM Waglerin-1 decreased the ACh response to 73 +/- 2% of control for wild-type mice less than 11 days old and had no effect on the ACh response of adult homozygous KO mice. Between 11 and 12 days after birth, the suppressant effect of Waglerin-1 on wild-type end-plate responses to ACh dramatically increased. Waglerin-1 reduced binding of alpha-bungarotoxin to end-plates of adult but not neonatal wild-type mice. These data demonstrate that Waglerin-1 selectively blocks the mouse muscle nicotinic acetylcholine receptor containing the epsilon-subunit.
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Affiliation(s)
- J J McArdle
- Department of Pharmacology and Physiology, New Jersey Medical School, Newark, USA
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Weinstein SA, Flaherty U, Soslow A. Teaming up for ergonomics? This facility shows you how. Health Facil Manage 1997; 10:58, 60, 62-4. [PMID: 10172988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Weinstein SA, Flaherty U, Soslow A. How to organize and implement health care ergonomics teams. Healthc Facil Manag Ser 1996:1-18. [PMID: 10172694] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Using a systems approach to safety and health management through a comprehensive ergonomic program addresses workplace processes, operations and conditions as interdependent systems in order to identify and eliminate or reduce all types of ergonomic hazards to employees. This document examines the way one health care facility improved its ergonomic program using this approach, from early data collection to implementation of the new plan. By creating several teams with different areas of concern, they set out to reduce ergonomic-related injuries in their facility by 10 percent.
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Abstract
Waglerins are 22-24 residue lethal peptides, found in the venom of Trimeresurus (Tropidolaemus) wagleri. The effects upon lethality and immunoreactivity resulting from structural modifications of these peptides were studied. A synthetic analogue with alanine residues in place of the two half-cystines of native peptide was nontoxic, suggesting that the single intramolecular disulfide bond in waglerins is critical for bioactivity. Substituting glutamic acid for aspartic acid at residue 5 slightly diminished lethality. Analogues containing asparagine instead of aspartic acid at residue 5 and/or a carboxamide- instead of a carboxy-terminus were lethal, demonstrating that neither a negative charge on residue 5 nor on the carboxy-terminus was required for bioactivity. A proteolytic fragment of waglerin I containing residues 6-22 was isolated and proved nontoxic. Therefore, one or more of the first five residues were necessary for bioactivity. Antiserum against waglerin I bound strongly to waglerins I, II, and SL-I, and to various analogues, proteolytic fragments, and chemically modified waglerin I. These findings suggest that the antibodies might be directed mainly against short, linear epitopes, implying an extended conformation for waglerin I.
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Affiliation(s)
- J J Schmidt
- Toxinology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702-5011, USA
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Abstract
Relatively little attention has been given to the biological properties of Duvernoy's secretions produced by opisthoglyphous and some aglyphous colubrid snakes. A review is presented of literature pertaining to these secretions. Most detailed analyses of Duvernoy's secretions and their biological properties have been performed since the late 1970s. The dispholidines, Dispholidus typus and Thelotornis sp., and the natricines, Rhabdophis tigrinus and R. subminiata, have received the most attention due to the high toxicity of their secretions and their medical importance. These species produce secretions with variably strong prothrombin-activating activity, defibrinating activity, and hemorrhagic potential. Boigines, and natricines other than Rhabdophis, produce secretions of low to moderate toxicity and are variably hemorrhagic and proteolytic. Xenodontines and homalopsines similarly show hemorrhagic potential with low to moderate toxicity. Neurotoxic activity has been reported only from secretions of the boigines, Boiga blandingi and B. irregularis and the xenodontine, Heterodon platyrhinos. These species produce secretions containing postsynaptically acting components. Analyses of some of these secretions have shown that enzymes common to many ophidian venoms such as phospholipases A and L-amino acid oxidase are uncommon in the colubrid secretions studied. This may be due to few studies assaying for multiple enzyme activities and/or the unavailability of many secretion samples for study. Methods of secretion extraction, storage, and assay are discussed. Projected future research and the adaptive implications of Duvernoy's secretions are considered.
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Affiliation(s)
- S A Weinstein
- Department of Zoology, Washington State University, Pullman 99164-4236
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