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Kumar R, Rathore AS. Snakebite Management: The Need of Reassessment, International Relations, and Effective Economic Measures to Reduce the Considerable SBE Burden. J Epidemiol Glob Health 2024:10.1007/s44197-024-00247-z. [PMID: 38856820 DOI: 10.1007/s44197-024-00247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024] Open
Abstract
The sole treatment for snakebite envenomation (SBE), the anti-snake venom (ASV), suffers from considerable drawbacks, including side effects and limited species specificity. Additionally, despite its existence for more than a century, uniform availability of good quality ASV does not yet exist. The present review describes the journey of a SBE victim and highlights the global crisis of SBE management. A detailed analysis of the current ASV market has also been presented along with the worldwide snake distribution. The current production of country specific licensed ASV throughout the globe along with their manufacturers has been examined at the snake species level. Furthermore, a detailed analysis of on-ground situation of SBE management in antivenom manufacturing countries has been done using the most recent literature. Additionally, the export and import of different ASVs have been discussed in terms of procurement policies of individual countries, their shortcomings, along with the possible solution at the species level. It is interesting to note that in most countries, the existence of ASV is really either neglected or overstated, implying that it is there but unsuitable for use, or that it is not present but can be obtained from other countries. This highlights the urgent need of significant reassessment and international collaborations not just for development and production, but also for procurement, distribution, availability, and awareness. A PROMISE (Practical ROutes for Managing Indigenous Snakebite Envenoming) approach has also been introduced, offering simple, economical, and easy to adopt steps to efficiently alleviate the worldwide SBE burden.
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Affiliation(s)
- Ramesh Kumar
- Department of Chemical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
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Razavi SA, Stewart CM, Nogee DP, Geller RJ, Seiler JG. Upper Extremity Crotalid Envenomation: A Review of Incidence and Recent Trends in Management of Snakebites. J Hand Surg Am 2023; 48:1277.e1-1277.e6. [PMID: 35725686 DOI: 10.1016/j.jhsa.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/06/2022] [Accepted: 04/21/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to evaluate the recent trends in the management of upper extremity Crotalid envenomation in the state of Georgia, United States. METHODS A retrospective review of the Georgia Poison Center database looking at the reported snakebites to the upper extremity between 2015 and 2020 was performed. Patient demographics, timing and location of injury, severity of envenomation, treatment, including use of antivenin and surgical intervention, and reported complications related to the use of antivenin was extracted. RESULTS A retrospective review of snakebites between 2015 and 2020 showed 2408 snakebite cases with a mean patient age of 37.4 years. Males incurred 62.8% of all bites. The highest incidence was in summer 52.5%, and between the hours of 5 PM to midnight 57.2%. Overall, 1010 (41.9%) of all bites were categorized as venomous snakebites (55.6% copperhead, 20% rattlesnake, 2.4% cottonmouth, and 22% miscellaneous [including 3 Elapid envenomations] or unidentified. The total number of venomous bites to the upper extremity was 575 (56.9%) and 567 patients received antivenin. Envenomation severity was mild in 29%, moderate in 45%, severe in 10%, and undetermined in 16% of cases. Crotalidae polyvalent immune Fab (Ovine) was the main antivenin used, with overall mean initial therapy dose of 6.2 vials and 59% of patients receiving maintenance therapy. Three patients (0.5%) had a severe anaphylactic reaction to antivenin requiring cessation of therapy. Seven patients had acute compartment syndrome of the upper extremity requiring fasciotomy (3 copperhead, 2 rattlesnake, and 2 unidentified). There was no reported mortality during this period. CONCLUSIONS Hand surgeons should be familiar with the management of upper extremity Crotalid envenomation. Antivenin remains the main treatment for symptomatic patients. Crotalid snakebites rarely require operative intervention. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- S Amir Razavi
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Christopher M Stewart
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
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Hack JB, Brewer KL, Meggs WJ. Comparing cost of F(.ab') 2AV vs FabAV in the treatment of copperhead envenomation-One center's experience. Am J Emerg Med 2023; 73:17-19. [PMID: 37573662 DOI: 10.1016/j.ajem.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023] Open
Abstract
The definitive treatment of North American crotalid snakebites is antivenin. In 2000, an FabAV antivenom (CroFab®) was introduced and in 2022, F(ab')2AV (Anavip®) was approved for treatment of copperhead bites. Our center that sees primarily copperhead snake bites added the recently approved treatment as a second option for the 2022 snake bite season. This brief report we describe our initial experience with the two antivenins via retrospective chart review: the cost, charge, laboratory differences, response to therapy, complications and duration of hospitalization of admitted patients with copperhead envenomation. Using three independent reviewers in this IRB exempt report we found 31 patients with copperhead bites (7 exclusions) leaving 19 adults and 7 children for analysis. We found there was no difference in age, sex, presence of lab abnormalities, total vials administered, or length of stay. There was significant differences in hospital costs and charges to the patient. Future research should include multi-center experiences comparing the two antivenins.
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Affiliation(s)
- Jason B Hack
- Division of Medical Toxicology, United States of America; Department of Emergency Medicine, East Carolina University, Greenville, NC 27858, United States of America.
| | - Kori L Brewer
- Department of Emergency Medicine, East Carolina University, Greenville, NC 27858, United States of America
| | - William J Meggs
- Department of Emergency Medicine, East Carolina University, Greenville, NC 27858, United States of America
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Trautman WJ, Ahmed F, Barton DJ, Abesamis MG, Lynch MJ. Safe administration of Crotalidae equine immune F(ab')2 antivenom in a patient who suffered anaphylaxis from Crotalidae polyvalent immune Fab antivenom. Am J Emerg Med 2023; 72:221.e1-221.e3. [PMID: 37648591 DOI: 10.1016/j.ajem.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Allergic reactions to Crotalidae polyvalent immune Fab and Crotalidae immune F(ab')2 are uncommon but potentially life-threatening. It is unknown whether cross-reactivity reactions exist between these two antivenoms. We report a case of a patient who suffered anaphylaxis from Crotalidae polyvalent immune Fab but subsequently was safely administered Crotalidae immune F(ab')2 after a presumed Agkistrodon contortix (copperhead) envenomation. This single case supports the safety of Crotalidae immune F(ab')2 administration in patients with a history of anaphylaxis to Crotalidae polyvalent immune Fab treatment.
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Affiliation(s)
- William J Trautman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Faiz Ahmed
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - David J Barton
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Michael G Abesamis
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Michael J Lynch
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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Rondon A, Rouanet J, Degoul F. Radioimmunotherapy in Oncology: Overview of the Last Decade Clinical Trials. Cancers (Basel) 2021; 13:cancers13215570. [PMID: 34771732 PMCID: PMC8583425 DOI: 10.3390/cancers13215570] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Monoclonal antibody-bearing radionuclides have been under clinical investigation over the last two decades for their use in theranostic (diagnostic and therapeutic) applications in cancer. However, despite the numerous trials that have been conducted, only two radioimmunotherapies (RIT) have been approved by the FDA for the targeted therapy of hematologic tumors expressing CD20 antigens. Moreover, RIT applications for solid cancers faced major issues—such as radiotoxicity due to low antibodies penetrance requiring substantial curative dose—where new discoveries concerning antibody engineering or radionuclides are trying to overcome. Here, we performed an overview of the last 11-year clinical trials involving RIT for solid and non-solid cancers conducted either with full antibodies or antibody fragments. We discussed the low-to-moderate efficiency of RIT compared to conventional therapies and described the last advances in clinic for antibodies carriers (F(ab′)2, Fab′, ScFv). Finally, we discussed about the complexity of RIT as a therapy and depicted both the issues and the prospects of such a strategy. Abstract The specific irradiation of tumors with selective radiolabeled antibodies constitutes an attractive therapeutic approach. Consequent preclinical research has been conducted by both biologists to identify pertinent targets and to select corresponding antibodies (mAb) and by radiochemists to radiolabel mAbs. These numerous preclinical investigations have ascertained the therapeutic interest of radioimmunotherapy (RIT) protocols in mice models. Here, we summarize the clinical studies that have been performed the last decade, including clinical trials (phases I, II, and III), prospective and retrospective studies, and cases series. We thereby reported 92 clinical studies. Among them, 62 concern the treatment of hematological malignancies, and 30 concern solid tumors. For hematologic diseases, the analysis was complex due to the high discrepancy of therapeutic strategies (first-line therapy, consolidation, stem cell transplantation conditioning) as well as the high variety of malignancies that were treated. The clinical studies from the last decade failed to expand anti-CD20 RIT indications but confirmed that RIT using radiolabeled anti-CD20 remains a pertinent choice for patients with relapse follicular lymphomas. For solid tumors, the positive benefit of RIT is more mitigated, apart for few malignancies that can be treated locally. Clinical trials also demonstrated the potential of some antibody formats, such as F(ab′)2, which has already been approved by the China State FDA under the trend name Licartin®. Despite disparate results, mAb fragments are an interesting prospect for the improvement of RIT efficiency as well as for pretargeted strategies that delay the injection of radioactive treatments from the mAb ones.
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Affiliation(s)
- Aurélie Rondon
- Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, BE-1200 Brussels, Belgium
- Correspondence: (A.R.); (F.D.)
| | - Jacques Rouanet
- Imagerie Moléculaire et Stratégies Théranostiques, Inserm UMR1240, Université Clermont-Auvergne, F-63000 Clermont-Ferrand, France;
- Service de Dermatologie et d’Oncologie Cutanée, CHU Estaing, F-63011 Clermont-Ferrand, France
| | - Françoise Degoul
- CNRS 6293, INSERM U1103, GReD, Centre de Recherche et de Biologie Clinique, Université Clermont-Auvergne, F-63000 Clermont-Ferrand, France
- Correspondence: (A.R.); (F.D.)
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Durso AM, Ruiz de Castañeda R, Montalcini C, Mondardini MR, Fernandez-Marques JL, Grey F, Müller MM, Uetz P, Marshall BM, Gray RJ, Smith CE, Becker D, Pingleton M, Louies J, Abegg AD, Akuboy J, Alcoba G, Daltry JC, Entiauspe-Neto OM, Freed P, de Freitas MA, Glaudas X, Huang S, Huang T, Kalki Y, Kojima Y, Laudisoit A, Limbu KP, Martínez-Fonseca JG, Mebert K, Rödel MO, Ruane S, Ruedi M, Schmitz A, Tatum SA, Tillack F, Visvanathan A, Wüster W, Bolon I. Citizen science and online data: Opportunities and challenges for snake ecology and action against snakebite. Toxicon X 2021; 9-10:100071. [PMID: 34278294 PMCID: PMC8264216 DOI: 10.1016/j.toxcx.2021.100071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
The secretive behavior and life history of snakes makes studying their biology, distribution, and the epidemiology of venomous snakebite challenging. One of the most useful, most versatile, and easiest to collect types of biological data are photographs, particularly those that are connected with geographic location and date-time metadata. Photos verify occurrence records, provide data on phenotypes and ecology, and are often used to illustrate new species descriptions, field guides and identification keys, as well as in training humans and computer vision algorithms to identify snakes. We scoured eleven online and two offline sources of snake photos in an attempt to collect as many photos of as many snake species as possible, and attempt to explain some of the inter-species variation in photograph quantity among global regions and taxonomic groups, and with regard to medical importance, human population density, and range size. We collected a total of 725,565 photos-between 1 and 48,696 photos of 3098 of the world's 3879 snake species (79.9%), leaving 781 "most wanted" species with no photos (20.1% of all currently-described species as of the December 2020 release of The Reptile Database). We provide a list of most wanted species sortable by family, continent, authority, and medical importance, and encourage snake photographers worldwide to submit photos and associated metadata, particularly of "missing" species, to the most permanent and useful online archives: The Reptile Database, iNaturalist, and HerpMapper.
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Affiliation(s)
- Andrew M. Durso
- Department of Biological Sciences, Florida Gulf Coast University, Ft. Myers, FL, USA
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- World Health Organization, Geneva, Switzerland
| | | | - M. Rosa Mondardini
- Citizen Science Center Zürich (ETH Zürich and University of Zürich), Zürich, Switzerland
| | | | | | | | - Peter Uetz
- The Reptile Database, Richmond, VA, USA
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | | | | | | | | | - Arthur D. Abegg
- Instituto Butantan, São Paulo, São Paulo, Brazil
- University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jeannot Akuboy
- University of Kisangani, Kisangani, Democratic Republic of the Congo
| | | | - Jennifer C. Daltry
- Flora & Fauna International, Cambridge, England, UK
- Global Wildlife Conservation, Austin, TX, USA
| | | | - Paul Freed
- The Reptile Database, Richmond, VA, USA
- Reptile Database, Scotts Mills, OR, USA
| | | | - Xavier Glaudas
- University of the Witwatersrand, Johannesburg, South Africa
- Bangor University, Bangor, Wales, UK
| | - Song Huang
- Anhui Normal University, Wuhu, Anhui, China
| | | | - Yatin Kalki
- Madras Crocodile Bank Trust, Mahabalipuram, Tamil Nadu, India
| | | | | | | | | | - Konrad Mebert
- Global Biology, Birr, Switzerland
- Institute of Development, Ecology, Conservation & Cooperation, Rome, Italy
| | - Mark-Oliver Rödel
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany
| | | | - Manuel Ruedi
- Museum d'Histoire naturelle Geneve, Geneva, Switzerland
| | | | | | - Frank Tillack
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany
| | | | - Wolfgang Wüster
- Molecular Ecology and Fisheries Genetics Laboratory, School of Natural Sciences, Bangor University, Bangor, Wales, UK
| | - Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Durso AM, Moorthy GK, Mohanty SP, Bolon I, Salathé M, Ruiz de Castañeda R. Supervised Learning Computer Vision Benchmark for Snake Species Identification From Photographs: Implications for Herpetology and Global Health. Front Artif Intell 2021; 4:582110. [PMID: 33959704 PMCID: PMC8093445 DOI: 10.3389/frai.2021.582110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022] Open
Abstract
We trained a computer vision algorithm to identify 45 species of snakes from photos and compared its performance to that of humans. Both human and algorithm performance is substantially better than randomly guessing (null probability of guessing correctly given 45 classes = 2.2%). Some species (e.g., Boa constrictor) are routinely identified with ease by both algorithm and humans, whereas other groups of species (e.g., uniform green snakes, blotched brown snakes) are routinely confused. A species complex with largely molecular species delimitation (North American ratsnakes) was the most challenging for computer vision. Humans had an edge at identifying images of poor quality or with visual artifacts. With future improvement, computer vision could play a larger role in snakebite epidemiology, particularly when combined with information about geographic location and input from human experts.
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Affiliation(s)
- Andrew M Durso
- Department of Biological Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Isabelle Bolon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marcel Salathé
- AICrowd, Lausanne, Switzerland.,Digital Epidemiology Laboratory, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
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Martin AM, Wang GS, Poel K. Use of both Fab and F(ab') 2 fragment antivenom in a pediatric patient for treatment of a North American Crotalidae envenomation. Am J Emerg Med 2020; 45:677.e1-677.e3. [PMID: 33293188 DOI: 10.1016/j.ajem.2020.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
Crotalidae envenomation has been managed successfully in emergency departments across the world with antivenom. Over the years, antivenom has evolved and newer agents have been studied with the possibility of eliminating maintenance antivenom therapy. Here we report a patient who had worsening platelet and fibrinogen concentrations, as well as complaints of swelling and pain at the site of a rattlesnake envenomation following an initial dose of F(ab')2AV (Crotalidae immune F(ab')2 (equine) [ANAVIP®]) Crotalidae antivenom. The patient was subsequently transferred to a tertiary children's hospital for a higher level of care and received FabAV (Crotalidae polyvalent immune Fab (ovine) [CroFab®]) Crotalidae antivenom. The details of this patient's treatment course highlight the possibility that patients who receive F(ab')2AV, may require additional antivenom treatment. Furthermore, it appears that based on our single patient experience, giving FabAV after F(ab')2AV is safe and effective.
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Affiliation(s)
- Ashley M Martin
- Department of Pharmacy, Children's Hospital Colorado, 13123 East 16th Avenue, Box 375, Aurora, CO 80045, United States.
| | - George S Wang
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 065, Aurora, CO 80045, United States
| | - Kevin Poel
- Department of Pharmacy, Children's Hospital Colorado, 13123 East 16th Avenue, Box 375, Aurora, CO 80045, United States
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