Australian Sea Snake Envenoming Causes Myotoxicity and Non-Specific Systemic Symptoms - Australian Snakebite Project (ASP-24)

Evaluating the global sea snake diversity and distribution under climate change scenario

Anthropogenically accelerated climate change has wreaked havoc on marine ecosystems, particularly affecting marine reptiles such as sea snakes. These reptiles are highly sensitive to climate change induced coral reef degradation and environmental fluctuations, leading to habitat expansion and increased human-sea snake interactions. Despite this, till date no comprehensive investigation of global sea snake diversity and distribution has been conducted. In this study, we used MaxEnt Species Distribution Modelling (SDM) to assess effects of climate change on sea snake distribution from 1993 to 2024. This analysis integrates occurrence data sourced from exhaustive literature reviews and biogeographic databases with environmental predictors like seawater temperature, salinity, and chlorophyll a concentration. The study identifies 74 species across 11 genera and 3 families. Among 14 biogeographic habitats examined, the South Pacific and Indian Oceans exhibit highest species richness, while the Atlantic Ocean shows the lowest. Notably, species in the Bay of Bengal and Arafura Sea demonstrate significant taxonomic distinctness. Furthermore, our findings reveal a substantial expansion of sea snake habitats from equatorial to temperate regions, primarily driven by increase in seawater temperature. Optimal habitat suitability is associated with temperatures of approximately 30 °C, chlorophyll a concentration of around 0.3 mg m-3, and salinity levels between 35 and 40 g L-1. These insights into sea snake diversity and distributional shifts induced by global climate change are critical for formulating evidence-based management strategies, including implementation of sustainable fishing practices, preservation of critical habitats, and establishment of rigorous bycatch mitigation protocols to ensure conservation of these ecologically significant marine reptiles.

A systematic review of reports on aquatic envenomation: are there global hot spots and vulnerable populations?

Envenomation by aquatic species is an under-investigated source of human morbidity and mortality. Increasing population density along marine and freshwater coastlines increases these incidents. Specific occupational groups - including commercial fishery workers, fisherfolk, marine tourism workers, and researchers - rely on aquatic resources for their livelihood. While diverse venomous aquatic species exhibit a broad array of habitats worldwide, they are most abundant in the tropics. Specific tropical regions present historic "hot spot" areas of concern for occupational groups with heightened risk of aquatic envenomation. Towards the overall objective of characterizing the health burden of aquatic envenomations, this review seeks to define (1) vulnerable, high-risk populations and (2) geographic hot-spot regions. To formally assess these metrics, a systematic literature review was performed where inclusion criteria requirements were peer-reviewed, published, epidemiological studies with defined denominators from January 1, 2000, to July 31, 2024, on the topic of human envenomation by aquatic species. Fifty-three articles met the inclusion criteria. Excluded articles were comprised of case reports, news and magazine articles, and those in languages aside from English, French, Portuguese, and Spanish. Most of the included articles examined emergency department and poison-control datasets that reported few overall envenomations (< 1%) from populations with physical and financial access to medical care. In contrast, datasets surveying beachgoers or fisherfolk directly, and life-guard incident reports, demonstrated that aquatic envenomation is an important source of injury for these groups and settings (envenomation frequency mean: 71%, median: 80%). Reports on additional high-risk groups, including marine and aquatic biologists, military personnel etc., and in key high-risk geographic regions including Thailand, Indonesia, and other Indo-Pacific countries were missing from the reviewed literature. Socio-demographic data were also largely missing from the literature. This systematic review highlights critical gaps where further research is needed, especially in under-represented regions and vulnerable populations.

Utility of Three Serum Biomarkers for Early Detection of Systemic Envenoming Following Viper Bites in Sri Lanka

STUDY OBJECTIVE

Early detection of systemic envenoming is critical for early antivenom therapy to minimize morbidity and mortality from snakebite. We assessed the diagnostic utility of 3 serum biomarkers in the early detection of systemic envenoming in viper bites in rural Sri Lanka.

METHODS

All confirmed snakebite patients admitted to Teaching Hospital Anuradhapura from July 2020 to June 2021 were included. On admission, blood was collected for venom concentrations, prothrombin time/international normalized ratio, fibrinogen concentration, serum creatinine concentration, and 3 serum biomarkers, namely secretory phospholipase A2 (sPLA2) activity, neutrophil gelatinase-associated lipocalin (sNGAL) concentration, and clusterin (sClu) concentration. Systemic envenoming was defined by the presence of venom-induced consumption coagulopathy, neurotoxicity, acute kidney injury, or the presence of nonspecific clinical effects.

RESULTS

A total of 237 confirmed snakebite patients (Russell's viper, 72; hump-nosed viper, 80; nonvenomous snakes, 31; and unidentified bites, 54) with sufficient preantivenom serum samples were recruited [median age: 42 years (interquartile range [IQR] 29 to 53 years); 173 men (73%)]. Systemic envenoming occurred in 68 (94%) Russell's viper bites, 48 (60%) hump-nosed viper bites, and 45 (83%) unidentified bites. The median sPLA2 activity was 72 nmol/mL/min (IQR 30 to 164) for Russell's viper envenoming, 12 nmol/mL/min (IQR 9 to 16) for hump-nosed viper envenoming, and 11 nmol/mL/min (IQR 9 to 14) for nonvenomous bites. There was no difference in sNGAL and sCLu concentrations among the 3 groups. The median sPLA2 activity of patients with systemic envenoming was 16 nmol/min/mL (IQR 11 to 59) compared to 11 nmol/min/mL (IQR 9 to 14) in patients without systemic envenoming; the difference between medians was 5 nmol/min/mL (95% confidence interval [CI] 4 to 12). The area under the receiver operator characteristic curve (AUC-ROC) of admission sPLA2 activity was the best predictor of systemic envenoming in all snakebites (AUC-ROC 0.72, 95% CI 0.66 to 0.79), whereas sNGAL and sClu concentrations were poor predictors. sPLA2 activity was a better predictor of systemic envenoming in Russell's viper bites (AUC-ROC 0.90, 95% CI 0.76 to 1.00) and in those presenting within 2 hours of a bite. A sPLA2 activity more than 23.5 nmol/min/mL had a sensitivity of 41% (95% CI 34% to 49%), and a specificity of 97% (95% CI 91% to 99.5%) in predicting systemic envenoming. A sPLA2 activity of more than 46 nmol/min/mL on admission had a sensitivity of 67% (95% CI 55% to 77%) and a specificity of 100% (95% CI 51% to 100%) in predicting systemic envenoming in Russell's viper bites.

CONCLUSIONS

sPLA2 activity is an early predictor of systemic envenoming following snakebite, particularly in Russell's viper bites and in those who present early.

Snakebite Management: The Need of Reassessment, International Relations, and Effective Economic Measures to Reduce the Considerable SBE Burden

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.

Alterations of the skeletal muscle contractile apparatus in necrosis induced by myotoxic snake venom phospholipases A2: a mini-review

Skeletal muscle necrosis is a common clinical manifestation of snakebite envenoming. The predominant myotoxic components in snake venoms are catalytically-active phospholipases A2 (PLA2) and PLA2 homologs devoid of enzymatic activity, which have been used as models to investigate various aspects of muscle degeneration. This review addresses the changes in the contractile apparatus of skeletal muscle induced by these toxins. Myotoxic components initially disrupt the integrity of sarcolemma, generating a calcium influx that causes various degenerative events, including hypercontraction of myofilaments. There is removal of specific sarcomeric proteins, owing to the hydrolytic action of muscle calpains and proteinases from invading inflammatory cells, causing an initial redistribution followed by widespread degradation of myofibrillar material. Experiments using skinned cardiomyocytes and skeletal muscle fibers show that these myotoxins do not directly affect the contractile apparatus, implying that hypercontraction is due to cytosolic calcium increase secondary to sarcolemmal damage. Such drastic hypercontraction may contribute to muscle damage by generating mechanical stress and further sarcolemmal damage.

A Bite by Shaw's Short Sea Snake (Hydrophis curtus): A Case of Mild Myotoxicity or a Dry Bite?

Although sea snakes (Elapidae) are commonly encountered by fishermen, accurately authenticated envenomings by them are uncommon in clinical literature. We report an authenticated case of Shaw's short, or spine-bellied, sea snake (Hydrophis curtus) bite in a young fisherman from northern Sri Lanka. The patient had clinical and biochemical evidence of mild transient myotoxicity but no evidence of neuromuscular paralysis or significant renal injury. Consideration of the clinical manifestations suggests either a mild envenoming or a dry bite. The patient completely recovered without any antivenom therapy and was discharged on the fourth day. Prolonged observation may be beneficial to exclude complications of sea snake envenoming.

Marine biological injuries and their medical management: A narrative review

The marine environment can be extremely dangerous, and the harm caused by marine organisms when they contact the human body can be especially harmful, even deadly. Contact includes stings, bites, wounds, and consumption as food. In this article, the characteristics of the common marine biological injuries are summarized, the major marine organisms causing damage in China's marine waters are described, and injury prevention and treatment methods are discussed.