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Aoki Y, Arrieta R, Aquino GJB, Smith C, Agosto LC. Very mild bilateral ptosis following snakebite. Acute Med Surg 2024; 11:e935. [PMID: 38476450 PMCID: PMC10928236 DOI: 10.1002/ams2.935] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Yoshihiro Aoki
- Coordination Office for Emergency Medicine and International Response, Acute and Critical Care CenterNagasaki University HospitalNagasakiJapan
- School of Tropical Medicine and Global HealthNagasaki UniversityNagasakiJapan
| | - Rustan Arrieta
- Department of Emergency MedicineEastern Visayas Medical CenterTaclobanPhilippines
| | | | - Chris Smith
- School of Tropical Medicine and Global HealthNagasaki UniversityNagasakiJapan
- Department of Clinical ResearchLondon School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical DiseasesLondonUK
| | - Lourdes C. Agosto
- Poison Control CenterEastern Visayas Medical CenterTaclobanPhilippines
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Paghubasan J, Aoki Y, Tiglao PJG, Sarmiento MJ, Tan MA, Sarsalijo MS, Aquino GJB, Comandante JDL, Santamaria EB, Takahashi K, Smith C, Ariyoshi K, Agosto LC, Warrell DA. A case series of samar cobra, Naja samarensis Peters, 1861 (Elapidae) envenomation. Toxicon 2023; 223:107008. [PMID: 36563861 DOI: 10.1016/j.toxicon.2022.107008] [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: 11/22/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
The Samar cobra, Naja samarensis Peters, 1861 is one of the World Health Organization's category I venomous snakes in the Philippines. Although N. samarensis is known to inhabit Eastern Visayas, unlike N. philippinensis in Luzon, no clinical case reports have yet been published in the international literature. No immuno-diagnostic assays have been developed for venomous snakes in the Philippines, even for research purposes. Therefore, identification of the causative snake in hospitals is challenging. In vivo pre-clinical tests using mice showed that locally-produced antivenom raised against N. philippinensis venom ["Purified Cobra Antivenom (PCAV)"] cross-neutralised N. samarensis venom. Here, we present five snakebite envenomation cases where causative snakes were confirmed in photos as N. samarensis by an expert local herpetologist. Patients' symptoms and signs varied, from mild to extensive local cytotoxic to systemic neurotoxic envenomation. In one case, venom had been spat into the eye. Out of five patients, two underwent surgical debridement of necrotic tissue at the bite site. One paediatric patient was intubated because of cardiopulmonary arrest. Except for the spitting cobra case, four cases were successfully treated with PCAV and supportive management. These are the first clinical case reports of confirmed N. samarensis envenomation.
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Affiliation(s)
- Jonathan Paghubasan
- Department of Emergency Medicine, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Yoshihiro Aoki
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Coordination Office for Emergency Medicine and International Response, Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan.
| | - Patrick Joseph G Tiglao
- Department of Emergency Medicine, Eastern Visayas Medical Center, Tacloban, Philippines; Department of Emergency Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines; Philippine Toxinology Society, Inc, Philippines
| | - Marvin Jay Sarmiento
- Philippine Toxinology Society, Inc, Philippines; Crocodylus Porosus Philippines Inc., Microbiological Laboratory Inc. Evangelista, Makati City, Philippines; University of the Philippines Los Banos, Los Banos, Philippines
| | - Mariedel A Tan
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Mardie S Sarsalijo
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Grace Joy B Aquino
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | - John David L Comandante
- Philippine Toxinology Society, Inc, Philippines; National Poison Management and Control Center, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Emelia B Santamaria
- Department of Emergency Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines; Philippine Toxinology Society, Inc, Philippines
| | - Kensuke Takahashi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Coordination Office for Emergency Medicine and International Response, Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Clinical Research, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lourdes C Agosto
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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