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Passos JGR, Gomes JAS, Xavier-Santos JB, Yamashita FO, Cavalcanti-Cruz JV, Siqueira EMS, Garcia VB, Zucolotto SM, de Araujo-Junior RF, Ferreira LS, Silva-Junior AA, Félix-Silva J, Fernandes-Pedrosa MF. Anti-inflammatory, healing and antiophidic potential of Jatropha mollissima (Pohl) Baill. (Euphorbiaceae): From popular use to pharmaceutical formulation in gel. Biomed Pharmacother 2024; 173:116290. [PMID: 38458010 DOI: 10.1016/j.biopha.2024.116290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/05/2024] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
Jatropha mollissima (Pohl) Baill. (Euphorbiaceae) is widely used in traditional medicine to treat inflammatory disorders. So, a topical gel containing the hydroethanolic extract of its leaves was developed and evaluated for its anti-inflammatory, wound healing, and antiophidic properties in mice. First, the chemical profile of different parts of the plant was characterized by liquid chromatography coupled to mass spectrometry (LC-MS) using molecular networking. In the leaf extract, 11 compounds were characterized, with a particular emphasis on the identification of flavonoids. The gel efficiently inhibited carrageenan-induced paw edema, as well as acute and chronic croton oil-induced ear edema models, thereby reducing inflammatory and oxidative parameters in inflamed tissues. Besides anti-inflammatory activity, the herbal gel showed significant wound healing activity. The edematogenic, hemorrhagic and dermonecrotic activities induced by Bothrops jararaca snake venom were effectively inhibited by the treatment with J. mollissima gel. The association with the herbal gel improved in up to 90% the efficacy of commercial snake antivenom in reduce venom-induced edema. Additionally, while antivenom was not able to inhibit venom-induced dermonecrosis, treatment with herbal gel reduced in 55% the dermonocrotic halo produced. These results demonstrate the pharmacological potential of the herbal gel containing J. mollissima extract, which could be a strong candidate for the development of herbal products that can be used to complement the current antivenom therapy against snake venom local toxicity.
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Affiliation(s)
- Júlia G R Passos
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Jacyra A S Gomes
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Jacinthia B Xavier-Santos
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Fabiana O Yamashita
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Joelly V Cavalcanti-Cruz
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Emerson M S Siqueira
- Laboratory of Pharmacognosy (PNBio), Department of Pharmacy, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Vinícius Barreto Garcia
- Cancer and Inflammatory Research Laboratory, Department of Morphology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal 59078-970, Brazil.
| | - Silvana M Zucolotto
- Laboratory of Pharmacognosy (PNBio), Department of Pharmacy, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Raimundo Fernandes de Araujo-Junior
- Cancer and Inflammatory Research Laboratory, Department of Morphology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal 59078-970, Brazil.
| | - Leandro S Ferreira
- Laboratory of Quality Control, Department of Pharmacy, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Arnóbio A Silva-Junior
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Juliana Félix-Silva
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil; Laboratory of Clinical Haematology, Faculty of Pharmacy, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil.
| | - Matheus F Fernandes-Pedrosa
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
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Erazo-Martínez V, Posso-Osorio I, Ruiz-Ordoñez I, Castro-Herrera F, Castaño-Valencia S, Delgado-Mora T, Cañas CA. Viperidae snake envenomation from a highly complex hospital in southwestern Colombia. Heliyon 2024; 10:e26768. [PMID: 38434332 PMCID: PMC10907710 DOI: 10.1016/j.heliyon.2024.e26768] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/14/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Background Snake envenomation is a medical condition with high morbidity and mortality in southwestern Colombia. Objectives To describe the characteristics of the envenomation caused by Viperidae snakes view in a highly complex hospital in Southwestern Colombia. Methods A cross-sectional study was carried out. Patients treated for Viperidae snake envenomation from 2001 to 2020 in a Hospital Fundación Valle del Lili, Cali, Colombia, were studied. Results Twenty-eight patients were included. Envenomation was caused by the genera Bothrops, Bothriechis, Porthidium, and Bothrocophias. The median age was 37.7 (±20.6), and they were predominantly male (19, 68%). Bites occurred on the upper extremities in 16 (57%) patients. Pain (23, 81%) and edema (22, 78%) were the most common clinical symptoms. Thirteen (46%) patients presented coagulopathy. Prolonged prothrombin and activated partial thromboplastin times were common: (22, 78% and 15, 53%, respectively). Twenty (71%) patients were treated with polyvalent antivenom (median dose of 6 (2-15) vials). The median time between the accident and antivenom administration was 9 h (5.5-17). Door-to-needle time was 37.5 (0-62) min. Eighteen (64%) patients were admitted to the intensive care unit. Three (11%) patients had serum sickness. Seven (25%) developed infectious complications, four (14%) had surgery, one (3%) had compartment syndrome, one (3%) underwent amputation of the affected limb, and one (3%) patient died. Conclusions Local manifestations and coagulopathy were common clinical features. Polyvalent antivenom was an effective treatment for disease control. Significant complications were associated with delays in seeking medical care.
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Affiliation(s)
| | | | - Ingrid Ruiz-Ordoñez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
| | - Fernando Castro-Herrera
- Universidad del Valle, Department of Physiological Science, Faculty of Health Sciences, Cali, Colombia
| | - Santiago Castaño-Valencia
- Universidad del Valle, Department of Physiological Science, Faculty of Health Sciences, Cali, Colombia
| | | | - Carlos A. Cañas
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cali, Colombia
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Seabra de Farias A, Saturnino Cristino J, Murta F, Sachett J, Monteiro W. Snakebites from the standpoint of an indigenous anthropologist from the Brazilian Amazon. Toxicon 2023; 234:107289. [PMID: 37717605 DOI: 10.1016/j.toxicon.2023.107289] [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: 06/28/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
Conflicting attempts between indigenous caregivers trying to exercise their healing practices in hospitals have been recorded in the Brazilian Amazon. In this work, we present an interview with the Baniwa indigenous anthropologist Francy Baniwa. In an external and colonial interpretation, it was previously stated that indigenous people attribute the origin of snakebites as supernatural and that indigenous medicine, when it saves a patient from complications and death, has symbolic efficacy. In this interview, we observed that this form of interpretation is asymmetric because, for indigenous people, their understanding of nature is broader than ours, with more possibilities of ways of existence, including non-human entities as well or ill-intentioned as humans. The interaction of humans with these identities produces a form of existence with its own clinical reality, which is full of symbolism. Effective communication between health agents and indigenous patients and caregivers must undergo this exercise of otherness and interculturality.
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Affiliation(s)
- Altair Seabra de Farias
- School of Health Sciences, Universidade Do Estado Do Amazonas, Brazil; Department of Teaching and Research, Fundaçao de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Joseir Saturnino Cristino
- School of Health Sciences, Universidade Do Estado Do Amazonas, Brazil; Department of Teaching and Research, Fundaçao de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Felipe Murta
- School of Health Sciences, Universidade Do Estado Do Amazonas, Brazil; Department of Teaching and Research, Fundaçao de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Brazil; Department of Teaching and Research, Fundaçao de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Wuelton Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Brazil; Department of Teaching and Research, Fundaçao de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.
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Rathnayaka RMMKN, Nishanthi Ranathunga PEA, Kularatne SAM. Epidemiology and clinical features of Hypnale nepa (hump-nosed pit viper) envenoming in Sri Lanka. Toxicon 2023; 231:107194. [PMID: 37321409 DOI: 10.1016/j.toxicon.2023.107194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
Sri Lanka homes 3 species of hump-nosed pit vipers including Hypnale Hypnale, H. zara and H. nepa from which, latter 2 are endemic to the country. Even though former 2 are the subject of several publications, no major clinical studies have been done regarding H. nepa bites. As these snakes confine only to central hills of the country, their bites are very rare. The objectives of this study were to describe epidemiological and clinical features of H. nepa bites. A prospective observational study was conducted for patients admitted with H. nepa bites to Teaching Hospital, Ratnapura, Sri Lanka for 5 years commencing from June 2015. Species identification was done using a standard key. There were 14 (3.6%) patients with H. nepa bites of which 9 (64%) were males and 5 (36%) were females. Their age ranged from 20 to 73 years (median 37.5). Seven bites (50%) occurred on lower limbs. Majority of bites (10; 71%) happened at daytime [0600-1759 h] in tea estates (8; 57%). Most patients (8; 57%) were admitted within 1-3 h from bite. Hospital stay was 2.5 days (IQR 2-3). Local envenoming was observed in all patients including local pain and swelling [mild (7; 50%), moderate (5; 36%), severe (2; 14%)], local bleeding (1; 7%) and lymphadenopathy (1; 7%). Nonspecific features were observed in 3 (21%). Systemic manifestations were found in 2 (14%) including microangiopathic haemolytic anaemia and sinus bradycardia. Two (14%) had myalgia. H. nepa bites frequently cause local envenoming. But, rarely systemic manifestations may occur.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka; Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka.
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Bhaumik S, Beri D, Zwi AB, Jagnoor J. Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study. Toxicon X 2023; 18:100157. [PMID: 37089517 PMCID: PMC10091724 DOI: 10.1016/j.toxcx.2023.100157] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March-May 2020; May-November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite. We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Deepti Beri
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
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Shahmy S, Kularatne SAM, Gawarammana IB, Rathnayake SS, Dawson AH. Compliance with national snakebite treatment guidelines in rural Sri Lankan hospitals: a cluster randomized controlled trial of a brief educational intervention. BMC Med Educ 2023; 23:390. [PMID: 37245040 DOI: 10.1186/s12909-023-04375-1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Snakebite is a global health problem that predominantly occurs in rural areas. In Sri Lanka, the majority of snakebite patients first present to smaller rural primary hospitals. Improving care delivered at rural hospitals has the potential to reduce morbidity and mortality from snakebites. OBJECTIVE In this study, we evaluated whether an educational intervention would increase compliance with national snakebite treatment guidelines in primary hospitals. METHODS The hospitals were randomized into educational intervention (n = 24) and control groups (n = 20). The intervention hospitals received a brief educational intervention based on Sri Lankan Medical Association (SLMA) guidelines on the management of snakebites. Control hospitals had free access to the guidelines but no additional promotion. Four outcomes were assessed: pre- and post-test knowledge at the completion of a one-day workshop of educational intervention (intervention group only); improvement in the quality of the patient's medical records; appropriateness of transfers to higher hospitals; and quality of overall management graded by a blinded expert. The data was collected over a period of 12 months. RESULTS All case notes of snakebite hospital admissions were reviewed. There were 1021 cases in the intervention group hospitals and 1165 cases in the control hospitals. Four hospitals in the intervention group and three hospitals in the control group did not have snakebite admissions and were excluded from the cluster analysis. The absolute quality of care was high in both groups. Post-test knowledge was improved (p < 0.0001) following the intervention group's educational workshop. There was no statistical difference between the two groups in terms of clinical data documentation in hospital notes (scores, p = 0.58) or transfer appropriateness (p = 0.68)-both of which were significantly different from the guidelines. CONCLUSION Education of primary hospital staff improved the immediate knowledge gained but did not improve record-keeping or the appropriateness of inter-hospital patient transfer. TRIAL REGISTRATION The study was registered with Sri Lanka Medical Associations' clinical trial registry. Reg. No SLCTR -2013-023. Registered: 30/07/2013.
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Affiliation(s)
- Seyed Shahmy
- National Science and Technology Commission of Sri Lanka, Colombo, Sri Lanka.
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shantha S Rathnayake
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew H Dawson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
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Dehghani R, Monzavi SM, Mehrpour O, Shirazi FM, Hassanian-Moghaddam H, Keyler DE, Wüster W, Westerström A, Warrell DA. Medically important snakes and snakebite envenoming in Iran. Toxicon 2023; 230:107149. [PMID: 37187227 DOI: 10.1016/j.toxicon.2023.107149] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Snakebite is a common health condition in Iran with a diverse snake fauna, especially in tropical southern and mountainous western areas of the country with plethora of snake species. The list of medically important snakes, circumstances and effects of their bite, and necessary medical care require critical appraisal and should be updated regularly. This study aims to review and map the distributions of medically important snake species of Iran, re-evaluate their taxonomy, review their venomics, describe the clinical effects of envenoming, and discuss medical management and treatment, including the use of antivenom. Nearly 350 published articles and 26 textbooks with information on venomous and mildly venomous snake species and snakebites of Iran, were reviewed, many in Persian (Farsi) language, making them relatively inaccessible to an international readership. This has resulted in a revised updated list of Iran's medically important snake species, with taxonomic revisions of some, compilation of their morphological features, remapping of their geographical distributions, and description of species-specific clinical effects of envenoming. Moreover, the antivenom manufactured in Iran is discussed, together with treatment protocols that have been developed for the hospital management of envenomed patients.
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Affiliation(s)
- Ruhollah Dehghani
- Department of Environmental Health, Kashan University of Medical Sciences, Kashan, Iran; Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mostafa Monzavi
- Medical Toxicology Center, Mashhad University of Medical Sciences, Mashhad, Iran; Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran; Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.
| | - Farshad M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Daniel E Keyler
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Wolfgang Wüster
- Molecular Ecology and Evolution at Bangor, School of Natural Sciences, Bangor University, Bangor, UK
| | | | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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9
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Cañas CA, Castaño-Valencia S, Castro-Herrera F. The Colombian bushmasters Lachesis acrochorda (García, 1896) and Lachesis muta (Linnaeus, 1766): Snake species, venoms, envenomation, and its management. Toxicon 2023; 230:107152. [PMID: 37178796 DOI: 10.1016/j.toxicon.2023.107152] [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: 01/26/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
In Colombia, there are two species of bushmaster snakes, Lachesis acrochorda, which is distributed mainly in the west of the country (in the Choco region), and Lachesis muta in the southeast (in the Amazon and Orinoquia region), whose presence has been reduced due to the destruction of their habitats. Captive maintenance is challenging, making it difficult to obtain their venom for study and antivenom manufacturing. They are the largest vipers in the world. The occurrence of human envenomation is quite rare, but when it occurs, it is associated with high mortality. Bushmaster venom is necrotizing, hemorrhagic, myotoxic, hemolytic, and cardiovascular depressant. Due to the presence of bradycardia, hypotension, emesis, and diarrhea in some patients (Lachesis syndrome), the possibility of a vagal or cholinergic effect is raised. The treatment of envenomation is hindered by the scarcity of antivenom and the need to use high doses. A review of the most relevant biological and medical aspects of bushmaster snakes is presented, mainly for those occurring in Colombia, to facilitate their recognition and raise awareness about the need for special attention to improve their conservation and advance scientific knowledge, in particular, about their venom.
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Affiliation(s)
- Carlos A Cañas
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, 760031, Colombia; Fundación Valle del Lili, Departamento de Reumatología, Cali, 760026, Colombia.
| | - Santiago Castaño-Valencia
- Department of Physiological Sciences, Department of Health Sciences, Universidad del Valle. Cali 760042, Colombia; Laboratorio de Herpetología y Toxinología, Universidad del Valle. Cali 760042, Colombia
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Rathnayaka RMMKN, Ranathunga PEAN, Silva MLID, Abeyrathna YNMP, Kularatne SAM. Cat-eyed snake (Genus: Boiga) bites in Sri Lanka: First authentic case series. Toxicon 2023; 225:107052. [PMID: 36791994 DOI: 10.1016/j.toxicon.2023.107052] [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: 12/10/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
Cat snakes (Genus: Boiga) are considered to be of lesser medical important in Sri Lanka, as their bites are known to cause only mild local effects such as local pain and swelling at the site of the bite. Five species of cat snakes are found in Sri Lanka, of which three are endemic. They are widely distributed all over the country. Out of seven cases of cat snake bites, including six adults and one child, five developed only mild local effects and two did not have any symptoms. Any of them did not develop systemic manifestations. The snakes responsible were the Sri Lanka cat snake (Boiga ceylonensis), Forsten's cat snake (Boiga forsteni), and also Ranawana's cat snake (Boiga ranawanei) which is the first report in Sri Lanka.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka; Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka.
| | | | - M L I De Silva
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Y N M P Abeyrathna
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Kazemi SM, Jahan-Mahin MH, Zangi B, Khozani RS, Warrell DA. A case of envenoming by a Persian false-horned viper Pseudocerastes persicus (Duméril, Bibron & Duméril, 1854) (Serpentes: Viperidae) in Southeastern Iran. Toxicon 2023; 223:107009. [PMID: 36586490 DOI: 10.1016/j.toxicon.2022.107009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
Despite the wide distribution of the Persian false-horned viper (Pseudocerastes persicus) in the Middle East, few identified bites have been reported. A 33-year-old herpetologist bitten on the hand by Pseudocerastes persicus in Kerman Province, Southeastern Iran, developed local pain and extensive swelling with mild non-specific systemic symptoms and minimal laboratory evidence of systemic envenoming.
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ZARAMBAUD R, PIAMALE G, LONGO JDD, DIEMER HSC, GRESENGUET G. [Incidence of snakebites in rural communities living in the Paoua savannah and Mbaïki forest areas in Central African Republic]. Med Trop Sante Int 2022; 2:mtsi.v2i4.2022.211. [PMID: 36815179 PMCID: PMC9940279 DOI: 10.48327/mtsi.v2i4.2022.211] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 02/24/2023]
Abstract
Introduction Snakebite is one of the most deadly neglected tropical diseases in Africa with more than 20,000 deaths reported each year. According to recent data from hospital in Central African Republic studies, the Paoua health district reports between 300 and 400 cases of ophidian envenomation each year. However, no epidemiological study on snakebites has been conducted at national level, nor a control strategy developed. The objective of this study is to describe the epidemiological aspects of snakebites in two rural communities, one located in savannah zone and the other in forest zone (both secondary and primary forest) in order to ensure adequate management of snakebites in these regions. Method Prospective community-based study in two health districts in the Central African Republic, the health district of Paoua in savannah area and the health district of Mbaïki in forest area, from December 2019 to January 2021. Snakebites were investigated in the community by selected trained people in charge of reporting data regarding all known cases of snakebites occurring during the study period. The data were actively notified either by health personal or community health workers in order to determine the circumstances and severity of the bite, its management and the clinical course in case of envenomation. Results A total of 412 snakebite cases were recorded during the study period, of which 198 cases occurred in the rural community of the forest zone and 214 in the community of the savannah zone. Case fatality rate was 5% in the forest zone and 1% in the savanna zone. The incidence rate of snakebite was significantly higher in savannah children compared to those in the forest (98/100,000 vs. 25.1/100,000; p<0.00001) while this incidence rate was significantly lower from age 45 onwards in the savannah area compared to the forest area (167/100,000 vs. 200/100,000; p=0.02). The case fatality rate of children and adults up to 44 years of age appeared to be significantly higher in the forest zone (7 deaths vs 1 death). Snakebites occurred significantly more frequently during field activities in the savannah zone than in the forest zone (51% vs 26%; p<0.0001). The symptomatology of bites was dominated by edema of the bitten limb and bleeding in the two study areas, compatible with cytotoxic and hemorrhagic syndromes due to viper bites. Conclusion With an incidence rate of more than 160 cases per 100,000 inhabitants in the active population aged 15-44 years in rural communities of the forest and savannah zone, snakebites remain a public health problem in Central African Republic. A study on the toxicity of snakebites in Central African Republic is recommended. Besides, it is urgent to make anti-venomous serums available in health facilities in order to reduce the mortality related to the envenomation.
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Affiliation(s)
- Romaric ZARAMBAUD
- École doctorale des sciences de la santé humaine et vétérinaire, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
- Département de santé publique, Faculté des sciences de la santé, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
| | - Germain PIAMALE
- École doctorale des sciences de la santé humaine et vétérinaire, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
- Département de santé publique, Faculté des sciences de la santé, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
| | - Jean de Dieu LONGO
- École doctorale des sciences de la santé humaine et vétérinaire, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
- Département de santé publique, Faculté des sciences de la santé, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
| | - Henri Saint-Calvaire DIEMER
- École doctorale des sciences de la santé humaine et vétérinaire, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
- Département de santé publique, Faculté des sciences de la santé, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
| | - Gérard GRESENGUET
- École doctorale des sciences de la santé humaine et vétérinaire, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
- Département de santé publique, Faculté des sciences de la santé, Université de Bangui, avenue des Martyrs, Bangui, République centrafricaine
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13
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Brasileiro-Martins LM, Nascimento TP, Silva-Neto AV, Martins F, Cavalcante SA, Martins RB, Marques H, Colombini M, Martins M, Sartim MA, Wen FH, Carlos de Lima Ferreira L, de Almeida Gonçalves Sachett J, Moura-da-Silva AM, Ferreira de Aquino P, Monteiro WM. The severity of acute kidney injury correlates with plasma venom levels in Bothrops atrox envenomings. Toxicon 2022; 219:106924. [PMID: 36126694 DOI: 10.1016/j.toxicon.2022.09.010] [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: 06/08/2022] [Revised: 08/17/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022]
Abstract
The Brazilian Amazon has high rates of snakebite envenomings (SBEs), with ∼90% caused by Bothrops atrox. Envenomings by this species can trigger local and systemic effects, such as acute kidney injury (AKI). Our aim was to identify predictors of AKI in Bothrops SBEs in patients from Manaus, Western Brazilian Amazon. A total of 127 patients were enrolled, with a predominance of men between 16 and 45 years old from rural areas. Of the 127 patients, 38.6% developed AKI, with 61.2% presenting stage I, 34.7% presenting stage II and 4.1% presenting stage III severity. The age groups 0-10 years and ≥60 years presented a significantly higher frequency of AKI compared to the 11-40 years group. Moderate/severe edema in the affeccted limb was significantly associated with lower risk of AKI [p = 0.01; OR = 0.11 (95%CI 0.02-0.53)]. Nausea [p = 0.01; OR = 54.44 (95%CI = 3.26-909.27)] and high blood urea levels [p = 0.01; OR = 5.38 (95%CI = 2.12-13.66)] were risk factors for AKI. There was a significant positive correlation between circulating venom levels and the highest creatinine serum values during the hospital stay (p = 0.03) and with the difference between the maximum creatinine levels and the creatinine levels on admission (p = 0.02). A positive correlation between serum venom concentrations and creatinine levels suggests a direct or indirect dose-dependent participation of the venom toxins in the pathogenesis of AKI.
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Affiliation(s)
- Lisele Maria Brasileiro-Martins
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Alexandre Vilhena Silva-Neto
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | - Felipe Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Hedylamar Marques
- Hemostasis Laboratory, Amazonas State Hematology and Hemotherapy Hospital Foundation, Manaus, 69050-001, Brazil
| | - Monica Colombini
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | - Marilaine Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Fan Hui Wen
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | | | - Jacqueline de Almeida Gonçalves Sachett
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Wuelton Marcelo Monteiro
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil.
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Kim D, Kim S, Kim JK, Lim JH, Choi G, Bae S, Kwon YS, Jang M. Clinical features and management of snake bites in 70 dogs in Korea. J Vet Sci 2022; 23:e81. [PMID: 36259100 PMCID: PMC9715381 DOI: 10.4142/jvs.22105] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/10/2022] [Accepted: 08/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Snakebites remain a devastating and life-threatening environmental hazard. While the management of snakebites has been well described in humans, few clinical data and guidelines exist for dogs, especially in Korea. OBJECTIVES This retrospective study evaluated the clinical features of 70 dogs with snakebite wounds in Korea. METHODS The medical records of 72 dogs that presented to three animal hospitals from June 2008 to July 2021 were reviewed; among these, 70 dogs that met the inclusion criteria were enrolled. Their signalment, history, clinical signs, physical examination, blood analysis, treatment, and prognosis were also evaluated. RESULTS Of 70 dog owners, 35 (50%) witnessed the bite, with a mean time between bite and hospital presentation of 9.7 ± 4.1 h in 58 dogs. Blood smears were evaluated in 45 dogs, of which 28 (62%) showed echinocytosis. Anemia and acute kidney injury were found in 21 (29%) and 2 dogs (3%), respectively. A total of 37 dogs (53%) were hospitalized, 5 (7%) of which died. CONCLUSIONS The most significant finding was the high prevalence of echinocytosis. The data from this retrospective study could inform the management of dogs bitten by snakes in Korea.
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Affiliation(s)
- Dongseok Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Seonghoon Kim
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea
| | - Jin-Kyung Kim
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea
| | | | - Geonho Choi
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Seulgi Bae
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Young-Sam Kwon
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Min Jang
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
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Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Kularatne SAM, Jayasinghe S. Acute ischemic stroke: a rare complication of hump-nosed pit viper (Hypnale spp.) bite: a case report. J Med Case Rep 2022; 16:218. [PMID: 35659733 PMCID: PMC9166429 DOI: 10.1186/s13256-022-03442-3] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hump-nosed pit viper is a medically important deadly venomous snake in Sri Lanka and is the commonest cause of venomous snakebites in the country. It frequently causes local effects and systemic manifestations such as acute kidney injury and coagulopathy that occur in less than 10% of all bites. This also includes some atypical presentations such as thrombotic microangiopathy and myocardial infarction. Currently, no antivenom is available for hump-nosed pit viper bites in Sri Lanka, and patients are managed with supportive treatment. This case illustrates an acute ischemic stroke following a hump-nosed viper bite, which is the second case in the literature. Case presentation A 71-year-old a Sinhalese male patient presented with left-sided hemiparesis with mouth deviation on day 2 of hump-nosed viper (Hypnale spp.) bite on the right foot. Non-contrast computed tomography of brain showed right ischemic stroke in internal capsule. He was given antiplatelets and statins and continued supportive treatment including limb physiotherapy and speech therapy. He recovered completely and was discharged on day 4 with clinic follow-up. Conclusions Physicians should be aware that ischemic cerebral infarcts may occur following hump-nosed pit viper bites.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka. .,Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka. .,Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka. .,No. 11, Flower Road, New Town Housing Scheme 01, New Town, Ratnapura, Sri Lanka.
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Ceesay B, Taal A, Kalisa M, Odikro MA, Agbope D, Kenu E. Analysis of snakebite data in Volta and Oti Regions, Ghana, 2019. Pan Afr Med J 2021; 40:131. [PMID: 34909099 PMCID: PMC8641636 DOI: 10.11604/pamj.2021.40.131.28217] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction globally about 5.4 million people are affected by snakebite annually leading to 2.7 million cases of snakebite envenoming and 81,000-138,000 deaths. In sub-Saharan Africa, the burden of disease caused by snakebite is often underestimated despite its status as a category A neglected tropical disease. We reviewed snakebite data to determine the magnitude of snakebite by person, place, and time in the Volta and Oti Regions of Ghana. Methods we conducted a descriptive secondary data analysis using snakebite data from 2014-2018 extracted from the District Health Information and Management Systems (DHIMS 2) database. Data were analyzed descriptively by person, place, and time using summary statistics and results were presented in proportions and graphs. Missed outbreaks were determined through calculation of cumulative sum (CUSUM 2). Results a total of 2,973 cases of snakebites were reported over the 5 years of which 1675 (56.3%) were males. Majority 867 (29.2%) of snakebite victims were between 20-34 years of age with recorded 5-year average incidence of 24 snakebite cases per 100,000. Nkwanta North District recorded the highest cases 499 (16.8%) with most of the snakebite cases 2,411 (81%) recorded in the rainy season. Overall, there was a decreasing trend of snakebites and four missed snakebite outbreaks occurred during the period. No snakebite death was recorded. Conclusion a 5-year average snakebite incidence of 24 cases per 100,000 persons was recorded and Nkwanta North District recorded the highest cases with peaks occurring in rainy and harvesting seasons. Four outbreaks were missed. There is a need to conduct periodic data analysis for effective intervention programs.
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Affiliation(s)
- Baba Ceesay
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.,Ministry of Health, Banjul, The Gambia
| | - Abdoulie Taal
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.,Ministry of Health, Banjul, The Gambia
| | - Momodou Kalisa
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.,Ministry of Health, Banjul, The Gambia
| | - Magdalene Akos Odikro
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana
| | | | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana
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Adinortey MB. Botanical treatments for snakebite in rural Ghana: A narrative review. J Ethnopharmacol 2021; 280:114432. [PMID: 34274442 DOI: 10.1016/j.jep.2021.114432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In the countryside, there are some limitations with the use of venom antisera to manage snake bites. Due to poor access to healthcare and as a result of the difficulty in receiving treatment for cases of snake bites, most rural people in Ghana, a West African country, rely on plant medicine as a first aid to manage cases of venomous snakebite. This calls for more research into the species of plants used to medically manage snakebite envenomation. AIM OF THE STUDY This review sought to present plants that are used in managing snakebite cases and also gather data supporting their use. METHODOLOGY This is a systematic search and review of information obtained from textbooks and databases such as PubMed and ScienceDirect between January 1975 and August 2020. RESULTS A search done identified 43 plant species and these were found to belong to 25 taxonomic families with the most frequent ones being, Fabaceae, Euphorbiaceae, Apocynaceae, and Solanaceae. Experimental data gathered indicate that among the many plants identified to be used to manage snakebites, only 5 were found with anti-venom in vitro and in vivo evidence-based data. CONCLUSION Data collated hint that a few plant species identified namely Anacardium occidentale, Euphorbia hirta, Mimosa pudica, Musa paradisiaca and Mangifera indica, work by targeting diverse physiopathological and biochemical processes involved in the clinical manifestations of snakebites. This review has also unearthed knowledge gaps that can form the basis for broad investigations and development of these and other medicinal plants into useful anti-venom medications.
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Villca-Corani H, Nieto-Ariza B, León R, Rocabado JA, Chippaux JP, Urra FA. First reports of envenoming by South American water snakes Helicops angulatus and Hydrops triangularis from Bolivian Amazon: A one-year prospective study of non-front-fanged colubroid snakebites. Toxicon 2021; 202:53-59. [PMID: 34562494 DOI: 10.1016/j.toxicon.2021.09.003] [Citation(s) in RCA: 3] [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: 05/08/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Although snakebite incidence is underestimated in Bolivia, the Amazon region presents the highest incidence of these accidents. The local effects of bites by some non-front-fanged colubroid (NFFC) snakes are usually confused with that of viperids, resulting in the improper use of antivenoms and medications. Since there is scarce information on clinical treatment and management of NFFC bites from Bolivian Amazon, we conducted a prospective study of NFFC snakebites by reviewing the records of patients admitted with a snakebite diagnosis at Hospital Central Ivirgarzama, Bolivia. Snakebites were recorded for 12 months (December 2019-November 2020), including information about the sex and age of the patient, snakebite date, and treatment. Eight (5.7 %) of 152 patients were bitten by NFFC Helicops angulatus, Hydrops triangularis, and Erythrolamprus sp. Our results showed that 5/7 patients had prolonged clotting time and INR, as well as local edema and mild pain, suggesting systemic envenoming. Previously non-documented mild coagulopathy was observed for H. angulatus and H. triangularis bites. In some cases, incorrect first-aid measures, and inappropriate use of bothropic/lachesic antivenom were administrated. All the patients received supportive therapy and antihistamine drugs. Unsupported use of non-evidence-based treatments for snakebites such as corticoids, non-steroidal anti-inflammatory drugs (NSAIDs), and prophylactic antibiotic prescription were recorded. In conclusion, we describe the first formally documented snakebite cases produced by NFFC from Bolivia, highlighting the urgent need for training of the medical team in the snake identification, clinical management of snakebite, and the existence of a human-snake conflict involving NFFC species.
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Affiliation(s)
- Huber Villca-Corani
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile.
| | - Beatriz Nieto-Ariza
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile
| | - Raúl León
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile
| | - José A Rocabado
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia
| | - Jean-Philippe Chippaux
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; CRT, Institut Pasteur, MERIT, Institut de Recherche pour le Développement et Université de Paris, Paris, France; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile
| | - Félix A Urra
- Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Santiago, 7800003, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile.
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM, Abeywardhana KPL. Purpura fulminans following hump-nosed pit viper (Hypnale hypnale) envenoming: A rare complication of snakebites. Toxicon 2021; 202:110-114. [PMID: 34582831 DOI: 10.1016/j.toxicon.2021.09.012] [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: 06/16/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022]
Abstract
Hump-nosed pit vipers of the genus Hypnale are highly venomous and reputed for the commonest venomous snakebites in Sri Lanka. They frequently cause local manifestations and less commonly cause systemic effects such as acute kidney injury and coagulopathy. There is no antivenom currently available in Sri Lanka for their envenoming. However, more and more complications of Hypnale bites are being recently described. Purpura fulminans, one of the rare complications of snakebites that we report following authentic Hypnale hypnale bite. A 58-year-old female was bitten by a hump-nosed viper and developed bilateral toe gangrenes, ultimately ended up with amputations. She got recovered with loss of toes in both feet for 46 days treatment at hospital.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka; Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka.
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Kularatne SAM. Paediatric cases of Ceylon krait (Bungarus ceylonicus) bites and some similar looking non-venomous snakebites in Sri Lanka: Misidentification and antivenom administration. Toxicon 2021; 198:143-50. [PMID: 33957150 DOI: 10.1016/j.toxicon.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
Ceylon krait (Bungarus ceylonicus) of the family Elapidae is a highly venomous endemic species inhabiting in the wet zone and some parts of the intermediate climatic zones of Sri Lanka. Clinical records of its bites are rare and limited to five case reports in the literature. It is of interest to note that there are several non-venomous snakes in Sri Lanka having similar morphological appearance to kraits causing identification difficulties which lead to unnecessary and unindicated administration of antivenom. We report two paediatric cases of proven Ceylon krait bites and three adult patients with similar looking non-venomous snakebites. These children were 1½ and 13 years old and developed neuroparalysis without progressing to respiratory failure and recovered. Both the children were administered Indian polyvalent antivenom which has not developed against endemic Ceylon krait venom. The two adult patients also received antivenom due to the misidentification without clinical and laboratory evidence of envenoming.
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Mahmoudi GA, Ahadi M, Fouladvand A, Rezaei B, Bodagh Z, Astaraki P. Evaluation of Allergic Reactions Following Intravenous Infusion of Polyvalent Antivenom in Snakebite Patients. Antiinflamm Antiallergy Agents Med Chem 2021; 20:367-372. [PMID: 33563188 DOI: 10.2174/1871523020666210204143756] [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: 10/26/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Antivenom is a gold-standard treatment for snakebite envenoming. However, adverse reactions to snake antivenom are common in many parts. OBJECTIVE The aim of this study was to evaluate the allergic reactions following intravenous administration of antivenom sera. METHODS This was retrospective study, conducted snakebites patients referred to the Rahimi Hospital in Khorramabad. The files of these patients were accessed for demographic data, snakebite-related data, treatment provided, clinical presentation and allergic reaction status as a result of antivenom treatment. RESULTS 141 cases were investigated including 73.8% male and 26.2% female patients. The mean age of the patients was 38.1±17.1years. Age group 30-39 years accounted for highest number of snakebite cases (24.1%). A majority of victims (89.4%) were from the rural areas. Most of the patients (51.8%) were bitten in the spring and highest number of snakebite were reported in May (39.1%). The most common site of snakebite was lower extremities (50.4%) and upper extremities (44.7%). Among clinical feature of snakebite, pain was the most prevalent in 135 cases (95.7%) followed by swelling (83.7%). The mean antivenom vials used were 6.5±3.7 vials. Allergic reactions occurred in 6 patients (4.26%); reactions were mild in 5 patients and sever in 1patient. The commonest presentation was maculopapular rash (1.4%) and the least common were headache (0.71%), nausea (0.71%), fever (0.71) and hypotension (0.71%). CONCLUSION Snakebite is one of the significantlife-threatening environmental events.Immediate antivenom treatment can reduce mortality however, patients should be carefully monitored for adverse allergic reactions.
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Affiliation(s)
- Ghafar-Ali Mahmoudi
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Maryam Ahadi
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Ali Fouladvand
- Department of Pediatrics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Bareza Rezaei
- Department of Emergency Medicine, School of Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah. Iran
| | - Zahra Bodagh
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Peyman Astaraki
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
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de Souza Barbosa Ê, Santos Ibiapina HN, Rocha da Silva S, Costa AG, Val FF, Mendonça-da-Silva I, Carlos de Lima Ferreira L, Sartim MA, Monteiro WM, Cardoso de Melo G, de Almeida Gonçalves Sachett J. Association of cfDNA levels and bothrops envenomation. Toxicon 2021; 192:66-73. [PMID: 33497746 DOI: 10.1016/j.toxicon.2021.01.015] [Citation(s) in RCA: 3] [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: 09/16/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 01/05/2023]
Abstract
In the Amazon, around 90% of snakebites are caused by the Bothrops genus. Complications arising from Bothrops envenomations result from the inflammatory and coagulotoxic activities of the venom. The aim of this study was to investigate the potential of cell-free DNA (cfDNA) as a biomarker of severity in Bothrops snakebites. Patients were treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, in the Brazilian Amazon. cfDNA plasma levels were measured by amplifying the human telomerase reverse transcriptase (hTERT) sequence using quantitative RT-PCR. Median levels of cfDNA were compared between envenomed and healthy volunteers and among patients presenting different complications, such as renal failure, bleeding and infection. Of the 76 patients included, 82.9% were male, with a mean age of 32.8 years, and envenomations were mainly classified as severe (39.5%). ROC curve analysis showed a good accuracy of cfDNA levels (AUROC of 0.745) in envenomation diagnosis. A correlation analysis using laboratory variables showed positive correlation with lactate dehydrogenase (p = 0.033) and platelet count (p = 0.003). When cfDNA levels were compared with clinical complications, significant statistical differences were only found among individuals with mild and severe pain (p < 0.05). In summary, our results demonstrated that cfDNA levels are sufficiently accurate for discriminating between envenomed and non-envenomed patients, but are not able to distinguish different complications and the level of severity among envenomed patients. Thus, the role of cfDNA in the pathogenesis of the snakebite envenomations needs to be further investigated.
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Affiliation(s)
- Êndila de Souza Barbosa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | | | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | - Fernando Fonseca Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Iran Mendonça-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | - Marco Aurélio Sartim
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil.
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Archundia IG, de la Rosa G, Olvera F, Calderón A, Benard-Valle M, Alagón A, Corzo G. Assessment of neutralization of Micrurus venoms with a blend of anti-Micrurus tener and anti-ScNtx antibodies. Vaccine 2021; 39:1000-1006. [PMID: 33423840 DOI: 10.1016/j.vaccine.2020.12.052] [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: 04/20/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Micrurus venoms contain two main groups of toxic protein components: short-chain α-neurotoxins (SNtx) and phospholipases type A2 (PLA2). In North America, generally, the Micrurus venoms have low abundance of SNtx compared to that of PLA2s; however, both are highly toxic to mammals, and consequently both can play a major role in the envenomation processes. Concerning the commercial horse-derived antivenoms against Micrurus from the North America region, they contain a relatively large amount of antibodies against PLA2s, and a low content of antibodies against short chain α-neurotoxins. This is mainly due to the lower relative abundance of SNtxs, and also to its poor immunogenicity due to their size and nature. Hence, Micrurus antivenoms made in North America usually present low neutralizing capacity towards Micrurus venoms whose lethality depend largely on short chain α-neurotoxins, such as South American Micrurus species. METHODS Horses were hyperimmunized with either the venom of M. tener (PLA2-predominant) or a recombinant short-chain consensus α-neurotoxin (ScNtx). Then, the combination of the two monospecific horse antibodies (anti-M. tener and anti-ScNtx) was used to test their efficacy against eleven Micrurus venoms. RESULTS The blend of anti-M. tener and anti-ScNtx antibodies had a better capacity to neutralize the lethality of diverse species from North, Central and South American Micrurus venoms. The antibodies combination neutralized both the ScNtx and ten out of eleven Micrurus venom tested, and particularly, it neutralized the venoms of M. distans and M. laticollaris that were neither neutralized by monospecific anti-M. tener nor anti-ScNtx. CONCLUSIONS These results provide a proof-of-principle for using recombinant immunogens to enrich poor or even non-neutralizing antisera against elapid venoms containing short chain α-neurotoxins to develop antivenoms with higher effectiveness and broader neutralizing capacity.
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Affiliation(s)
- Irving G Archundia
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología - UNAM, Av. Universidad 2001, Cuernavaca, Morelos 62210, Mexico
| | - Guillermo de la Rosa
- The Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario M5S3E1, Canada.
| | - Felipe Olvera
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología - UNAM, Av. Universidad 2001, Cuernavaca, Morelos 62210, Mexico
| | - Arlene Calderón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología - UNAM, Av. Universidad 2001, Cuernavaca, Morelos 62210, Mexico
| | - Melisa Benard-Valle
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología - UNAM, Av. Universidad 2001, Cuernavaca, Morelos 62210, Mexico
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología - UNAM, Av. Universidad 2001, Cuernavaca, Morelos 62210, Mexico
| | - Gerardo Corzo
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología - UNAM, Av. Universidad 2001, Cuernavaca, Morelos 62210, Mexico.
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24
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Bisneto PF, Araújo BDS, Pereira HDS, Mendonça da Silva I, Sachett JDAG, Bernarde PS, Monteiro WM, Kaefer IL. Envenomations by coral snakes in an Amazonian metropolis: Ecological, epidemiological and clinical aspects. Toxicon 2020; 185:193-202. [PMID: 32710896 DOI: 10.1016/j.toxicon.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/02/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
Envenomation by coral snakes represents a little known burden in Brazilian Amazonia. So far, details on clinical and epidemiological aspects remain obscure in the region. We gathered data from medical charts and from the scientific collection of snakes from Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, finding 26 cases of envenomation by five species of Micrurus in Manaus region, between 1987 and 2018. They represent 0.7% of the snakebites treated in the hospital since the records began, in 1979. Micrurus lemniscatus was responsible for most of the bites (10), followed by M. hemprichii (five), M. spixii (three), M. surinamensis (three) and M. averyi (one). There was no difference between the sexes of the snakes that caused bites. Patients were mostly males, and most of the cases were reported in urban areas. Bites predominated in dry season, and there was a clear geographical segregation among species. We describe seven cases of envenomation, three mild and four severe, all of which evolved to cure. Paresthesia (six), pain (five) and edema (four) were the most common local symptoms. Systemic features such as dyspnea/shallow breath (four), palpebral ptosis (four), blurred vision (three), dysarthria (three) and difficulty to walk (three) were also detected. Two patients bitten by Micrurus sp. and M. hemprichii, showed slight increased serum levels of creatine kinase (reference level <190 U/L), 1184 U/L and 1229 U/L, respectively, indicative of mild systemic myotoxicity. This is the first report of myotoxic manifestation in the envenomation by M. hemprichii. No patient developed respiratory failure, though one bitten by an adult M. spixii required intubation and mechanical ventilation due to decreased level of consciousness during evolution, probably related to induced sedation caused by concurrent alcohol intoxication. All patients were treated with Brazilian Micrurus antivenom (soro antielapídico, median = 10 vials). Six patients were pretreated intravenously with H1 and H2 antagonists and steroids, with two patients developing early adverse reactions. The median length of hospital stay was four days. Envenomations by coral snakes in Manaus region are clinically severe, but rare and sparsely distributed over time, making the detection of epidemiological and clinical patterns a challenge for public health.
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Affiliation(s)
- Pedro Ferreira Bisneto
- Universidade Federal do Amazonas - UFAM, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Zoologia, Av. General Rodrigo Octavio, 1200, Coroado I, 69067-005, Manaus, Amazonas, Brazil.
| | - Bruno Dos Santos Araújo
- Faculdade Estácio do Amazonas, Av. Constantino Nery, 3693, Chapada, 69050-001, Manaus, Amazonas, Brazil
| | | | - Iran Mendonça da Silva
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, 25, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação Alfredo da Matta - FUAM, Diretoria de Ensino e Pesquisa, Av. Codajás, 24, Cachoeirinha, 69065-130, Manaus, Amazonas, Brazil
| | - Paulo Sérgio Bernarde
- Universidade Federal do Acre - UFAC, Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Estrada do Canela Fina, Km 12, 69980-000, Cruzeiro do Sul, Acre, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, 25, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil
| | - Igor Luis Kaefer
- Universidade Federal do Amazonas - UFAM, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Zoologia, Av. General Rodrigo Octavio, 1200, Coroado I, 69067-005, Manaus, Amazonas, Brazil
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25
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Chiang LC, Tsai WJ, Liu PY, Ho CH, Su HY, Lai CS, Lai KL, Lin WL, Lee CH, Yang YY, Doan UV, Maharani T, Mao YC. Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200043. [PMID: 32983233 PMCID: PMC7500479 DOI: 10.1590/1678-9199-jvatitd-2020-0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite.
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Affiliation(s)
- Liao-Chun Chiang
- National Tsing Hua University, College of Life Sciences, Hsinchu, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Clinical Toxicology and Occupational Medicine, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Jen Tsai
- Division of Clinical Toxicology and Occupational Medicine, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Yu Liu
- Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Cheng-Hsuan Ho
- School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Emergency Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Hung-Yuan Su
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan.,The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Sheng Lai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Loung Lin
- Taichung Wildlife Conservation Group, Taichung, Taiwan
| | - Chi-Hsin Lee
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Graduate Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Core Laboratory of Antibody Generation and Research, Taipei Medical University, Taipei, Taiwan
| | - Yi-Yuan Yang
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Graduate Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Core Laboratory of Antibody Generation and Research, Taipei Medical University, Taipei, Taiwan
| | - Uyen Vy Doan
- Department of Clinical Toxicology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tri Maharani
- Department of Emergency Medicine, Daha Husada Hospital, Kediri, East Java, Indonesia
| | - Yan-Chiao Mao
- School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Clinical Toxicology and Occupational Medicine, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Ramirez-Cruz MP, Smolinske SC, Warrick BJ, Rayburn WF, Seifert SA. Envenomations during pregnancy reported to the national poison data system, 2009-2018. Toxicon 2020; 186:78-82. [PMID: 32771392 DOI: 10.1016/j.toxicon.2020.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/15/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Envenomations during pregnancy have consequences affecting both maternal and fetal outcomes. U.S. poison center data on envenomations offers a comparative view of envenomations in pregnant and non-pregnant women. The National Poison Data System of the American Association of Poison Control Centers was searched for cases of envenomation during pregnancy between January 1, 2009 and December 31, 2018 and compared with exposures to non-pregnant females of childbearing age. Odds ratios and descriptive statistics were used where appropriate. There were a total of 3,555 venomous animal exposures in pregnant women during this 10-year period, most commonly with scorpion stings. These were compared with 87,553 envenomations in non-pregnant women of childbearing age during that time period. Overall, drug treatment was administered in 350 (9.9%) cases of envenomation in pregnant women compared with 21,381 (24.4%) of non-pregnant patients. Antihistamines were less likely to be used in pregnant patients with scorpion (1.8% v. 9.2%), hymenoptera (bee, wasp, or hornet) (12.4% v. 37.1%), black widow spider (2.8% v. 8.1%), and caterpillar (10.4% v. 37.7%) exposures. There was an increased likelihood of antivenom use during pregnancy with rattlesnake envenomations (85.0% v. 58.9%) and black widow spider bites (4.8% v. 2.2%). There were no maternal deaths, and most maternal outcomes were coded as having no (1.0%) or minor (87.6%) effects. Three fetal deaths occurred, all following snakebites and all before 20 weeks gestation. Two were attributed as related, and one as of uncertain relationship to the exposure, by the managing poison centers. Most envenomations caused no or minor effects to pregnant women.
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Affiliation(s)
- M P Ramirez-Cruz
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - S C Smolinske
- New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - B J Warrick
- New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - W F Rayburn
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - S A Seifert
- New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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27
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Kularatne SAM, Colombage A, de Silva A, Weerasinghe V, Rathnayaka RMMKN. Acute neuromuscular paralysis, rhabdomyolysis and long lasting neurological deficits in Ceylon krait ( Bungarus ceylonicus) bites: Two authentic cases from a serpentarium in Sri Lanka. Toxicon X 2019; 4:100015. [PMID: 32550572 PMCID: PMC7286062 DOI: 10.1016/j.toxcx.2019.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/26/2019] [Accepted: 09/12/2019] [Indexed: 11/30/2022] Open
Abstract
The Ceylon krait (Bungarus ceylonicus) is a highly venomous elapid snake endemic to Sri Lanka. Its bites are rare and only seven reports are found in the literature. Therefore, the clinical manifestations and natural history of envenoming of Ceylon krait are not well studied yet. Neuroparalysis is the main clinical manifestation of their bites. We report two cases of proven Ceylon krait bites of two young snake keepers working in a serpentarium. They developed acute neuroparalysis, abdominal pain and a period of amnesia. The first patient developed myalgia and increased level of serum creatine kinase suggestive of rhabdomyolysis. One was treated with Indian polyvalent antivenom and both recovered with some long-lasting clinical disabilities namely impairment of sensation of the bitten arm and persistent refraction errors in the eyes in the first patient. The second patient had persistent marked nystagmus. Ceylon krait (Bungarus ceylonicus) is endemic to Sri Lanka and bites rarely. Two authentic bites are described. Both developed neuromuscular paralysis manageable without assisted ventilation. Long lasting deficits were sensory impairment of bitten arm, refraction errors and nystagmus.
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Affiliation(s)
- S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | | | | | - Vajira Weerasinghe
- Teaching Hospital Peradeniya, Sri Lanka.,Department of Physiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - R M M K Namal Rathnayaka
- Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka.,Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka.,Postgraduate Institute of Medicine (Clinical Pharmacology and Therapeutics), University of Colombo, Sri Lanka
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM. Systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (Hypnale hypnale) envenoming: A case report from Sri Lanka. Toxicon 2019; 170:21-8. [PMID: 31513811 DOI: 10.1016/j.toxicon.2019.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022]
Abstract
Out of seven venomous land snake species of Sri Lanka, hump-nosed pit viper (Hypnale spp.) causes the commonest venomous snakebites. It is widely distributed all over the country except in the peninsula of Jaffna. The genus has three species naming H. hypnale, H. zara and H. nepa. They frequently cause local envenoming and rarely cause coagulopathy and acute kidney injury. Systemic bleeding is the most trivial complication associated with coagulopathy caused by these snakes and pulmonary haemorrhages are one of them which are rarely reported. Antivenoms are currently not available for genus Hypnale bites in Sri Lanka. We describe a fatal case of pulmonary haemorrhage caused by a proven hump-nosed viper (Hypnale hypnale) bite associated with other systemic bleeding manifestations and thrombotic microangiopathy. This is the first known case of pulmonary and intracranial haemorrhages caused by hump-nosed viper bite.
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Tchoffo D, Kamgno J, Kekeunou S, Yadufashije C, Nana Djeunga HC, Nkwescheu AS. High snakebite underreporting rate in the Centre Region of Cameroon: an observational study. BMC Public Health 2019; 19:1040. [PMID: 31376829 PMCID: PMC6679494 DOI: 10.1186/s12889-019-7363-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Cameroon, since the first epidemiological week held in 2015, snakebites have been registered among Potential Epidemic Diseases (PED). In the Centre Region, the most densely populated of the country, weekly reports of snakebites are generated at health districts level for monthly data updates. METHODS To contribute to the better management of snakebite cases, an observational study was conducted to assess the snakebite reporting rate in the Centre Region of Cameroon. The results of this retro-prospective survey were confronted to those of the weekly epidemiological surveillance system, recorded in the PED regional data base. RESULTS The incidence of bites was relatively high (36.6 bites per 100,000 inhabitants), as well as the general attack rate (about 49 envenomations per 100 victims). The lethality recorded was 2.5% and the mortality was about 1 death per 100,000 inhabitants a year. The sex ratio was largely female biased (61.6%). The bites occurred mostly during the rainy season (73.0%). Bitten victims were mainly farmers (47.4%), and agriculture was the main risk factor. The comparative analysis of the data suggested a high non-reporting rate of snakebite cases (67.8%). CONCLUSION Snakebite is an endemic condition in the Centre Region of Cameroon. Because of the high rate of non-reporting of cases, the collection of information from the registers of the health facilities only appears not enough to assess the real importance of envenomation in this Region.
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Affiliation(s)
- Désiré Tchoffo
- Faculty of Health and Life Science, Distant Production House University (DPHU), Delaware, USA.
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon.,Department of Public Health, Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
| | - Sévilor Kekeunou
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Hugues C Nana Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon.,Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Armand Séraphin Nkwescheu
- Laboratory of Public Health for Biotechnology and Research, University of Yaoundé I, Yaoundé, Cameroon
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Martín-Sierra C, Nogué-Xarau S, Pinillos Echeverría MÁ, Rey Pecharromán JM. Snakebite poisoning in Spain. Emergencias 2019; 30:126-132. [PMID: 29547237] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Emergencies due to snakebites, although unusual in Spain, are potentially serious. Of the 13 species native to the Iberian peninsula, only 5 are poisonous: 2 belong to the Colubridae family and 3 to the Viperidae family. Bites from these venemous snakes can be life-threatening, but the venomous species can be easily identified by attending to certain physical traits. Signs denoting poisoning from vipers, and the appropriate treatment to follow, have changed in recent years.
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Fernandes FH, Bustos-Obregon E, Matias R, Dourado DM. Crotalus durissus sp. rattlesnake venom induces toxic injury in mouse sperm. Toxicon 2018; 153:17-18. [PMID: 30149042 DOI: 10.1016/j.toxicon.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 11/19/2022]
Abstract
Accidents involving snakebites constitute a serious public health problem in many regions around the world. However, there are no study about a possible action of snake venom on the reproductive system. Herein we show that Crotalus durissus sp. (Linnaeus) rattlesnake venom (25 μg/kg of body weight) affected chromatin condensation, and increased the number of sperm with abnormal morphology and the sperm count. In conclusion, besides the known hazards of the C. durissus sp. venom to animal health, this study was the first to show its effect also on male germ cells.
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Affiliation(s)
- Fábio Henrique Fernandes
- São Paulo State University - UNESP, Medical School, Department of Pathology, Rubião Junior, 18618-000, Botucatu, São Paulo, Brazil.
| | | | - Rosemary Matias
- Anhanguera-Uniderp University, Environment and Regional Development, Postgraduate Program, R. Alexandre Herculano, 1400, 79037-280, Campo Grande, Mato Grosso do Sul, Brazil.
| | - Doroty Mesquita Dourado
- Anhanguera-Uniderp University, Laboratory of Toxinology and Medicinal Plants, R. Alexandre Herculano, 1400, 79037-280. Campo Grande, Mato Grosso do Sul, Brazil.
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Strauch MA, Souza GJ, Pereira JN, Ramos TDS, Cesar MO, Tomaz MA, Monteiro-Machado M, Patrão-Neto FC, Melo PA. True or false coral snake: is it worth the risk? A Micrurus corallinus case report. J Venom Anim Toxins Incl Trop Dis 2018; 24:10. [PMID: 29651298 PMCID: PMC5894131 DOI: 10.1186/s40409-018-0148-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.
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Affiliation(s)
- Marcelo Abrahão Strauch
- Vital Brazil Institute, Niterói, RJ Brazil.,2Laboratory of Pharmacology of Toxins, Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Guilherme Jones Souza
- Vital Brazil Institute, Niterói, RJ Brazil.,4Postgraduate Program in Teaching of Science, Environment and Society, Rio de Janeiro State University, Rio de Janeiro, RJ Brazil
| | | | | | - Marcelo Oliveira Cesar
- Vital Brazil Institute, Niterói, RJ Brazil.,2Laboratory of Pharmacology of Toxins, Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Marcelo Amorim Tomaz
- 2Laboratory of Pharmacology of Toxins, Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Marcos Monteiro-Machado
- 2Laboratory of Pharmacology of Toxins, Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Fernando Chagas Patrão-Neto
- 2Laboratory of Pharmacology of Toxins, Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Paulo A Melo
- 2Laboratory of Pharmacology of Toxins, Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ Brazil
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Tsai YH, Hsu WH, Huang KC, Yu PA, Chen CL, Kuo LT. Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan. Int J Infect Dis 2017; 63:30-36. [PMID: 28811229 DOI: 10.1016/j.ijid.2017.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/03/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis. METHODS Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups. RESULTS None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae (p=0.000), patients with underlying chronic disease (p=0.019), white blood cell counts (p=0.035), segmented white cell counts (p=0.02), and days of hospitalization (p=0.001). CONCLUSIONS Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm3 and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.
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Affiliation(s)
- Yao-Hung Tsai
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China.
| | - Wei-Hsiu Hsu
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
| | - Pei-An Yu
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China
| | - Chi-Lung Chen
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
| | - Liang Tseng Kuo
- Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospita, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China
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Johnston CI, Ryan NM, Page CB, Buckley NA, Brown SG, O'Leary MA, Isbister GK. The Australian Snakebite Project, 2005-2015 (ASP-20). Med J Aust 2017; 207:119-125. [PMID: 28764620 DOI: 10.5694/mja17.00094] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 01/31/2017] [Accepted: 06/08/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the epidemiology, treatment and adverse events after snakebite in Australia. DESIGN Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation. MAIN OUTCOME MEASURES Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths. RESULTS 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours). CONCLUSIONS Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.
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Namal Rathnayaka RMMK, Ranathunga PEAN, Kularatne SAM. Epidemiology and clinical features of Green pit viper (Trimeresurus trigonocephalus) envenoming in Sri Lanka. Toxicon 2017; 137:99-105. [PMID: 28735968 DOI: 10.1016/j.toxicon.2017.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/10/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022]
Abstract
Green pit viper is a venomous endemic snake in Sri Lanka. But little is known regarding its envenoming in the country. This study was carried out in order to find out epidemiology and clinical profile of its bites. A series of 17 patients with Sri Lankan Green pit viper (Trimeresurus trigonocephalus) bites was prospectively studied over 4 years. The mean age was 36 ½ years (range 12-61 years) and comprised 14 (82%) males. Except one case, all bites occurred during day time (0600 h-1800 h) due to inadvertent provocation. In 13 cases (76%) bite took place in estates (tea or cinnamon) and 8 patients (47%) were estate workers. The bitten sites were upper limbs in 11 cases (65%) and lower limbs in 6 cases (35%). Ten patients (59%) brought the offending snake to the hospital and one patient was asymptomatic. Sixteen (94%) developed local envenoming features- 16 (94%) local pain and swelling, 6 (35%) local bleeding and lymphadenopathy and blistering in 4 (24%) patients. Systemic envenoming developed in 4 (24%) patients including 3 (18%) with coagulopathy that was treated with fresh frozen plasma. One (6%) patient developed bradycardia. Sri Lankan Green pit viper bites commonly occurs in estates and causes local envenoming frequently and coagulopathy occasionally.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Provincial General Hospital, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka.
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Muhammed A, Dalhat MM, Joseph BO, Ahmed A, Nguku P, Poggensee G, Adeiza M, Yahya GI, Hamza M, Habib ZG, Oladimeji AM, Nasidi A, Balla A, Nashabaru I, Sani-Gwarzo N, Yakasai AM, Difa JA, Sheikh TL, Habib AG. Predictors of depression among patients receiving treatment for snakebite in General Hospital, Kaltungo, Gombe State, Nigeria: August 2015. Int J Ment Health Syst 2017; 11:26. [PMID: 28413440 PMCID: PMC5390352 DOI: 10.1186/s13033-017-0132-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Snakebite though neglected, affects 5 million people yearly. More neglected is the psychological effect of envenomation. We determined prevalence and pattern of depression among patients admitted into snakebite wards of Kaltungo General Hospital Nigeria, and percentage recognized by clinicians. We also assessed for factors associated with depression. METHODS In a descriptive hospital based study, we used Patient Health questionnaire (PHQ-9) to make diagnosis of depression among the patients. We reviewed patients' clinical records to determine clinicians' recognition of depression. RESULTS Of 187 interviews analyzed, 47 (25%) had depression with none recognized by attending clinicians. Patients with snakebite complications (odd ratio [OR] 3.1, 95% CI 1.1-8.5), and previous history of snakebites (OR 2.7, 95% CI 1.1-6.1) were associated with mild depression. Worrying about family welfare (OR 31.5, 95% CI 6.5-152.9), financial loss (OR 14.6, 95% CI 1.8-121.5) and time loss (OR 14.6, 95% CI 1.8-121.5), past history of snakebites (OR 8.3, 95% CI 1.9-36.5) and lower income (Mean difference -25,069 [84 USD], 95% CI 35,509 [118 USD]-14,630 [49 USD]) were associated with severe depression. CONCLUSION A quarter of in-patients of snakebite wards of the general hospital had comorbid depression that went unrecognized. Independent predictors of depression such as past history of snakebite, worrying about relations and having snakebite complications could help clinicians anticipate depression among patients. We recommend training of clinicians in the hospital on recognition of common psychological disorders like depression.
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Affiliation(s)
- Abdulaziz Muhammed
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.,Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
| | - Mahmood M Dalhat
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Babalola O Joseph
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Abubakar Ahmed
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Gabriele Poggensee
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Mukthar Adeiza
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Garba I Yahya
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Muhammad Hamza
- Department of Medicine, Bayero University, Kano, Nigeria
| | - Zaiyad G Habib
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | - Abubakar Balla
- Kaltungo General Hospital, Kaltungo, Gombe State Nigeria
| | | | - Nasir Sani-Gwarzo
- Port Health Services, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Ahmad M Yakasai
- Public Health and Diagnostic Institute, College of Medical Sciences, Northwest University, Kano, Nigeria
| | | | - Taiwo Lateef Sheikh
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
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Namal Rathnayaka RMMK, Kularatne SAM, Ranathunga PEAN. Coagulopathy and extensive local swelling following Green pit viper (Trimeresurus trigonocephalus) envenoming in Sri Lanka. Toxicon 2017; 129:95-99. [PMID: 28216410 DOI: 10.1016/j.toxicon.2017.02.011] [Citation(s) in RCA: 7] [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: 01/23/2017] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
Trimeresurus trigonocephalus (Sri Lankan Green pit viper) is a moderately venomous arboreal snake endemic to Sri Lanka. Even though, its bites are not uncommon, published reports of such cases are limited to three in literature. We report three cases of coagulopathy following Green pit viper bites and treatment with fresh frozen plasma.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Provincial General Hospital, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka.
| | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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de la Rosa G, Pastor N, Alagón A, Corzo G. Synthetic peptide antigens derived from long-chain alpha-neurotoxins: Immunogenicity effect against elapid venoms. Peptides 2017; 88:80-86. [PMID: 28010961 DOI: 10.1016/j.peptides.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Abstract
Three-finger toxins (3FTXs), especially α-neurotoxins, are the most poorly neutralized elapid snake toxins by current antivenoms. In this work, the conserved structural similarity and motif arrangements of long-chain α-neurotoxins led us to design peptides with consensus sequences. Eight long-chain α-neurotoxins (also known as Type II) were used to generate a consensus sequence from which two peptides were chemically synthesized, LCP1 and LCP2. Rabbit sera raised against them were able to generate partially-neutralizing antibodies, which delayed mice mortality in neutralization assays against Naja haje, Dendrospis polylepis and Ophiophagus hannah venoms.
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Affiliation(s)
- Guillermo de la Rosa
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, UNAM, Apartado Postal 510-3, Cuernavaca Morelos 61500, Mexico
| | - Nina Pastor
- Centro de Investigación en Dinámica Celular, IICBA, UAEM, Av. Universidad 1001 Col. Chamilpa, Cuernavaca, Morelos 62209, Mexico
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, UNAM, Apartado Postal 510-3, Cuernavaca Morelos 61500, Mexico
| | - Gerardo Corzo
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, UNAM, Apartado Postal 510-3, Cuernavaca Morelos 61500, Mexico.
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Namal Rathnayaka RMMK, Kularatne SAM, Kumarasinghe KDM, Ranaweera J, Nishanthi Ranathunga PEA. Ischemic brain infarcts and intracranial haemorrhages following Russell's viper (Daboia russelii) bite in Sri Lanka. Toxicon 2017; 125:70-73. [PMID: 27871786 DOI: 10.1016/j.toxicon.2016.11.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/12/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
Snakebite is an important medical problem in Sri Lanka. Of the deadly venomous snakes, Russell's viper (Daboia russelii) is widely distributed and responsible for most of the fatalities of snakebite in the country. It is not uncommon to see atypical manifestations in Russell's viper bite. We report the events of intracranial haemorrhages and multiple ischemic brain infarcts following Russell's viper (Daboia russelii) bite of a previously healthy 43-years-old male who succumbed to envenoming.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Provincial General Hospital, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka.
| | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | | | - Janaka Ranaweera
- Intensive Care Unit, Provincial General Hospital, Ratnapura, Sri Lanka
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Ehelepola NDB, Samaranayake SMAN, Basnayake BMLS, Amiyangoda CGK, Dhanapala DMUCB, Kalupahana KLR. Multisystem failure and death due to extensive hemorrhaging and brain herniation subsequent to a bite by an unidentified snake. Trop Med Health 2016; 44:29. [PMID: 27651731 PMCID: PMC5022210 DOI: 10.1186/s41182-016-0029-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/04/2016] [Indexed: 11/24/2022] Open
Abstract
Background Snakebites cause considerable morbidity and mortality in tropical and subtropical countries even though existing treatment methods can prevent most deaths if presentation occurs early to hospitals. Envenomation by unidentified snakes is common in central Sri Lanka. Management of such patients is challenging especially if presentation is late. Case presentation Here, we report a case of a 52-year-old man from central Sri Lanka who presented late after being bitten by an unidentified snake. He developed `severe coagulopathy, neurotoxicity, acute kidney injury, and rhabdomyolysis. Subsequently, despite of treatment, he died due to extensive hemorrhaging in many organs. A large intracranial hemorrhage lead to fatal brain herniation. Conclusions Envenomation by some snake species can severely affect multiple body systems and give rise to fatal brain hemorrhages and brain herniation. Considering the known effects of local snake venom, the responsible species is likely to be Russell’s viper (Daboia russelii). We recommend some simple measures to reduce the chances of such deaths in the future.
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Silva TPD, Moura VMD, Souza MCSD, Santos VNC, Silva KAMMD, Mendes MGG, Nunez CV, Almeida PDOD, Lima ES, Mourão RHV, Dos-Santos MC. Connarus favosus Planch.: An inhibitor of the hemorrhagic activity of Bothrops atrox venom and a potential antioxidant and antibacterial agent. J Ethnopharmacol 2016; 183:166-175. [PMID: 26940897 DOI: 10.1016/j.jep.2016.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/29/2016] [Accepted: 02/28/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The plant species Connarus favosus is used in folk medicine in the west of Pará state, Brazil, to treat snakebites. AIM OF THE STUDY To investigate the potential of the aqueous extract of Connarus favosus (AECf) to inhibit hemorrhagic and phospholipase A2 activities induced by Bothrops atrox venom (BaV) and to determine the antioxidant and antimicrobial potentials of the extract. MATERIALS AND METHODS AECf was analyzed phytochemically for phenolics (condensed tannins and hydrolyzable tannins) by colorimetry. Antioxidant activity was evaluated by quantitative assays using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and Fe(3+)/phenanthroline. Antimicrobial activity was evaluated by the minimal inhibitory concentration test, and cytotoxicity was evaluated using human fibroblast cells (MRC-5). Inhibition of BaV-induced hemorrhagic activity was assessed after oral administration of the extract using pre-treatment, post-treatment and combined (BA plus AECf) treatment protocols. Inhibition of indirect hemolysis caused by phospholipase A2 (PLA2) was investigated in vitro. Interaction between AECf and BaV was investigated by SDS-PAGE electrophoresis, Western blot (Wb) and zymography. RESULTS The phytochemical profile of AECf revealed ten secondary metabolite classes, and colorimetry showed high total phenolic and total (condensed and hydrolyzable) tannin content. AECf exhibited high antioxidant and antimicrobial potentials. The IC50 for the cytotoxic effect was 51.91 (46.86-57.50)µg/mL. Inhibition of BaV-induced hemorrhagic activity was significant in all the protocols, and inhibition of PLA2 activity was significant with the two highest concentrations. The BaV/AECf mixture produced the same bands as BaV by itself in SDS-PAGE and Wb although the bands were much fainter. Zymography confirmed the proteolytic activity of BaV, but when the venom was pre-incubated with AECf this activity was blocked. CONCLUSION AECf was effective in reducing BaV-induced hemorrhagic activity when administered by the same route as that used in folk medicine and exhibited antioxidant and antimicrobial potentials.
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Affiliation(s)
- Thaís Pereira da Silva
- Programa Multi-Institucional de Pós-graduação em Biotecnologia, Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, AM, Brazil; Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, AM, Brazil.
| | - Valéria Mourão de Moura
- Programa Multi-Institucional de Pós-graduação em Biotecnologia, Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, AM, Brazil; Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, AM, Brazil
| | - Maria Carolina Scheffer de Souza
- Programa Multi-Institucional de Pós-graduação em Biotecnologia, Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, AM, Brazil; Laboratório de Bioprospecção e Biotecnologia - LABB, Instituto Nacional de Pesquisas da Amazônia-INPA, Manaus, AM, Brazil; Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, AM, Brazil
| | - Vanessa Neves Carvalho Santos
- Laboratório de Bioprospecção e Biotecnologia - LABB, Instituto Nacional de Pesquisas da Amazônia-INPA, Manaus, AM, Brazil
| | - Kissinara A M Moreira da Silva
- Laboratório de Bioprospecção e Biotecnologia - LABB, Instituto Nacional de Pesquisas da Amazônia-INPA, Manaus, AM, Brazil
| | - Mara Giselle Guimarães Mendes
- Laboratório de Bioprospecção e Biotecnologia - LABB, Instituto Nacional de Pesquisas da Amazônia-INPA, Manaus, AM, Brazil
| | - Cecília Verônica Nunez
- Programa Multi-Institucional de Pós-graduação em Biotecnologia, Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, AM, Brazil; Laboratório de Bioprospecção e Biotecnologia - LABB, Instituto Nacional de Pesquisas da Amazônia-INPA, Manaus, AM, Brazil
| | | | - Emerson Silva Lima
- Laboratório de Atividade Biológica - Biophar, Faculdade de Ciências Farmacêuticas, Universidade Federal do Amazonas, AM, Brazil
| | - Rosa Helena Veras Mourão
- Programa de Pós-graduação em Recursos Naturais da Amazônia, Laboratório de Bioprospecção e Biologia Experimental, Universidade Federal do Oeste do Pará, Santarém, PA, Brazil
| | - Maria Cristina Dos-Santos
- Programa Multi-Institucional de Pós-graduação em Biotecnologia, Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, AM, Brazil; Laboratório de Imunoquímica, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, AM, Brazil
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Kipanyula MJ, Kimaro WH. Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem. J Venom Anim Toxins Incl Trop Dis 2015; 21:32. [PMID: 26309444 DOI: 10.1186/s40409-015-0033-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/13/2015] [Indexed: 12/02/2022] Open
Abstract
Background Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions. Methods This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection. Results A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (χ2 = 4.6; p = 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p = 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years. Conclusion Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania.
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