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Saladini LY, Magalhães-Junior MJ, da Silva CCF, Oliveira PGC, Kodama RT, Gomes L, Nishiyama-Jr MY, Spencer PJ, da Silva WD, Portaro FCV. Evaluation of the Inhibitory Potential of Synthetic Peptides Homologous to CDR3 Regions of a Monoclonal Antibody against Bothropic Venom Serine Proteases. Int J Mol Sci 2024; 25:5181. [PMID: 38791221 DOI: 10.3390/ijms25105181] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Snakebite accidents, neglected tropical diseases per the WHO, pose a significant public health threat due to their severity and frequency. Envenomation by Bothrops genus snakes leads to severe manifestations due to proteolytic enzymes. While the antibothropic serum produced by the Butantan Institute saves lives, its efficacy is limited as it fails to neutralize certain serine proteases. Hence, developing new-generation antivenoms, like monoclonal antibodies, is crucial. This study aimed to explore the inhibitory potential of synthetic peptides homologous to the CDR3 regions of a monoclonal antibody targeting a snake venom thrombin-like enzyme (SVTLE) from B. atrox venom. Five synthetic peptides were studied, all stable against hydrolysis by venoms and serine proteases. Impressively, four peptides demonstrated uncompetitive SVTLE inhibition, with Ki values ranging from 10-6 to 10-7 M. These findings underscore the potential of short peptides homologous to CDR3 regions in blocking snake venom toxins, suggesting their promise as the basis for new-generation antivenoms. Thus, this study offers potential advancements in combatting snakebites, addressing a critical public health challenge in tropical and subtropical regions.
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Affiliation(s)
- Lucas Yuri Saladini
- Laboratory of Structure and Function of Biomolecules, Butantan Institute, São Paulo 05503-900, Brazil
| | | | | | | | - Roberto Tadashi Kodama
- Laboratory of Structure and Function of Biomolecules, Butantan Institute, São Paulo 05503-900, Brazil
| | - Lais Gomes
- Laboratory of Structure and Function of Biomolecules, Butantan Institute, São Paulo 05503-900, Brazil
| | - Milton Yutaka Nishiyama-Jr
- Laboratory of Applied Toxinology, Center of Toxins, Immune-Response and Cell Signaling (CeTICS), Instituto Butantan, São Paulo 05503-900, Brazil
| | - Patrick Jack Spencer
- Biotechnology Center, Nuclear and Energy Research Institute (IPEN/CNEN/SP), São Paulo 05503-900, Brazil
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Davi SD, Lumeka A, Hildebrandt TR, Endamne LR, Otchague C, Okwu DG, Artus R, Hunstig F, Manego RZ, Blessmann J, Kremsner PG, Lell B, Mombo-Ngoma G, Agnandji ST, Ramharter M, Kreuels B. Assessing the Incidence of Snakebites in Rural Gabon-A Community-Based, Cross-Sectional Pilot Survey. Trop Med Infect Dis 2024; 9:68. [PMID: 38668529 PMCID: PMC11053831 DOI: 10.3390/tropicalmed9040068] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
Snakebite envenoming (SBE) is a neglected tropical disease (NTD). Community-based studies from sub-Saharan Africa are urgently required as data on the incidence are scarce. This study aimed to determine the lifetime prevalence of snakebites in rural Gabon by preparing the conduct of a larger regional survey. A cross-sectional community-based epidemiological survey in Sindara, Ngounie province, was conducted. Households were interviewed about the history of snakebites of household members to calculate lifetime prevalence. In addition, the average annual incidence rate per 100,000 over the last 5 years was calculated. A total of 771 inhabitants were enrolled, of which 5 (0.65%; 95% confidence interval (95% CI: 0.2-1.5%)) were victims of snakebites. Over the past 5 years, annual incidence was 77 bites per 100,000 (95% CI: 0-620). This study provides a first rough estimate of the incidence of SBE from rural central Gabon, demonstrating the importance of this NTD. Key Contribution: The estimated annual incidence of snakebites found was 77 per 100,000. Snakebites occurred mainly during agricultural activities.
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Affiliation(s)
- Saskia Dede Davi
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, 20359 Hamburg, Germany
| | - Anita Lumeka
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Teite Rebecca Hildebrandt
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Lilian Rene Endamne
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
| | - Cedric Otchague
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Dearie Glory Okwu
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Rica Artus
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
| | - Friederike Hunstig
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
| | - Rella Zoleko Manego
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Jörg Blessmann
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, 72016 Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Research Group Drug Implementation, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Michael Ramharter
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, 20359 Hamburg, Germany
| | - Benno Kreuels
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, 20359 Hamburg, Germany
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
- Division for Tropical Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany
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Méndez-Molina R, Villela-Oriza AK, Espinosa-Couoh AA, Huchim-Lara O. Snakebites epidemiology in Mexico: a 13-year ecological analysis. Trans R Soc Trop Med Hyg 2024; 118:118-126. [PMID: 37746875 DOI: 10.1093/trstmh/trad070] [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: 05/13/2023] [Revised: 06/30/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Globally, snakebites have a significant impact on public health and represent substantial costs for health services. Their severity is particularly relevant in developing countries due to the lack of resources and accessibility to health facilities. Additionally, the number of cases may be underestimated, highlighting the urgent need for improved prevention measures. METHODS An observational ecological study was undertaken using the records identified with X200-X209 codes registered in the Ministry of Health injuries database during 2010-2022. Variables included information related to the patient, the snakebite and the healthcare provided. Statistical analysis was carried out with STATA 16 and Microsoft Excel 2020. RESULTS A total of 10 420 snakebites were registered. The average number of cases per year was 788 (IQR 615, 875) and 82.74% occurred during the rainy season. The median age was 35 (IQR 19, 52) y and early adulthood was the most affected age group; bites were most common on the hand and in the living place. The Eastern region of Mexico registered the highest number of cases, with 3496 (33.71%) of snakebites. The lethality rate was 18.23 per 10 000. CONCLUSIONS Snakebites are a significant health problem in Mexico. Most injuries occur among men in early adulthood, in households and in the upper extremities.
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Cavecci-Mendonça B, Luciano KM, Vaccas T, de Oliveira LA, Clemente EF, Rossini BC, Vieira JCS, de Barros LC, Biondi I, de Magalhães Padilha P, dos Santos LD. Preliminary Insights of Brazilian Snake Venom Metalloproteomics. Toxins (Basel) 2023; 15:648. [PMID: 37999511 PMCID: PMC10675094 DOI: 10.3390/toxins15110648] [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: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Snakebite envenoming is one of the most significantly neglected tropical diseases in the world. The lack of diagnosis/prognosis methods for snakebite is one of our motivations to develop innovative technological solutions for Brazilian health. The objective of this work was to evaluate the protein and metallic ion composition of Crotalus durissus terrificus, Bothrops jararaca, B. alternatus, B. jararacussu, B. moojeni, B. pauloensis, and Lachesis muta muta snake venoms. Brazilian snake venoms were subjected to the shotgun proteomic approach using mass spectrometry, and metal ion analysis was performed by atomic spectrometry. Shotgun proteomics has shown three abundant toxin classes (PLA2, serine proteases, and metalloproteinases) in all snake venoms, and metallic ions analysis has evidenced that the Cu2+ ion is present exclusively in the L. m. muta venom; Ca2+ and Mg2+ ions have shown a statistical difference between the species of Bothrops and Crotalus genus, whereas the Zn2+ ion presented a statistical difference among all species studied in this work. In addition, Mg2+ ions have shown 42 times more in the C. d. terrificus venom when compared to the average concentration in the other genera. Though metal ions are a minor fraction of snake venoms, several venom toxins depend on them. We believe that these non-protein fractions are capable of assisting in the development of unprecedented diagnostic devices for Brazilian snakebites.
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Affiliation(s)
- Bruna Cavecci-Mendonça
- Biotechnology Institute (IBTEC), São Paulo State University (UNESP), Botucatu 18607-440, SP, Brazil; (B.C.-M.); (B.C.R.)
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (T.V.); (L.A.d.O.)
- Triad for Life Ltda, Prospecta–Botucatu Technological Incubator, Botucatu 18610-034, SP, Brazil
| | - Karen Monique Luciano
- Center of Studies of Venoms and Animals Venomous (CEVAP), São Paulo State University (UNESP), Botucatu 18619-002, SP, Brazil; (K.M.L.); (L.C.d.B.)
| | - Tauane Vaccas
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (T.V.); (L.A.d.O.)
| | - Laudicéia Alves de Oliveira
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (T.V.); (L.A.d.O.)
| | - Eloisa Fornaro Clemente
- Graduate Program in Research and Development (Medical Biotechnology), Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil;
| | - Bruno Cesar Rossini
- Biotechnology Institute (IBTEC), São Paulo State University (UNESP), Botucatu 18607-440, SP, Brazil; (B.C.-M.); (B.C.R.)
- Department of Chemical and Biological Sciences, Institute of Biosciences (IBB), São Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil; (J.C.S.V.); (P.d.M.P.)
| | - José Cavalcante Souza Vieira
- Department of Chemical and Biological Sciences, Institute of Biosciences (IBB), São Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil; (J.C.S.V.); (P.d.M.P.)
| | - Luciana Curtolo de Barros
- Center of Studies of Venoms and Animals Venomous (CEVAP), São Paulo State University (UNESP), Botucatu 18619-002, SP, Brazil; (K.M.L.); (L.C.d.B.)
| | - Ilka Biondi
- Laboratory of Venomous Animals and Herpetology, State University of Feira de Santana (UEFS), Feira de Santana 44036-900, BA, Brazil;
| | - Pedro de Magalhães Padilha
- Department of Chemical and Biological Sciences, Institute of Biosciences (IBB), São Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil; (J.C.S.V.); (P.d.M.P.)
| | - Lucilene Delazari dos Santos
- Biotechnology Institute (IBTEC), São Paulo State University (UNESP), Botucatu 18607-440, SP, Brazil; (B.C.-M.); (B.C.R.)
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (T.V.); (L.A.d.O.)
- Graduate Program in Research and Development (Medical Biotechnology), Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil;
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM. Long-term health manifestations of hump-nosed pit viper (Genus: Hypnale) bites. Clin Toxicol (Phila) 2023; 61:680-686. [PMID: 37882639 DOI: 10.1080/15563650.2023.2265549] [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: 04/29/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION The hump-nosed pit viper (Genus: Hypnale) is a highly medically significant snake in Sri Lanka, responsible for the majority of venomous snakebites (22-77%). They are found throughout Sri Lanka and the Western Ghats region of India. The venom can lead to two types of effects: acute and long-term. Acutely, bites often result in local symptoms, with less common systemic effects such as acute kidney injury, venom-induced consumption coagulopathy, and thrombotic microangiopathy. METHODS We conducted a prospective observational study at Teaching Hospital Ratnapura, Sri Lanka, spanning six years, starting in June 2015. Patients bitten by hump-nosed pit vipers were followed up for two years, with assessments every three months to identify long-term effects. Data was gathered through interviewer-administered questionnaires. RESULTS Out of 728 patients bitten by hump-nosed pit vipers, 22 (3%) were lost to follow-up. Forty-four (6.2%) experienced long-term effects, including chronic kidney disease (24; 3.4%), chronic wounds (five; 0.7%), amputations (five; 0.7%), fasciotomy-related wounds (four; 0.6%), and psychological illnesses (four; 0.6%). There were nine (1.3%) deaths in this group. Among those with chronic effects, 27 (61%) were males, and 17 (39%) were females, with ages ranging from 29 to 82 years (mean 57.6 years). The time it took to diagnose acute kidney injury from the snakebite was 18 h (interquartile range: 15-23.5 h), while the time to diagnose chronic kidney disease was 69 days (interquartile range: 64-74.75 days). In these patients, the estimated glomerular filtration rate was 29.3 mL/min/1.73 m2 (interquartile range: 14-50.75 mL/min/1.73 m2). Among the patients who did not develop long-term complications (662; 91%) 660 (90.7%) experienced local effects, and 82 (11.3%) developed systemic manifestations, including acute kidney injury in 60 (8%) and coagulopathy in 35 (5%). CONCLUSION Following hump-nosed pit viper bites, a subset of patients may experience long-term health complications, including chronic kidney disease, chronic ulcers, amputations, fasciotomy-related wounds, and psychological illnesses, with chronic kidney disease being the most frequently observed among these manifestations.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, 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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Guile L, Lee A, Gutiérrez JM. Factors associated with mortality after snakebite envenoming in children: a scoping review. Trans R Soc Trop Med Hyg 2023; 117:617-627. [PMID: 37264929 PMCID: PMC10472879 DOI: 10.1093/trstmh/trad031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
Snakebite envenoming is an important public health issue in many tropical and subtropical countries, where the burden of morbidity and mortality falls particularly on impoverished rural communities. Children are an especially vulnerable group. This scoping review provides an overview of the extent, type and content of peer-reviewed evidence regarding factors associated with mortality in snakebite-envenomed children. A comprehensive literature search of MEDLINE and the Global Index Medicus yielded 623 articles, of which 15 met the criteria for inclusion; 67% of studies were conducted in India, with the remaining studies taking place in Papua New Guinea, Morocco and The Gambia. There was a notable scarcity of eligible studies from sub-Saharan Africa and Latin America despite the high burden of envenoming in these regions. The risk factors for mortality that were identified by the greatest number of studies were younger patient age (n=4), delay in administration of antivenom (n=4) and acute kidney injury (n=3). Identification of poor prognostic factors can assist clinicians in making timely referrals to centres with paediatric critical care capability. Future research must address the lack of studies from key geographical regions so that evidence-based improvements to the care of this vulnerable group can be implemented.
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Affiliation(s)
- Lucy Guile
- Peninsula Medical School, University of Plymouth, Plymouth PL6 8BU, UK
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Adrienne Lee
- Peninsula Medical School, University of Plymouth, Plymouth PL6 8BU, UK
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - José María Gutiérrez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San José 11501, Costa Rica
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Cavalcante TTA, de Souza MBS, Neves JCF, Ibiapina HNS, Barbosa FBA, Bentes KO, Alves EC, Marques HO, Colombini M, Sampaio SV, Pucca MB, da Silva IM, Ferreira LCDL, Sampaio VDS, Moura-da-Silva AM, Costa AG, Monteiro WM, Sachett JAG, Sartim MA. Inflammatory Profile Associated with Secondary Infection from Bothrops atrox Snakebites in the Brazilian Amazon. Toxins (Basel) 2023; 15:524. [PMID: 37755950 PMCID: PMC10537699 DOI: 10.3390/toxins15090524] [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: 07/17/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
Bothrops snakebite envenomation (SBE) is consider an important health problem in Brazil, where Bothrops atrox is mainly responsible in the Brazilian Amazon. Local effects represent a relevant clinical issue, in which inflammatory signs and symptoms in the bite site represent a potential risk for short and long-term disabilities. Among local complications, secondary infections (SIs) are a common clinical finding during Bothrops atrox SBE and are described by the appearance of signs such as abscess, cellulitis or necrotizing fasciitis in the affected site. However, the influence of SI in the local events is still poorly understood. Therefore, the present study describes for the first time the impact of SBE wound infection on local manifestations and inflammatory response from patients of Bothrops atrox SBE in the Brazilian Amazon. This was an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (Brazil), involving victims of Bothrops SBE. Clinical and laboratorial data were collected along with blood samples for the quantification of circulating cytokines and chemokines before antivenom administrations (T0) and 24 h (T1), 48 h (T2), 72 h (T3) and 7 days after (T4). From the 94 patients included in this study, 42 presented SI (44.7%) and 52 were without SI (NSI, 55.3%). Patients classified as moderate envenoming presented an increased risk of developing SI (OR = 2.69; CI 95% = 1.08-6.66, p = 0.033), while patients with bites in hands showed a lower risk (OR = 0.20; CI 95% = 0.04-0.96, p = 0.045). During follow-up, SI patients presented a worsening of local temperature along with a sustained profile of edema and pain, while NSI patients showed a tendency to restore and were highlighted in patients where SI was diagnosed at T2. As for laboratorial parameters, leukocytes, erythrocyte sedimentation ratio, fibrinogen and C-reactive protein were found increased in patients with SI and more frequently in patients diagnosed with SI at T3. Higher levels of circulating IL-2, IL-10, IL-6, TNF, INF-γ and CXCL-10 were observed in SI patients along with marked correlations between these mediators and IL-4 and IL-17, showing a plurality in the profile with a mix of Th1/Th2/Th17 response. The present study reports for the first time the synergistic effects of local infection and envenoming on the inflammatory response represented by local manifestations, which reflected on laboratorial parameters and inflammatory mediators and thus help improve the clinical management of SI associated to Bothrops SBE.
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Affiliation(s)
- Távila Tatiane Amorim Cavalcante
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
| | | | - Juliana Costa Ferreira Neves
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
| | | | | | - Karolaine Oliveira Bentes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
| | - Eliane Campos Alves
- Instituto Federal de Educação, Ciência e Tecnologia do Amazonas-IFAM, Manaus 69025-010, Brazil
| | - Hedylamar Oliveira Marques
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas-HEMOAM, Manaus 69050-001, Brazil
| | - Monica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, Brazil
| | - Suely Vilela Sampaio
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo-USP, Ribeirão Preto 14040-903, Brazil
| | - Manuela Berto Pucca
- Curso de Medicina, Universidade Federal de Roraima-UFRR, Boa Vista 69310-000, Brazil
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidaed Estadual Paulista-UNESP, Araraquara 14800-903, Brazil
| | - Iran Mendonça da Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | | | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas-HEMOAM, Manaus 69050-001, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado–FMT-HVD, Manaus 69040-000, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas-UFAM, Manaus 69080-900, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas-UEA, Manaus 69040-000, Brazil (J.A.G.S.)
- Pró-Reitoria de Pesquisa e Pós-Graduação, Universidade Nilton Lins, Manaus 69058-030, Brazil
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Reyes A, Hatcher JD, Salazar E, Galan J, Iliuk A, Sanchez EE, Suntravat M. Proteomic Profiling of Extracellular Vesicles Isolated from Plasma and Peritoneal Exudate in Mice Induced by Crotalus scutulatus scutulatus Crude Venom and Its Purified Cysteine-Rich Secretory Protein (Css-CRiSP). Toxins (Basel) 2023; 15:434. [PMID: 37505703 PMCID: PMC10467150 DOI: 10.3390/toxins15070434] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Increased vascular permeability is a frequent outcome of viperid snakebite envenomation, leading to local and systemic complications. We reported that snake venom cysteine-rich secretory proteins (svCRiSPs) from North American pit vipers increase vascular permeability both in vitro and in vivo. They also induce acute activation of several adhesion and signaling molecules that may play a critical role in the pathophysiology of snakebites. Extracellular vesicles (EVs) have gained interest for their diverse functions in intercellular communication, regulating cellular processes, blood-endothelium interactions, vascular permeability, and immune modulation. They also hold potential as valuable biomarkers for diagnosing, predicting, and monitoring therapeutic responses in different diseases. This study aimed to identify proteins in peritoneal exudate and plasma EVs isolated from BALB/c mice following a 30 min post-injection of Crotalus scutulatus scutulatus venom and its purified CRiSP (Css-CRiSP). EVs were isolated from these biofluids using the EVtrap method. Proteomic analysis of exudate- and plasma-derived EVs was performed using LC-MS/MS. We observed significant upregulation or downregulation of proteins involved in cell adhesion, cytoskeleton rearrangement, signal transduction, immune responses, and vesicle-mediated transports. These findings suggest that svCRiSPs play a crucial role in the acute effects of venom and contribute to the local and systemic toxicity of snakebites.
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Affiliation(s)
- Armando Reyes
- National Natural Toxins Research Center (NNTRC), Texas A&M University-Kingsville, MSC 224, 975 West Avenue B, Kingsville, TX 78363, USA; (A.R.); (J.D.H.); (E.S.); (E.E.S.)
| | - Joseph D. Hatcher
- National Natural Toxins Research Center (NNTRC), Texas A&M University-Kingsville, MSC 224, 975 West Avenue B, Kingsville, TX 78363, USA; (A.R.); (J.D.H.); (E.S.); (E.E.S.)
| | - Emelyn Salazar
- National Natural Toxins Research Center (NNTRC), Texas A&M University-Kingsville, MSC 224, 975 West Avenue B, Kingsville, TX 78363, USA; (A.R.); (J.D.H.); (E.S.); (E.E.S.)
| | - Jacob Galan
- Department of Human Genetics, The University of Texas Rio Grande Valley School of Medicine, Brownsville, TX 78539, USA;
| | - Anton Iliuk
- Tymora Analytical Operations, West Lafayette, IN 47906, USA;
| | - Elda E. Sanchez
- National Natural Toxins Research Center (NNTRC), Texas A&M University-Kingsville, MSC 224, 975 West Avenue B, Kingsville, TX 78363, USA; (A.R.); (J.D.H.); (E.S.); (E.E.S.)
- Department of Chemistry, Texas A&M University-Kingsville, MSC 161, Kingsville, TX 78363, USA
| | - Montamas Suntravat
- National Natural Toxins Research Center (NNTRC), Texas A&M University-Kingsville, MSC 224, 975 West Avenue B, Kingsville, TX 78363, USA; (A.R.); (J.D.H.); (E.S.); (E.E.S.)
- Department of Chemistry, Texas A&M University-Kingsville, MSC 161, Kingsville, TX 78363, USA
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Lertsakulbunlue S, Suebtuam R, Eamchotchawalit T, Chantkran W, Chaisakul J. Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand. Trop Med Infect Dis 2023; 8:346. [PMID: 37505642 PMCID: PMC10383512 DOI: 10.3390/tropicalmed8070346] [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: 06/14/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Snakebite envenoming is an occupational hazard in remote rural areas of South Thailand, where the highest incidence of snakebites is reported. In this work, a hospital-based retrospective study of snakebite patients from 2012 to 2022 at Fort Wachirawut Hospital and Fort Thepsatrisrisunthon Hospital, located in Nakhon Si Thammarat province, Thailand was conducted. Data from the laboratory investigation, physical examinations of snakebite victims, and clinical management, including pharmacological and non-pharmacological treatments, were evaluated. A total of 54 snakebite victims were included. The median age of patients was 49 years (IQR, 28 to 63). Males accounted for 74.1% of all participants. The majority of patients were bitten by Malayan pit vipers (68.5%), followed by unidentified snakes (18.5%), other non-venomous snakes (7.4%), and cobras (5.6%). The most common clinical manifestations were swelling (90.2%) and local pain (73.2%). One patient experienced respiratory failure following an envenoming by an unidentified venomous snake. No deaths were observed in this study. In total, 24 patients received antivenom administration (44.4%), most of whom were from Fort Wachirawut Hospital. Patients who were administered antivenom showed a median admission duration of three days (IQR, 3 to 4), compared with two days (IQR, one to three) for those who did not receive antivenom treatment (p < 0.001). In addition, paracetamol and prophylactic antibiotics, namely, amoxicillin-clavulanate and dicloxacillin, were the most common pharmacotherapies following snakebites. Overall, it was observed that these two community hospitals undertook appropriate clinical management under the standard guidelines for snakebite patients. This might be due to the effective emergency management, facilities, and clinical consultations. Finally, the management process in the medical teams also plays a crucial role in minimizing the severity of snakebite outcomes.
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Affiliation(s)
| | | | | | - Wittawat Chantkran
- Department of Pathology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Janeyuth Chaisakul
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
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Wafula ST, Mugume IB, Namakula LN, Nalugya A, Naggayi V, Walekhwa AW, Musoke D. Healthcare practitioners' knowledge of snakebite management and associated factors in high-burden, low-resource settings in Uganda. Trans R Soc Trop Med Hyg 2023:7128317. [PMID: 37072287 DOI: 10.1093/trstmh/trad015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/21/2023] [Accepted: 03/10/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Snakebites cause significant morbidity and mortality in Uganda. Effective management of snakebites requires knowledge of the appropriate first aid measures, as well as knowledge of the appropriate antivenom to use, but little is known about familiarity with effective snakebite management techniques and associated factors among healthcare practitioners (HCPs) in Uganda. METHODS In May 2022, we collected data on sociodemographic characteristics, knowledge of snakebite first aid, envenomation signs, diagnosis and antivenom administration among 311 HCPs from two snakebite high-incidence districts in Uganda using a semi-structured questionnaire. RESULTS Of the 311 HCPs, 64.3% had ever treated snakebite cases, 87.1% were confident to provide supportive treatment, but only 9.6% had ever been trained on snakebite management. Overall, 22.8% of HCPs had high knowledge of snakebite management. Higher education (at least degree vs certificate; PR=2.21 95% CI 1.508 to 4.56), older age (30-45 vs <30 y; PR=1.97, 95% CI 1.22 to 3.21) and previous training (PR=1.82, 95% CI 1.08 to 3.05) were associated with high knowledge of snakebite diagnosis and management. CONCLUSIONS Overall, knowledge of snakebite management was limited. Training, level of education and age of the HCP all had an impact on knowledge. Deliberate efforts are required to increase HCPs' knowledge of snakebite case care in high-burden regions to manage incident cases.
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Affiliation(s)
- Solomon T Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, 7072, Kampala, Uganda
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute of Tropical Medicine, D-20359, Hamburg, Germany
| | | | - Lydia N Namakula
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, 7072, Kampala, Uganda
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, 7072, Kampala, Uganda
| | - Vencia Naggayi
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, 7072, Kampala, Uganda
| | - Abel W Walekhwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, 7072, Kampala, Uganda
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, CB3 0ES, Cambridge, UK
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, 7072, Kampala, Uganda
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Yeh H, Gao SY, Lin CC. Wound Infection of Snakebite from Venomous Protobothrops mucrosquamatus, Viridovipera stejnegeri and Naja atra in Taiwan: Validation of BITE and Cobra BITE Scoring Systems and their Bacteriological Differences in Wound Cultures. Toxins (Basel) 2023; 15:78. [PMID: 36668897 PMCID: PMC9861491 DOI: 10.3390/toxins15010078] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Patients bitten by Protobothrops mucrosquamatus, Viridovipera stejnegeri, and Naja atra develop different degrees of wound infection. This study validated BITE and Cobra BITE scoring systems that we established previously. Bacteriological studies of patients with wound infection were conducted. The operating characteristic curves and area under the curve (AUC) and wound infection rates were compared between the derivation set (our previous study patient population) and the validation set (new patient cohorts enrolled between June 2017 and May 2021). No significant differences in the AUC for both the BITE (0.84 vs. 0.78, p = 0.27) and Cobra BITE (0.88 vs. 0.75, p = 0.21) scoring systems were observed between the derivation and validation sets. Morganella morganii and Enterococcus faecalis were the two most commonly detected bacteria in the microbiological study. More bacterial species were cultured from N. atra-infected wounds. Antibiotics such as amoxicillin with clavulanic acid, oxacillin, and ampicillin may not be suitable for treating patients with P. mucrosquamatus, V. stejnegeri, and N. atra bites in Taiwan. Carbapenem, third-generation cephalosporins, and fluoroquinolone may be superior alternatives.
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Affiliation(s)
- Heng Yeh
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shi-Ying Gao
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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12
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Abdullahi A, Yusuf N, Debella A, Eyeberu A, Deressa A, Bekele H, Ketema I, Abdulahi IM, Weldegebreal F. Seasonal variation, treatment outcome, and its associated factors among the snakebite patients in Somali region, Ethiopia. Front Public Health 2022; 10:901414. [PMID: 36276393 PMCID: PMC9583943 DOI: 10.3389/fpubh.2022.901414] [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: 03/21/2022] [Accepted: 08/09/2022] [Indexed: 01/22/2023] Open
Abstract
Background Snakebite is a major cause of mortality and morbidity in many areas, particularly in the rural tropics, and is a major public health problem around the world. It also imposes significant economic burdens on snakebite victims due to treatment-related expenses and lost productivity. Objective The purpose of this study was to assess seasonal variation, treatment outcomes, and its associated factors among snakebite in Denan health center in the Somali region, Ethiopia. Method A facility-based cross-sectional study was conducted from 10 to 30 September 2020 in Denan health center, Somali region, Ethiopia. All snakebite cases in Denan health center from 1 September 2015 to 31 August 2020 were included. Data were collected using a pre-tested structured checklist from the patient cards. Data were entered into EpiData version 3.1 and analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported by proportion with 95% confidence interval (CI) and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at p-value < 0. 05. Result The overall prevalence of poor outcome of venomous snakebites was 31.4% (95% CI 26.3% 35.4%). Study participants with an age of less than 10 years old (AOR = 2.01; 95% CI 1.39, 4.05), age between 10 and 30 years old (AOR = 2.06; 95% CI 1.39, 9.30), arrival times greater than or equal to 6 hours (AOR = 2.37; 95% CI 1.39, 4.05), and timing of snakebite (AOR = 0.49; 95% CI 0.31-0.87) were factors found to be significantly associated with poor treatment outcome. Conclusion According to this study, about one in every three snakebite patients have a poor outcome. Patients with poor outcomes were those who did not improve as a result of treatment or died as a result of it. Designing appropriate engagement of public health education about snakebite prevention techniques, particularly during entry and exit of rainy seasons and establishment of appropriate case management protocol is strongly recommended, as well as increasing the accessibility or availability of antivenoms will undoubtedly have a significant impact on the reduction of mortality and disability related to that of the snakebites.
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Affiliation(s)
- Ahmed Abdullahi
- Department of Medicine, Denan Health Center, Somalia Region, Jijiga, Ethiopia
| | - Nejib Yusuf
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,*Correspondence: Adera Debella
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Indeshaw Ketema
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa Abdulahi
- Department of Public Health and Health Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Fitsum Weldegebreal
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Blasco Mariño R, Soteras Martínez I, Hernandez Roca AI, Zafren K. Isolated Ptosis Following a Vipera aspis Bite. Wilderness Environ Med 2022; 33:245-247. [PMID: 35367125 DOI: 10.1016/j.wem.2022.02.007] [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: 10/05/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022]
Abstract
In Spain, snakebites are uncommon medical emergencies that cause barely 100 hospitalizations annually. Most of the venomous bites are by snakes of the Viperidae family. Venom from Vipera snakes is reported to have cytotoxic and hematotoxic effects, and neurological effects have also been described. Ptosis (cranial nerve III palsy) is the most common sign, although any cranial nerve can be affected. We describe isolated ptosis, which was very likely after a Vipera aspis bite in the East Catalonian Pyrenees. No antivenom was administered. The ptosis resolved spontaneously within 10 h. Although neurologic findings are usually mild, they indicate a moderate or severe envenomation. Treating snakebites can be challenging for clinicians, especially when there are uncommon clinical manifestations. A toxicologist at a poison center should be consulted to help guide management. Development of local protocols may provide clinical support.
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Affiliation(s)
- Robert Blasco Mariño
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain.
| | - Iñigo Soteras Martínez
- Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain; Department of Emergency, Cerdanya Hospital, Puigcerdà, Spain; Sistema Emergències Mèdiques (SEM), Catalonia, Spain
| | | | - Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska; Department of Emergency Medicine, Stanford University Medical Center, Stanford, California; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
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14
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Martinez PA, Gutiérrez JM, Olalla-Tárraga MÁ, Amado TF. Venomous animals in a changing world. Glob Chang Biol 2022; 28:3750-3753. [PMID: 35384171 DOI: 10.1111/gcb.16175] [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: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
The climatic changes of the next decades will modify human and livestock interactions with venomous animals; Some venomous species will disappear in the coming decades; Other venomous species will shift their distributions or increase their geographic ranges invading new countries that may not have specific antivenoms.
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Affiliation(s)
- Pablo Ariel Martinez
- Laboratório de Pesquisa Integrativa em Biodiersidade - PIBi Lab, Departamento de Biologia, Universidade Federal de Sergipe, São Cristovão, Brazil
- Biodiversity & Macroecology Lab - BioMa, Universidad Rey Juan Carlos, Móstoles, España
| | - José Maria Gutiérrez
- Facultad de Microbiología, Instituto Clodomiro Picado, Universidad de Costa Rica, San José, Costa Rica
| | | | - Talita Ferreira Amado
- Biodiversity & Macroecology Lab - BioMa, Universidad Rey Juan Carlos, Móstoles, España
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Adrião AAX, dos Santos AO, de Lima EJSP, Maciel JB, Paz WHP, da Silva FMA, Pucca MB, Moura-da-Silva AM, Monteiro WM, Sartim MA, Koolen HHF. Plant-Derived Toxin Inhibitors as Potential Candidates to Complement Antivenom Treatment in Snakebite Envenomations. Front Immunol 2022; 13:842576. [PMID: 35615352 PMCID: PMC9126284 DOI: 10.3389/fimmu.2022.842576] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Snakebite envenomations (SBEs) are a neglected medical condition of global importance that mainly affect the tropical and subtropical regions. Clinical manifestations include pain, edema, hemorrhage, tissue necrosis, and neurotoxic signs, and may evolve to functional loss of the affected limb, acute renal and/or respiratory failure, and even death. The standard treatment for snake envenomations is antivenom, which is produced from the hyperimmunization of animals with snake toxins. The inhibition of the effects of SBEs using natural or synthetic compounds has been suggested as a complementary treatment particularly before admission to hospital for antivenom treatment, since these alternative molecules are also able to inhibit toxins. Biodiversity-derived molecules, namely those extracted from medicinal plants, are promising sources of toxin inhibitors that can minimize the deleterious consequences of SBEs. In this review, we systematically synthesize the literature on plant metabolites that can be used as toxin-inhibiting agents, as well as present the potential mechanisms of action of molecules derived from natural sources. These findings aim to further our understanding of the potential of natural products and provide new lead compounds as auxiliary therapies for SBEs.
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Affiliation(s)
- Asenate A. X. Adrião
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Aline O. dos Santos
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Emilly J. S. P. de Lima
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Jéssica B. Maciel
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Weider H. P. Paz
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
| | - Felipe M. A. da Silva
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
- Multidisciplinary Support Center, Federal University of Amazonas, Manaus, Brazil
| | - Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
| | - Ana M. Moura-da-Silva
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Laboratory of Immunopathology, Institute Butantan, São Paulo, Brazil
| | - Wuelton M. Monteiro
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Marco A. Sartim
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- University Nilton Lins, Manaus, Brazil
| | - Hector H. F. Koolen
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
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Chuang PC, Lin WH, Chen YC, Chien CC, Chiu IM, Tsai TS. Oral Bacteria and Their Antibiotic Susceptibilities in Taiwanese Venomous Snakes. Microorganisms 2022; 10:microorganisms10050951. [PMID: 35630396 PMCID: PMC9147925 DOI: 10.3390/microorganisms10050951] [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: 03/14/2022] [Revised: 04/15/2022] [Accepted: 04/28/2022] [Indexed: 12/07/2022] Open
Abstract
Wound infections after venomous snakebites are clinically important. Information regarding the nature and antibiotic susceptibilities of snake oral bacterial flora could support empiric antibiotic therapy. Wild venomous snakes were collected from southern Taiwan: a total of 30 each of Bungarus multicinctus, Naja atra, Protobothrops mucrosquamatus, and Trimeresurus stejnegeri; 3 Deinagkistrodon acutus; and 4 Daboia siamensis. The species and antibiotic susceptibilities of their oral bacteria were determined. Aerobic gram-negative bacteria, especially Pseudomonas aeruginosa and Proteus vulgaris, were the most abundant. Proteus vulgaris were more abundant in B. multicinctus, N. atra, and P. mucrosquamatus than in T. stejnegeri (40%, 43.3%, and 40% vs. 13.3%, respectively). The gram-negative species were less susceptible to first- and second-generation cephalosporins and ampicillin-sulbactam than to third-generation cephalosporins, fluoroquinolones, carbapenems, or piperacillin-tazobactam. The most abundant aerobic gram-positive species cultured was Enterococcus faecalis, which was more abundant in N. atra than in other snakes (p < 0.001) and was highly susceptible to ampicillin, high-level gentamicin, penicillin, teicoplanin, and vancomycin. Bacteroides fragilis and Clostridium species were the most common anaerobic bacteria. The anaerobic organisms were highly susceptible to metronidazole and piperacillin. As a reference for empiric antimicrobial therapy, third-generation cephalosporins, fluoroquinolones, carbapenems, or piperacillin-tazobactam can be initiated in venomous snakebites wound infections.
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Affiliation(s)
- Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-C.C.); (I.-M.C.)
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
| | - Wen-Hao Lin
- Institute of Wildlife Conservation, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan;
| | - Yi-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan;
| | - Chun-Chih Chien
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan;
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-C.C.); (I.-M.C.)
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
| | - Tein-Shun Tsai
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan
- Correspondence: or
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Bamogo R, Thiam M, Nikièma AS, Somé FA, Mané Y, Sawadogo SP, Sow B, Diabaté A, Diatta Y, Dabiré RK. Snakebite frequencies and envenomation case management in primary health centers of the Bobo-Dioulasso health district (Burkina Faso) from 2014 to 2018. Trans R Soc Trop Med Hyg 2021; 115:1265-1272. [PMID: 34581814 PMCID: PMC8560633 DOI: 10.1093/trstmh/trab146] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background Snakebite envenomation is a significant public health problem in Burkina Faso. Our study describes the epidemiological and therapeutic aspects of snakebite cases at primary health centers in Houet Province, which is located in the western area of Burkina Faso. Methods We conducted a retrospective study of 664 snakebite cases occurring at 10 primary health centers in Houet Province from January 2014 to December 2018. Data were collected from the patient consultation recording database registry system. Results Affected individuals had a male/female ratio of 1.31. The lowest annual incidences (0.02 [95% CI –0.01 to 0.05] and 0.24 [95% CI 0.05 to 0.43]) were observed in the urban primary health centers of Bolomakoté and Sarfalao, respectively. Rural primary health centers in Nasso in 2016 and in Soumousso in 2014 had the highest annual incidence (13.80 [95% CI 7.59 to 20.00] and 3.92 [95% CI 2.99 to 4.86], respectively). Of the 664 registered snakebite victims, none received antivenom immunotherapy treatment. Conclusion Our study shows that snakebite envenomation incidents are common at the 10 primary health centers in Houet Province. Furthermore, despite the lack of antivenom and often inadequate treatment at these primary health centers, they remain the first point of care for snakebite victims.
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Affiliation(s)
- Rabila Bamogo
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso.,Université Cheikh Anta Diop, Ecole Doctorale en Sciences de la Vie, de la Santé et de l'Environnement, Faculté des Sciences et Techniques BP : 5005, Dakar, Sénégal.,Université Cheikh Anta Diop, Institut Fondamental d'Afrique Noire (IFAN), Laboratoire de Zoologie et des Vertébrés terrestres de Dakar, BP 206, Dakar, Sénégal
| | - Massamba Thiam
- Université Cheikh Anta Diop, Institut Fondamental d'Afrique Noire (IFAN), Laboratoire de Zoologie et des Vertébrés terrestres de Dakar, BP 206, Dakar, Sénégal
| | - Achille Sindimbasba Nikièma
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Fabrice Anyirekun Somé
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Youssouph Mané
- Institut de Recherche pour le Développement (IRD) de Dakar, BP 1386 CP 18524, Dakar, Sénégal
| | - Simon Péguédwindé Sawadogo
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Bazoumana Sow
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Abdoulaye Diabaté
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Youssouph Diatta
- Université Cheikh Anta Diop, Institut Fondamental d'Afrique Noire (IFAN), Laboratoire de Zoologie et des Vertébrés terrestres de Dakar, BP 206, Dakar, Sénégal
| | - Roch Kounbobr Dabiré
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
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Boels D, Courtois A, Paradis C, Caillet P, Labadie M. First step in assessment of VipGrade ®, a computerized clinical decision system to assess Vipera envenomation grading: a single-center interrater reliability study. Clin Toxicol (Phila) 2021; 60:514-520. [PMID: 34709955 DOI: 10.1080/15563650.2021.1993241] [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] [Indexed: 10/20/2022]
Abstract
METHODS We conducted a retrospective review of Vipera spp. snakebite cases registered by the PCC of Bordeaux, France, between January 1, 2018, and December 31, 2020, evaluating the agreement between VipGrade® assessments, toxicologists' assessments, and current guidelines. RESULTS 133 patients with Vipera aspis snakebites were included. There was 100% agreement in severity grading by PCC guidelines and VipGrade®. However, grading by toxicologists and VipGrade® diverged in 19 cases (85% agreement; κ = 0.80; 95% CI: 0.71 to 0.87). CONCLUSIONS The VipGrade® tool's grading reflects current PCC guidelines, which are authoritative in France, and may allow for a more rapid and standardized determination of management and follow-up of viper-bitten patients. It should be noted, however, that the more complex and dynamic aspects of management are not included in VipGrade®. Its purpose is to supplement, not replace, the advice of the PCC's clinical toxicologists, and this advice should be sought whenever a viper bite is encountered in clinical practice.
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Affiliation(s)
- David Boels
- Clinical Toxicology Unit, Pharmacology Department, Nantes University Hospital, Nantes, France.,SPIN Unit, Public Health Department, Nantes University Hospital, Nantes, France.,Inserm UMR-1144, Descartes University, Paris, France
| | - Arnaud Courtois
- Poison Control Center, Bordeaux University Hospital, Bordeaux, France
| | - Camille Paradis
- Poison Control Center, Bordeaux University Hospital, Bordeaux, France
| | - Pascal Caillet
- SPIN Unit, Public Health Department, Nantes University Hospital, Nantes, France
| | - Magali Labadie
- Poison Control Center, Bordeaux University Hospital, Bordeaux, France
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM. Clinico-epidemiology of Hypnale zara (hump-nosed pit viper) envenoming in Sri Lanka. Trans R Soc Trop Med Hyg 2021; 115:603-612. [PMID: 33948662 DOI: 10.1093/trstmh/trab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/19/2020] [Revised: 01/21/2021] [Accepted: 04/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hump-nosed vipers of the genus Hypnale are the most common cause of venomous snakebites in Sri Lanka. The genus includes three species: Hypnale hypnale, Hypnale zara and Hypnale nepa. Of them, H. hypnale bites are the most common and are the subject of many publications. The epidemiology and clinical features of bites by the other two species have been less investigated. METHODS We conducted a prospective observational study of H. zara bites from January 2015 to June 2020 at the Teaching Hospital, Ratnapura, Sri Lanka. Data were collected for 5.5 years in the wet zone of the island, where the principal investigator did assessment of all patients and the data collection. RESULTS H. zara envenoming was confirmed through identification of dead or live snake specimens brought with the patients. Of the 480 patients with proven hump-nosed viper bites, H. zara bites accounted for 105 (22%), including dry bites (n=5 [5%]) and envenoming (n=100 [95%]), with gender distribution of 65 (62%) males and a mean age of 43.1 y. Most bites occurred on the lower limbs (n=71 [68%]) in the daytime (n=69 [66%]) in home gardens (n=45 [43%]). A total of 100 (95%) patients had local manifestations, including pain (n=100 [95%]), swelling (n=100 [95%]), bleeding (n=20 [19%]), bruising (n=11 [10%]), lymphadenopathy (n=10 [9%]), necrosis at the bite site (n=9 [9%]) and blistering (n=8 [8%]). Seven (6.7%) patients showed systemic effects, including acute kidney injury (n=2 [2%]), microangiopathic haemolysis (n=2 [2%]), sinus bradycardia (2 [2%]) and one (1%) each had coagulopathy, thrombotic microangiopathy, Kounis syndrome and ischaemic changes on electrocardiography. Eosinophilia was a significant haematological finding (n=26 [25%]) and 16 (15%) had leucocytosis and 15 (14%) had neutrophilia. Ninety six percent of patients (n=101) recovered. Antivenom is not available for hump-nosed viper bites in Sri Lanka and therefore patients were managed conservatively. CONCLUSIONS This study shows that H. zara bites mainly cause local envenoming and rarely systemic effects.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka.,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, Sri Lanka
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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20
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Lin CC, Chaou CH, Gao SY. Influential Factors of Local Tissue Necrosis after Taiwan Cobra Bites: A Secondary Analysis of the Clinical Significance of Venom Detection in Patients of Cobra Snakebites. Toxins (Basel) 2021; 13:338. [PMID: 34067062 DOI: 10.3390/toxins13050338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/04/2022] Open
Abstract
Local tissue swelling, inflammation, and wound necrosis are observed in Taiwan cobra bites. Knowledge of the factors influencing local tissue necrosis after cobra bites might improve the cobra bite treatment strategy. Therefore, we aimed to explore the factors influencing local tissue necrosis after cobra bites. This was a retrospective observational cohort study. All patients clinical presentations including serum venom levels for determining the influential factors in this study were obtained from Hung et al.’s previous study. Clinical features, such as bite information, initial swelling, patient presentation time, serum venom levels, and antivenom, use were extracted. The measurement outcome was the development of wound necrosis. The factors influencing wound necrosis were investigated using univariate and logistic regression analyses. The influential factors of local tissue necrosis and their areas under the curve were: initial limb swelling, 0.88; presentation time × serum level, 0.80; initial necrosis, 0.75; patient presentation time, 0.70. Serum venom level alone cannot be used as a predictive factor. The development of tissue necrosis might be associated with the venom factor, time factor, and their interaction. These influential factors can be used in future studies to evaluate antivenom efficacy.
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21
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Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Kularatne SAM. Kounis Syndrome Following Hypnale zara (Hump-Nosed Pit Viper) Bite in Sri Lanka. Wilderness Environ Med 2021; 32:210-216. [PMID: 33775497 DOI: 10.1016/j.wem.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/10/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
A 47-y-old man was bitten by a hump-nosed viper (Hypnale zara) and gradually developed retrosternal chest pain associated with ST segment elevation on electrocardiogram. He had normal troponin I levels and no evidence of coagulopathy. Initially, he was managed as having anterior ST elevation myocardial infarction with thrombolysis. Later, because troponin levels were normal, he was suggested to have the type I variant of Kounis syndrome (allergic coronary artery spasm). This was supported by high eosinophil counts in peripheral blood. He was successfully managed with supportive treatment and discharged 6 d after the snakebite. Cardiac complications are rarely reported after hump-nosed viper bites, and clinical reports of coronary vasospasm after snakebites are extremely rare in the literature. This is the first known report of Kounis syndrome after a hump-nosed viper bite.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Teaching Hospital Ratnapura, Sri Lanka; Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peredeniya, Sri Lanka.
| | | | - S A M Kularatne
- Faculty of Medicine, University of Peradeniya, Peredeniya, Sri Lanka
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22
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Yeh H, Gao SY, Lin CC. Wound Infections from Taiwan Cobra ( Naja atra) Bites: Determining Bacteriology, Antibiotic Susceptibility, and the Use of Antibiotics-A Cobra BITE Study. Toxins (Basel) 2021; 13:toxins13030183. [PMID: 33801318 PMCID: PMC7999477 DOI: 10.3390/toxins13030183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 02/04/2023] Open
Abstract
Wound necrosis and secondary infection are common complications after Naja atra bites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. In this Cobra BITE study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with Taiwan cobra snakebites. Patients with wound infection lacking tissue necrosis were included in developing Cobra BITE score utilizing univariate and multiple logistic regression, as patients with wound necrosis require antibiotics for infection treatment. 8,295,497 emergency department visits occurred in the span of this study, with 195 of those patients being diagnosed as having cobra bites. Of these patients, 23 had wound necrosis, and 30 had wound infection, resulting in a wound infection rate of 27.2% (53/195). Enterococcus faecalis and Morganella morganii were the main bacteria identified in the culture report regardless of whether patients’ wounds had necrosis. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neu-trophil-lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88; ideal sensitivity and specificity were 0.89 and 0.76. This scoring system enables the assessment of wound infections after N. atra bites, and it could be modified and improved in the future for other Naja spp. bites.
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Affiliation(s)
- Heng Yeh
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shi-Ying Gao
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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23
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Kim KJ, Min JH, Yoo I, Kim SW, Lee J, Ryu S, You YH, Park JS, Jeong WJ, Cho YC, Oh SK, In YN, Ahn HJ, Kang CS, Kyung H, Lee BK, Lee DH, Lee DH. Negative pressure wound therapy for skin necrosis prevention after snakebite in the emergency department: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e24290. [PMID: 33546055 PMCID: PMC7837876 DOI: 10.1097/md.0000000000024290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
This retrospective cohort study aimed to compare the effectiveness of conventional treatment and ultra-early application of negative pressure wound therapy (NPWT) in patients with snakebites.Patients who visited the emergency department within 24 hours after a snakebite were assigned to the non- NPWT or NPWT group. Swelling resolution time and rates of necrosis, infection, and operations were compared between the 2 groups. The Stony Brook Scar Evaluation Scale was used to measure short- and long-term wound healing results.Among the included 61 patients, the swelling resolution time was significantly shorter in the NPWT group than in non- NPWT group (P = .010). The NPWT group showed lower necrosis (4.3% versus 36.8%; P = .003) and infection (13.2% and 4.3%; P = .258) rates than the non- NPWT group. The median Stony Brook Scar Evaluation Scale scores were higher in the NPWT group than in the non- NPWT group (P< .001).These findings suggest that ultra-early application of NPWT reduces edema, promotes wound healing, and prevents necrosis in patients with snakebites.
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Affiliation(s)
- Kwan Jae Kim
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Jin Hong Min
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
- Department of Emergency Medicine
| | - Insool Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, 282
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
| | - Seung Whan Kim
- Department of Emergency Medicine, Chungnam National University Hospital, 282
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
| | - Jinwoong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, 282
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | | | | | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Chang Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Hyunwoo Kyung
- Department of Plastic Surgery, Chungnam National University Sejong Hospital, 7, Bodam-ro, Sejong
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University School of Medicine
- Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju
| | - Dong Hoon Lee
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, 47, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea
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24
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Lin CC, Chen YC, Goh ZNL, Seak CK, Seak JCY, Shi-Ying G, Seak CJ. Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics-A BITE Study. Toxins (Basel) 2020; 12:toxins12090575. [PMID: 32906845 PMCID: PMC7551380 DOI: 10.3390/toxins12090575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022] Open
Abstract
Snakebites from Taiwan habus (Protobothrops mucrosquamatus) and green bamboo vipers (Viridovipera stejnegeri) account for two-thirds of all venomous snakebites in Taiwan. While there has been ongoing optimization of antivenin therapy, the proper management of superimposed bacterial wound infections is not well studied. In this Bacteriology of Infections in Taiwanese snake Envenomation (BITE) study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with snakebites from these two snakes. We further developed a BITE score to evaluate the probability of wound infections and guide antibiotic usage in this patient population. All snakebite victims who presented to the emergency departments of seven training and research hospitals and received at least one vial of freeze-dried hemorrhagic antivenin between January 2001 and January 2017 were identified. Patient biodata, laboratory investigation results, and treatment modalities were retrieved. We developed our BITE score via univariate and multiple logistic regression analyses. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the BITE score. Out of 8,295,497 emergency department visits, 726 patients presented with snakebites from a Taiwan habu or a green bamboo viper. The wound infection rate was 22.45%, with seven positive wound cultures, including six polymicrobial infections. Morganella morganii, Enterococcus spp., Bacteroides fragilis, and Aeromonas hydrophila were most frequently cultured. There were no positive blood cultures. A total of 33.0% (n = 106) of snakebite patients who received prophylactic antibiotics nevertheless developed wound infections, while 44.8% (n = 73) of wound infection patients were satisfactorily treated with one of the following antibiotics: amoxicillin/clavulanic acid, oxacillin, cefazolin, and ampicillin/sulbactam. With the addition of gentamicin, the success of antibiotic therapy increased by up to 66.54%. The prognostic factors for the secondary bacterial infection of snakebites were white blood cell counts, the neutrophil lymphocyte ratio, and the need for hospital admission. The area under the ROC curve for the BITE score was 0.839. At the optimal cut-off point of 5, the BITE score had a 79.58% accuracy, 82.31% sensitivity, and 79.71% specificity when predicting infection in snakebite patients. Our BITE score may help with antibiotic stewardship by guiding appropriate antibiotic use in patients presenting with snakebites. It may also be employed in further studies into antibiotic prophylaxis in snakebite patients for the prevention of superimposed bacterial wound infections.
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Affiliation(s)
- Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yen-Chia Chen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Zhong Ning Leonard Goh
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
| | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
| | - Joanna Chen-Yeen Seak
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
| | - Gao Shi-Ying
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Correspondence:
| | - SPOT Investigators
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
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Katali O, Shipingana L, Nyarangó P, Pääkkönen M, Haindongo E, Rennie T, James P, Eriksson J, Hunter CJ. Protein Identification of Venoms of the African Spitting Cobras, Naja mossambica and Naja nigricincta nigricincta. Toxins (Basel) 2020; 12:E520. [PMID: 32823821 DOI: 10.3390/toxins12080520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/16/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022] Open
Abstract
Cobra snakes, including Naja mossambica and Naja nigricincta nigricincta, are one of the major groups of snakes responsible for snakebites in southern Africa, producing significant cytotoxicity and tissue damage. The venom of N. mossambica has been briefly characterised, but that of N. n. nigricincta is not reported. The current study identifies the venom proteins of N. mossambica and N. n. nigricincta. This is achieved using sodium dodecyl sulphate (SDS)-polyacrylamide gel eletrophroresis (PAGE), followed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Most of the proteins were less than 17 kDa in both snakes. N. mossambica was found to have 75 proteins in total (from 16 protein families), whereas N.n. nigricincta had 73 (from 16 protein families). Of these identified proteins, 57 were common in both snakes. The proteins identified belonged to various families, including the three-finger toxins (3FTx), Cysteine-rich secretory proteins (CRiSP), Phospholipase A2 (PLA2) and Venom metalloproteinase M12B (SVMP). The current study contributes to the profile knowledge of snake venom compositions, which is of fundamental value in understanding the proteins that play a major role in envenomation.
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Namal Rathnayaka RMMK, Ranathunga PEAN, Kularatne SAM. Venom-Induced Consumption Coagulopathy Following Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka: Uncertain Efficacy of Fresh Frozen Plasma. Wilderness Environ Med 2020; 31:131-143. [PMID: 32336579 DOI: 10.1016/j.wem.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/30/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hump-nosed pit vipers (Hypnale spp) cause the highest number of venomous snakebites in Sri Lanka. Bites commonly cause local envenoming leading to local pain, swelling, and necrosis of the site of the bite. Acute kidney injury is the most common systemic manifestation, and some patients develop venom-induced consumption coagulopathy (VICC). Genus Hypnale comprises 3 species. Of them, H hypnale is found in Sri Lanka and the Western Ghats region of India. The other 2 (H nepa and H zara) are endemic species in Sri Lanka. METHODS This study included 500 patients with hump-nosed viper bites studied prospectively over 4.5 y starting June 2014. All patients were assessed and the data were collected by the principal investigator (primary data). A subgroup of patients who developed VICC is described. There were 2 groups, including proven (patients with the specimen of the snake) and probable (specimen of snake not available) bites. RESULTS Thirty (n=500; 6%) patients developed VICC; of them, 17 (3%) were proven cases, and 13 (2%) were probable cases. In both groups, 24 (80%) recovered, 2 (7%) progressed to chronic kidney disease, 1 (3%) died of severe hemostatic dysfunction, and 3 (10%) were lost to follow-up. Systemic bleeding was observed in 16 patients (53%), including hematuria (microscopic and gross) in 8 (27%) and venipuncture bleeding in 5 (17%). Eleven (37%) developed local bleeding at the site of the bite. Fresh frozen plasma was administered to 20 patients (67%), among whom only 11 (55%) experienced early correction of VICC. In both groups, 15 (50%) developed acute kidney injury, and 2 (7%) progressed to chronic kidney disease. Microangiopathic hemolysis was observed in 18 patients (60%) and thrombocytopenia in 16 (53%). Thrombotic microangiopathy was detected in 13 patients (43%), of whom 10 (33%) developed hemolytic uremic syndrome and 2 (7%) had thrombotic thrombocytopenic purpura. Of patients with VICC in the proven group, 94% (n=16) was caused by H hypnale and 1 (6%) was caused by H zara. In the proven group, median international normalized ratio was 3.7 (interquartile range 1.6-5.0); in the probable group, it was 5.0 (interquartile range 2.1-5.4). CONCLUSIONS We found that 6% of patients develop hemostatic dysfunction after hump-nosed viper bites. However, which patients will develop coagulopathy or die of envenoming is unpredictable. Reliable and accessible treatments are unmet essential needs because antivenoms for these bites are currently not available in the country. Therapy with fresh frozen plasma has doubtful efficacy in early correction of VICC and needs further evaluation.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peredeniya, Sri Lanka; Intensive Care Unit/Anaesthesia, Teaching Hospital Ratnapura, Sri Lanka; Postgraduate Institute of Medicine (Clinical Pharmacology and Therapeutics), University of Colombo, Colombo, Sri Lanka.
| | | | - S A M Kularatne
- Faculty of Medicine, University of Peradeniya, Peredeniya, Sri Lanka
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Aruwa CE, Mukaila YO, Ajao AA, Sabiu S. An Appraisal of Antidotes' Effectiveness: Evidence of the Use of Phyto-Antidotes and Biotechnological Advancements. Molecules 2020; 25:E1516. [PMID: 32225103 DOI: 10.3390/molecules25071516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/21/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Abstract
Poisoning is the greatest source of avoidable death in the world and can result from industrial exhausts, incessant bush burning, drug overdose, accidental toxication or snake envenomation. Since the advent of Albert Calmette’s cobra venom antidote, efforts have been geared towards antidotes development for various poisons to date. While there are resources and facilities to tackle poisoning in urban areas, rural areas and developing countries are challenged with poisoning management due to either the absence of or inadequate facilities and this has paved the way for phyto-antidotes, some of which have been scientifically validated. This review presents the scope of antidotes’ effectiveness in different experimental models and biotechnological advancements in antidote research for future applications. While pockets of evidence of the effectiveness of antidotes exist in vitro and in vivo with ample biotechnological developments, the utilization of analytic assays on existing and newly developed antidotes that have surpassed the proof of concept stage, as well as the inclusion of antidote’s short and long-term risk assessment report, will help in providing the required scientific evidence(s) prior to regulatory authorities’ approval.
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Magalhães SFV, Peixoto HM, Moura N, Monteiro WM, de Oliveira MRF. Snakebite envenomation in the Brazilian Amazon: a descriptive study. Trans R Soc Trop Med Hyg 2020; 113:143-151. [PMID: 30476298 DOI: 10.1093/trstmh/try121] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/05/2018] [Accepted: 10/30/2018] [Indexed: 02/01/2023] Open
Abstract
Snakebite envenomation in the Brazilian Amazon is a recognized public health problem that does not receive the appropriate attention from key stakeholders. The morbidity rate is relevant, but still underestimated. Thus, the present study updates the current state of knowledge on snakebite envenomation in the Brazilian Amazon. It follows a descriptive method and contributes new knowledge about the dynamics of snakebites and the associated morbidity and mortality reported in the Brazilian Amazon. The study is based on information from cases registered and retrieved from the Brazilian Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação-SINAN). The registers we studied covers a period of six years, 2010-2015. Most snakebites occurred in the states of Pará (30 693 cases, 43.34%) and Amazonas (9386 cases, 13.25%), with a higher prevalence in males of an economically active age. The main genus involved in bites was Bothrops sp. The mortality rate was 0.24 per hundred thousand and the case fatality rate was 0.51%. Although low case fatality and mortality rates were observed, much can still be done to prevent snakebites as they continue to be a serious public health problem considering the severity and potentially high economic impact for the individual and to society.
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Affiliation(s)
- Samara Freire Valente Magalhães
- Núcleo de Medicina Tropical (Tropical Medicine Centre), Universidade de Brasília (UnB), University Campus Darcy Ribeiro, Asa Norte, Brasília-DF, Brazil
| | - Henry Maia Peixoto
- Núcleo de Medicina Tropical (Tropical Medicine Centre), Universidade de Brasília (UnB), University Campus Darcy Ribeiro, Asa Norte, Brasília-DF, Brazil.,Institute of Health Technology Assessment of the National Council for Scientific and Technological Development (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Noely Moura
- Ministry of Health. Radio and TV Department (SRTV) 701, via W5 Norte. Edf. PO700 -6th floor
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, número 25, Dom Pedro, Manaus-AM, Brazil.,Universidade do Estado do Amazonas (UEA), Av. Pedro Teixeira, 25, Dom Pedro, Manaus-AM, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical (Tropical Medicine Centre), Universidade de Brasília (UnB), University Campus Darcy Ribeiro, Asa Norte, Brasília-DF, Brazil.,Institute of Health Technology Assessment of the National Council for Scientific and Technological Development (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM. Kidney injury following envenoming by hump-nosed pit viper (Genus: Hypnale) in Sri Lanka: proven and probable cases. Trans R Soc Trop Med Hyg 2020; 113:131-142. [PMID: 30544230 DOI: 10.1093/trstmh/try120] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/26/2018] [Revised: 08/20/2018] [Accepted: 10/24/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hump-nosed pit vipers (Hypnale hypnale) are highly venomous snakes found in Sri Lanka and the Western Ghats region of India. They are the most common cause of venomous snakebites in Sri Lanka, mainly causing local envenoming leading to pain, swelling and necrosis. Systemic envenoming causing acute kidney injury and coagulopathy are more commonly recognized following their bites. METHOD A series of 465 patients with hump-nosed viper bites was prospectively studied over four years from January 2014. All patients were assessed and the data were collected by the principal investigator (primary data). RESULTS Forty-four (9.5%) patients developed acute kidney injury, of which 23 (5%) were proven cases and 21 (4.5%) were probable cases. Of the proven cases, 4 (17%) progressed to chronic kidney disease and 12 (52%) had thrombotic microangiopathy, from which 11 (48%) developed haemolytic uremic syndrome and 1 (4%) had thrombotic thrombocytopenic purpura. Twelve (52%) showed microangiopathic haemolysis and 15 (65%) had thrombocytopenia. Oliguria was observed in 10 (43%) whereas 7 (30%) each had anuria and normal urine output. Ten patients (43%) developed haematuria, from which 6 had microscopic haematuria and 4 had macroscopic haematuria. Proteinuria was observed in 8 (35%). Coagulopathy developed in 3 (13%) patients. In probable cases, 3 (14%) died due to complications of kidney injury. CONCLUSION A significant proportion of patients develop acute kidney injury following hump-nosed pit viper bite. Who will develop acute kidney injury or succumb to the venom is unpredictable. Reliable and accessible treatments are a critical unmet need.
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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.,Postgraduate Institute of Medicine, University of Colombo (Clinical Pharmacology and Therapeutics), Sri Lanka
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Huang TI, Hsieh CL. Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan. Toxins (Basel) 2020; 12:E132. [PMID: 32093388 PMCID: PMC7076781 DOI: 10.3390/toxins12020132] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Herein, we review the characteristics of the six predominant venomous snakes in Taiwan and the effects of traditional Chinese medicine on the long-term outcomes of snakebite venom. We electronically searched databases, including PubMed, ClinicalKey, China National Knowledge Infrastructure, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library, from their inception to November 2019 by using the following Medical Subject Headings' keywords: snakebite, long-term, chronic, Chinese medicine, CAM, herb, and Taiwan. The most common long-term effects of snakebite envenomation include "migraine-like syndrome", brain injuries caused by hypoxia or intracranial hemorrhage, and chronic kidney disease. In addition, hypopituitarism is also worth mentioning. Traditional Chinese medicine can potentially be used in a complementary or alternative treatment for these effects, but additional studies are needed.
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Affiliation(s)
- Teng-I Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Chinese Medicine Research Center, China Medical University, Taichung 40402, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
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Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Kularatne SAM. Thrombotic Microangiopathy Following Hypnale zara (Hump-Nosed Pit Viper) Envenoming: The First Known Case Report from Sri Lanka. Wilderness Environ Med 2019; 31:71-77. [PMID: 31870797 DOI: 10.1016/j.wem.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/01/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022]
Abstract
A 65-y-old previously healthy farmer developed thrombotic microangiopathy (TMA) comprising the triad of acute kidney injury, microangiopathic haemolysis, and thrombocytopenia after a proven Hypnale zara (hump-nosed pit viper) bite. He developed coagulopathy, which was treated with fresh frozen plasma, and underwent 8 cycles of hemodialysis. He is being followed up in the nephrology clinic for acute kidney injury. TMA caused by Hypnale hypnale, the commonest species of genus Hypnale, has previously been reported, but this is the first known case of TMA following a bite by H zara, the endemic species in Sri Lanka.
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Affiliation(s)
- Rathnayaka Mudiyanselage M K Namal Rathnayaka
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka; Intensive Care Unit/Anaesthesia, Teaching Hospital, Ratnapura, Sri Lanka; Clinical Pharmacology and Therapeutics, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
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El Zahran T, Kazzi Z, Chehadeh AAH, Sadek R, El Sayed MJ. Snakebites in Lebanon: A Descriptive Study of Snakebite Victims Treated at a Tertiary Care Center in Beirut, Lebanon. J Emerg Trauma Shock 2018; 11:119-124. [PMID: 29937642 PMCID: PMC5994845 DOI: 10.4103/jets.jets_141_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 11/30/2022] Open
Abstract
Background: Snakebites lead to at least 421,000 envenomations and result in more than 20,000 deaths per year worldwide. Few reports exist in the Mediterranean region. This study describes demographic and clinical characteristics, treatment modalities, and outcomes of snakebites in Lebanon. Materials and Methods: This was a retrospective chart review of patients who presented with snakebite complaint to the emergency department between January 2000 and September 2014. Results: A total of 24 patients were included in this study. The mean age was 34.6 (±16.4) years and 58.3% were males. Local manifestations were documented in 15 (62.5%) patients, systemic effects in 10 (41.7%), hematologic abnormalities in 10 (41.7%), and neurologic effects in 4 (16.7%) patients. Nine patients (37.5%) received antivenom. The median amount of antivenom administered was 40 ml or 4 vials (range: 1–8 vials). About 50% of patients were admitted to the hospital with 75% to an Intensive Care Unit and 25% to a regular bed. All were discharged home with a median hospital length of stay of 4 (interquartile range 11) days. Among those admitted, seven patients (58.3%) had at least one documented complication (compartment syndrome, fasciotomy, intubation, deep vein thrombosis, coagulopathy, acute respiratory distress syndrome, sepsis, congestive heart failure, cellulitis, upper gastrointestinal bleeding, and vaginal bleeding). Conclusion: Victims of snakebites in Lebanon developed local, systemic, hematologic, or neurologic manifestations. Complications from snakebites were frequent despite antivenom administration. Larger studies are needed to assess the efficacy of available antivenom and to possibly create a local antivenom for the treatment of snakebites in Lebanon.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Emergency Medicine, Emory University, Georgia Poison Center, Atlanta, Georgia
| | - Ahel Al-Hajj Chehadeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Riyad Sadek
- Department of Biology, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Mazen J El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Aye KP, Thanachartwet V, Soe C, Desakorn V, Chamnanchanunt S, Sahassananda D, Supaporn T, Sitprija V. Predictive Factors for Death After Snake Envenomation in Myanmar. Wilderness Environ Med 2018; 29:166-175. [PMID: 29572088 DOI: 10.1016/j.wem.2018.01.001] [Citation(s) in RCA: 8] [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: 08/18/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Factors predictive for death from snake envenomation vary between studies, possibly due to variation in host genetic factors and venom composition. This study aimed to evaluate predictive factors for death from snake envenomation in Myanmar. METHODS A prospective study was performed among adult patients with snakebite admitted to tertiary hospitals in Yangon, Myanmar, from May 2015 to August 2016. Data including clinical variables and laboratory parameters, management, and outcomes were evaluated. Multivariate regression analysis was performed to evaluate factors predictive for death at the time of presentation to the hospital. RESULTS Of the 246 patients with snake envenomation recruited into the study, 225 (92%) survived and 21 (8%) died during hospitalization. The snake species responsible for a bite was identified in 74 (30%) of the patients; the majority of bites were from Russell's vipers (63 patients, 85%). The independent factors predictive for death included 1) duration from bite to arrival at the hospital >1 h (odds ratio [OR]: 9.0, 95% confidence interval [CI]: 1.1-75.2; P=0.04); 2) white blood cell counts >20 ×103 cells·μL-1 (OR: 8.9, 95% CI: 2.3-33.7; P=0.001); and 3) the presence of capillary leakage (OR: 3.7, 95% CI: 1.2-11.2; P=0.02). A delay in antivenom administration >4 h increases risk of death (11/21 deaths). CONCLUSIONS Patients who present with these independent predictive factors should be recognized and provided with early appropriate intervention to reduce the mortality rate among adults with snake envenomation in Myanmar.
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Affiliation(s)
- Kyi-Phyu Aye
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (Drs Aye, Thanachartwet, Desakorn, and Chamnanchanunt); Medical Ward, Medical Department, Naypyitaw, Myanmar (Dr Aye)
| | - Vipa Thanachartwet
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (Drs Aye, Thanachartwet, Desakorn, and Chamnanchanunt).
| | - Chit Soe
- Department of Rheumatology, University of Medicine 1, Yangon, Myanmar (Dr Soe)
| | - Varunee Desakorn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (Drs Aye, Thanachartwet, Desakorn, and Chamnanchanunt)
| | - Supat Chamnanchanunt
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (Drs Aye, Thanachartwet, Desakorn, and Chamnanchanunt)
| | - Duangjai Sahassananda
- Information Technology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (Dr Sahassananda)
| | - Thanom Supaporn
- Division of Nephrology, Phramongkutklao Hospital, Bangkok, Thailand (Dr Supaporn)
| | - Visith Sitprija
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand (Dr Sitprija); Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand (Dr Sitprija)
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Tritz D, Dormire K, Brachtenbach T, Gordon J, Sanders D, Gearheart D, Crawford J, Vassar M. Research Gaps in Wilderness Medicine. Wilderness Environ Med 2018; 29:291-303. [PMID: 29784570 DOI: 10.1016/j.wem.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Wilderness medicine involves the treatment of individuals in remote, austere environments. Given the high potential for injuries as well as the unique treatment modalities required in wilderness medicine, evidence-based clinical practice guidelines are necessary to provide optimal care. In this study, we identify evidence gaps from low-quality recommendations in wilderness medicine clinical practice guidelines and identify new/ongoing research addressing them. METHODS We included relevant clinical practice guidelines from the Wilderness Medical Society and obtained all 1C or 2C level recommendations. Patient/Problem/Population, intervention, comparison, outcome (PICO) questions were created to address each recommendation. Using 24 search strings, we extracted titles, clinical trial registry number, and recruitment status for 8899 articles. We categorized the articles by trial design to infer the effect they may have on future recommendations. RESULTS Twelve clinical practice guidelines met inclusion criteria. From these we located 275 low-quality recommendations and used them to create 275 PICO questions. Thirty-three articles were relevant to the PICO questions. Heat-related illness had the highest number of relevant articles (n=9), but acute pain and altitude sickness had the most randomized clinical trials (n=6). CONCLUSION Overall, few studies were being conducted to address research gaps in wilderness medicine. Heat-related illness had the most new or ongoing research, whereas no studies were being conducted to address gaps in eye injuries, basic wound management, or spine immobilization. Animals, cadavers, and mannequin research are useful in cases in which human evidence is difficult to obtain. Establishing research priorities is recommended for addressing research gaps identified by guideline panels.
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Affiliation(s)
- Daniel Tritz
- Oklahoma State University Center for Health Sciences, Tulsa, OK (Mr Tritz, Dormire, Brachtenbach and Ms Crawford).
| | - Kody Dormire
- Oklahoma State University Center for Health Sciences, Tulsa, OK (Mr Tritz, Dormire, Brachtenbach and Ms Crawford)
| | - Travis Brachtenbach
- Oklahoma State University Center for Health Sciences, Tulsa, OK (Mr Tritz, Dormire, Brachtenbach and Ms Crawford)
| | - Joshua Gordon
- Anesthesiology Department, University of Oklahoma Medical Center, Oklahoma City, OK (Dr Gordon)
| | - Donald Sanders
- Emergency Department, Oklahoma State University Medical Center, Tulsa, OK (Drs Sanders and Gearheart)
| | - David Gearheart
- Emergency Department, Oklahoma State University Medical Center, Tulsa, OK (Drs Sanders and Gearheart)
| | - Julia Crawford
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, OK (Dr Vassar)
| | - Matt Vassar
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, OK (Dr Vassar)
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Parker-Cote J, Meggs WJ. First Aid and Pre-Hospital Management of Venomous Snakebites. Trop Med Infect Dis 2018; 3:E45. [PMID: 30274441 PMCID: PMC6073535 DOI: 10.3390/tropicalmed3020045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/21/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antivenom is the definitive treatment for venomous snakebites, but is expensive and not available in many rural and poorly developed regions. Timely transportation to facilities that stock and administer antivenom may not be available in rural areas with poorly developed emergency medical services. These factors have led to consideration of measures to delay onset of toxicity or alternatives to antivenom therapy. METHODS PubMed searches were conducted for articles on snakebite treatment, or that contained first aid, emergency medical services, tourniquets, pressure immobilization bandages, suction devices, and lymphatic flow inhibitors. RESULTS The reviewed articles describe how venoms spread after a venomous snakebite on an extremity, list the proposed first aid measures for delaying the spread of venoms, and evaluate the scientific studies that support or refute methods of snakebite first aid. The recommendations for field treatment of venomous snakebites will be discussed. CONCLUSIONS The evidence suggests that pressure immobilization bandages and related strategies are the best interventions to delay onset of systemic toxicity from venomous snakebites but may increase local toxicity for venoms that destroy tissue at the site of the bite, so their use should be individualized to the circumstances and nature of the venom.
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Affiliation(s)
- Jennifer Parker-Cote
- Division of Toxicology, Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27858, USA.
| | - William J Meggs
- Division of Toxicology, Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27858, USA.
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Shashar S, Yitshak-Sade M, Sonkin R, Novack V, Jaffe E. The Association Between Heat Waves and Other Meteorological Parameters and Snakebites: Israel National Study. J Emerg Med 2018; 54:819-826. [PMID: 29661659 DOI: 10.1016/j.jemermed.2018.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Published annual estimates report a global burden of 2.5 million snakebite cases and >100,000 deaths. In Israel, envenomations are the third most frequent cause of poisonings that are of moderate to major clinical severity. Most studies focus on the clinical descriptions of snakebites in tropical climates, and we sought to investigate the association between snakebite frequency and meteorological parameters. OBJECTIVE We sought to investigate the seasonality of snakebites and evaluate the association between increasingly common heat waves and other meteorological parameters and snakebite frequency in a semiarid nontropical climate. METHODS We obtained data for all medical evacuations (2008-2015) because of snakebites in Israel. Climate data included daily 24-hour average temperature (°C) and relative humidity (%). We used a time-stratified case crossover method, in which a conditional logistic regression was applied to estimate the association, and we also stratified our analysis by season and by region. RESULTS We identified 1234 snakebite cases over 8 years, of which most (74.2%) occurred in hot seasons and between 6 pm and 9 pm. The risk of snakebite was positively associated with temperature >23°C (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.01-1.53) and inversely with humidity >40% (OR 0.74, 95% CI 0.57-0.97). We also found an association with heat waves both in cold (OR 1.62, 95% CI 1.01-2.60) and hot seasons (OR 1.50, 95% CI 1.18-1.92). CONCLUSIONS In a semiarid nontropical climate, we observed an association between an increase in the number of snakebite cases and higher temperatures and lower humidity. Moreover, heat waves increased the frequency of snakebites in both cold and hot seasons.
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Affiliation(s)
- Sagi Shashar
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maayan Yitshak-Sade
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Victor Novack
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Landová E, Bakhshaliyeva N, Janovcová M, Peléšková Š, Suleymanova M, Polák J, Guliev A, Frynta D. Association Between Fear and Beauty Evaluation of Snakes: Cross-Cultural Findings. Front Psychol 2018; 9:333. [PMID: 29615942 PMCID: PMC5865084 DOI: 10.3389/fpsyg.2018.00333] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 08/30/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Abstract
According to the fear module theory, humans are evolutionarily predisposed to perceive snakes as prioritized stimuli and exhibit a fast emotional and behavioral response toward them. In Europe, highly dangerous snake species are distributed almost exclusively in the Mediterranean and Caspian areas. While the risk of a snakebite is relatively low in Central Europe, Azerbaijan, on the other hand, has a high occurrence of the deadly venomous Levant viper (Macrovipera lebetina). We hypothesize that co-habitation with this dangerous snake has shaped the way in which humans evaluate snake species resembling it. For that purpose, we asked respondents from the Czech Republic and Azerbaijan to rank photographs depicting 36 snake species according to perceived fear and beauty. The results revealed a high cross-cultural agreement in both evaluations (fear r2 = 0.683, p < 0.0001; beauty: r2 = 0.816, p < 0.0001). Snakes species eliciting higher fear tend to be also perceived as more beautiful, yet people are able to clearly distinguish between these two dimensions. Deadly venomous snakes representing a serious risk are perceived as highly fearful. This is especially true for the vipers and allies (pit vipers) possessing a characteristic body shape with a distinct triangular head and thick body, which was found as the most fear evoking by respondents from both countries. Although the attitude toward snakes is more negative among the respondents from Azerbaijan, their fear evaluation is similar to the Czechs. For instance, despite co-habitation with the Levant viper, it was not rated by the Azerbaijanis as more fearful than other dangerous snakes. In conclusion, agreement in the evaluation of snake fear and beauty is cross-culturally high and relative fear attributed to selected snake species is not directly explainable by the current environmental and cultural differences. This may provide some support for the evolutionary hypothesis of preparedness to fear snakes.
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Affiliation(s)
- Eva Landová
- Department of Zoology, Faculty of Science, Charles University, Prague, Czechia.,Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czechia
| | | | - Markéta Janovcová
- Department of Zoology, Faculty of Science, Charles University, Prague, Czechia.,Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czechia
| | - Šárka Peléšková
- Department of Zoology, Faculty of Science, Charles University, Prague, Czechia.,Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czechia
| | - Mesma Suleymanova
- Natural Historical Museum Named After Gasanbey Zardabi, Baku, Azerbaijan
| | - Jakub Polák
- Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia
| | - Akif Guliev
- Biology Faculty, Baku State University, Baku, Azerbaijan
| | - Daniel Frynta
- Department of Zoology, Faculty of Science, Charles University, Prague, Czechia.,Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czechia
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Isbister GK, Jayamanne S, Mohamed F, Dawson AH, Maduwage K, Gawarammana I, Lalloo DG, de Silva HJ, Scorgie FE, Lincz LF, Buckley NA. A randomized controlled trial of fresh frozen plasma for coagulopathy in Russell's viper (Daboia russelii) envenoming. J Thromb Haemost 2017; 15:645-654. [PMID: 28106331 PMCID: PMC5408386 DOI: 10.1111/jth.13628] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Indexed: 11/29/2022]
Abstract
Essentials Russell's viper envenoming is a major health issue in South Asia and causes coagulopathy. We studied the effect of fresh frozen plasma and two antivenom doses on correcting coagulopathy. Fresh frozen plasma did not hasten recovery of coagulopathy. Low-dose antivenom did not worsen coagulopathy. SUMMARY Background Russell's viper (Daboia russelii) envenoming is a major health issue in South Asia and causes venom-induced consumption coagulopathy (VICC). Objectives To investigate the effects of fresh frozen plasma (FFP) and two antivenom doses in correcting VICC. Methods We undertook an open-label randomized controlled trial in patients with VICC at two Sri Lankan hospitals. Patients with suspected Russell's viper bites and coagulopathy were randomly allocated (1 : 1) to high-dose antivenom (20 vials) or low-dose antivenom (10 vials) plus 4 U of FFP. The primary outcome was the proportion of patients with an International Normalized Ratio (INR) of < 2 at 6 h after antivenom administration. Secondary outcomes included anaphylaxis, major hemorrhage, death, and clotting factor recovery. Results From 214 eligible patients, 141 were randomized: 71 to high-dose antivenom, and 70 to low-dose antivenom/FFP; five had no post-antivenom blood tests. The groups were similar except for a delay of 1 h in antivenom administration for FFP patients. Six hours after antivenom administration, 23 of 69 (33%) patients allocated to high-dose antivenom had an INR of < 2, as compared with 28 of 67 (42%) allocated to low-dose antivenom/FFP (absolute difference 8%; 95% confidence interval - 8% to 25%). Fifteen patients allocated to FFP did not receive it. Severe anaphylaxis occurred equally frequently in each group. One patient given FFP developed transfusion-related acute lung injury. Three deaths occurred in low-dose antivenom/FFP patients, including one intracranial hemorrhage. There was no difference in recovery rates of INR or fibrinogen, but there was more rapid initial recovery of factor V and FX in FFP patients. Conclusion FFP after antivenom administration in patients with Russell's viper bites did not hasten recovery of coagulopathy. Low-dose antivenom/FFP did not worsen VICC, suggesting that low-dose antivenom is sufficient.
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Affiliation(s)
- G. K. Isbister
- Clinical Toxicology Research GroupUniversity of NewcastleNewcastleNew South WalesAustralia
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
| | - S. Jayamanne
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
- Department of MedicineFaculty of MedicineUniversity of KelaniyaRagamaSri Lanka
| | - F. Mohamed
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
| | - A. H. Dawson
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
- Department of PharmacologySOMSSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - K. Maduwage
- Clinical Toxicology Research GroupUniversity of NewcastleNewcastleNew South WalesAustralia
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
- Department of BiochemistryFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
| | - I. Gawarammana
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
- Department of MedicineFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
| | - D. G. Lalloo
- Clinical Sciences and International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - H. J. de Silva
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
- Department of MedicineFaculty of MedicineUniversity of KelaniyaRagamaSri Lanka
| | - F. E. Scorgie
- Hunter Haematology Research GroupCalvary Mater NewcastleNewcastleNew South WalesAustralia
| | - L. F. Lincz
- Hunter Haematology Research GroupCalvary Mater NewcastleNewcastleNew South WalesAustralia
| | - N. A. Buckley
- South Asian Clinical Toxicology Research CollaborationFaculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
- Department of PharmacologySOMSSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
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Isbister GK, Buckley NA, Page CB, Scorgie FE, Lincz LF, Seldon M, Brown SGA. A randomized controlled trial of fresh frozen plasma for treating venom-induced consumption coagulopathy in cases of Australian snakebite (ASP-18). J Thromb Haemost 2013; 11:1310-8. [PMID: 23565941 DOI: 10.1111/jth.12218] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 02/25/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Venom-induced consumption coagulopathy (VICC) is a major effect of snake envenoming. OBJECTIVES To investigate whether fresh frozen plasma (FFP) given after antivenom resulted in more rapid correction of coagulation. PATIENTS/METHODS This was a multicenter open-label randomized controlled trial in patients with VICC of FFP vs. no FFP within 4 h of antivenom administration. Patients (> 2 years) recruited to the Australian snakebite project with VICC (International Normalized Ratio [INR] > 3) were eligible. Patients were randomized 2 : 1 to receive FFP or no FFP. The primary outcome was the proportion with an INR of < 2 at 6 h after antivenom administration. Secondary outcomes included time from antivenom administration to discharge, adverse effects, major hemorrhage, and death. RESULTS Of 70 eligible patients, 65 consented to be randomized: 41 to FFP, and 24 to no FFP. Six hours after antivenom administration, more patients randomized to FFP had an INR of < 2 (30/41 [73%] vs. 6/24 [25%]; absolute difference, 48%; 95% confidence interval 23-73%; P = 0.0002). The median time from antivenom administration to discharge was similar (34 h, range 14-230 h vs. 39 h, range 14-321 h; P = 0.44). Seven patients developed systemic hypersensitivity reactions after antivenom administration - two mild and one severe (FFP arm), and three mild and one severe (no FFP). One serious adverse event (intracranial hemorrhage and death) occurred in an FFP patient with pre-existing hypertension, who was hypertensive on admission, and developed a headache 6 h after FFP administration. Post hoc analysis showed that the median time from bite to FFP administration was significantly shorter for non-responders to FFP than for responders (4.7 h, interquartile range [IQR] 4.2-6.7 h vs. 7.3 h, IQR 6.1-8 h; P = 0.002). CONCLUSIONS FFP administration after antivenom administration results in more rapid restoration of clotting function in most patients, but no decrease in discharge time. Early FFP administration (< 6-8 h) post-bite is less likely to be effective.
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Affiliation(s)
- G K Isbister
- Department of Clinical Toxicology and Pharmacology, School of Medicine and Public Health, University of Newcastle, Calvary Mater Newcastle, Newcastle, NSW, Australia.
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