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Ugeskrift For Laeger Aug 2020Snakebite envenoming is a neglected tropical disease killing more than 100,000 people every year. Reducing the mortality and morbidity of snakebite envenoming depends on... (Review)
Review
Snakebite envenoming is a neglected tropical disease killing more than 100,000 people every year. Reducing the mortality and morbidity of snakebite envenoming depends on the accessibility of healthcare and antivenom, but also on sufficient knowledge on correct first aid treatment. In this review, we summarise the indications for antivenom treatment and which first-aid measures have proven effective, and which methods should be avoided, since many traditional methods of first-aid treatment of snakebites have been proven to be ineffective or even harmful.
Topics: Antivenins; Humans; Snake Bites
PubMed: 32800051
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jan 2022
Review
Topics: Antivenins; Humans; Practice Guidelines as Topic; Primary Health Care; Snake Bites
PubMed: 34996773
DOI: 10.1136/bmj-2020-057926 -
Medicina (Kaunas, Lithuania) 2011More than 5 million people are bitten by venomous snakes annually and more than 100,000 of them die. In Europe, one person dies due to envenomation every 3 years. There...
More than 5 million people are bitten by venomous snakes annually and more than 100,000 of them die. In Europe, one person dies due to envenomation every 3 years. There is only one venomous snake species in Lithuania--the common adder (Vipera berus)--which belongs to the Viperidae family; however, there are some exotic poisonous snakes in the zoos and private collections, such as those belonging to the Elapidae family (cobras, mambas, coral snakes, etc.) and the Crotalidae subfamily of the Viperidae family (pit vipers, such as rattlesnakes). Snake venom can be classified into hemotoxic, neurotoxic, necrotoxic, cardiotoxic, and nephrotoxic according to the different predominant effects depending on the family (i.e., venom of Crotalidae and Viperidae snakes is more hemotoxic and necrotoxic, whereas venom of Elapidae family is mainly neurotoxic). The intoxication degree is estimated according to the appearance of these symptoms: 1) no intoxication ("dry" bite); 2) mild intoxication (local edema and pain); 3) moderate intoxication (pain, edema spreading out of the bite zone, and systemic signs); 4) severe intoxication (shock, severe coagulopathy, and massive edemas). This topic is relevant because people tend to make major mistakes providing first aid (e.g., mouth suction, wound incision, and application of ice or heat). Therefore, this article presents the essential tips on how first aid should be performed properly according to the "Guidelines for the Management of Snake-Bites" by the World Health Organization (2010). Firstly, the victim should be reassured. Rings or other things must be removed preventing constriction of the swelling limb. Airway/breathing must be maintained. The bitten limb should be immobilized and kept below heart level to prevent venom absorption and systemic spread. Usage of pressure bandage is controversial since people usually apply it improperly. Incision, mouth suction, or excision should not be performed; neither a tourniquet nor ice or heat should be applied. A doctor must monitor respiratory rate, blood pressure, heart rate, renal function, fluid balance, and coagulation status. The only specific treatment method is antivenin--serum with antibodies against antigens of snake venom. Antivenins against pit vipers used in the United States are Antivenin Crotalidae Polyvalent (ACP) and a more purified and hence causing less adverse reactions--Crotalidae Polyvalent Immune Fab (CroFab). In Europe, a polyvalent antiserum against Viperidae family snakes (including the common adder) can be used. Antivenins often may cause severe hypersensitivity reactions because of their protein nature. The bite of the common adder (the only poisonous snake in such countries as Lithuania and Great Britain) relatively rarely results in death; thus, considering the risk of dangerous reactions the antivenin causes itself, the usage of it is recommended to be limited only to life-threatening conditions.
Topics: Animals; Antivenins; First Aid; Humans; Snake Bites; Viper Venoms; Viperidae
PubMed: 22123554
DOI: No ID Found -
Frontiers in Immunology 2021Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually.... (Review)
Review
Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually. The diagnosis of snakebite envenoming is commonly based on a combination of patient history and a syndromic approach. However, the availability of auxiliary diagnostic tests at the disposal of the clinicians vary from country to country, and the level of experience within snakebite diagnosis and intervention may be quite different for clinicians from different hospitals. As such, achieving timely diagnosis, and thus treatment, is a challenge faced by treating personnel around the globe. For years, much effort has gone into developing novel diagnostics to support diagnosis of snakebite victims, especially in rural areas of the tropics. Gaining access to affordable and rapid diagnostics could potentially facilitate more favorable patient outcomes due to early and appropriate treatment. This review aims to highlight regional differences in epidemiology and clinical snakebite management on a global scale, including an overview of the past and ongoing research efforts within snakebite diagnostics. Finally, the review is rounded off with a discussion on design considerations and potential benefits of novel snakebite diagnostics.
Topics: Animals; Antivenins; Early Diagnosis; Health Services Accessibility; Humans; Outcome Assessment, Health Care; Rural Population; Snake Bites; Snakes; Tropical Climate
PubMed: 33995385
DOI: 10.3389/fimmu.2021.661457 -
Toxins Sep 2018Antivenom cross-reactivity has been investigated for decades to determine which antivenoms can be used to treat snakebite envenomings from different snake species.... (Review)
Review
Antivenom cross-reactivity has been investigated for decades to determine which antivenoms can be used to treat snakebite envenomings from different snake species. Traditionally, the methods used for analyzing cross-reactivity have been immunodiffusion, immunoblotting, enzyme-linked immunosorbent assay (ELISA), enzymatic assays, and in vivo neutralization studies. In recent years, new methods for determination of cross-reactivity have emerged, including surface plasmon resonance, antivenomics, and high-density peptide microarray technology. Antivenomics involves a top-down assessment of the toxin-binding capacities of antivenoms, whereas high-density peptide microarray technology may be harnessed to provide in-depth knowledge on which toxin epitopes are recognized by antivenoms. This review provides an overview of both the classical and new methods used to investigate antivenom cross-reactivity, the advantages and disadvantages of each method, and examples of studies using the methods. A special focus is given to antivenomics and high-density peptide microarray technology as these high-throughput methods have recently been introduced in this field and may enable more detailed assessments of antivenom cross-reactivity.
Topics: Animals; Antivenins; Cross Reactions; Peptides; Snake Venoms
PubMed: 30261694
DOI: 10.3390/toxins10100393 -
Toxins Jun 2022There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review... (Review)
Review
There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.
Topics: Animals; Antivenins; Bungarus; Elapidae; Humans; Snake Bites; Viperidae
PubMed: 35878174
DOI: 10.3390/toxins14070436 -
Prague Medical Report 2016Snakebites by exotic venomous snakes can cause serious or even life-threatening envenoming. In Europe and North America most victims are breeders, with a few snakebites... (Review)
Review
Snakebites by exotic venomous snakes can cause serious or even life-threatening envenoming. In Europe and North America most victims are breeders, with a few snakebites from wild native American rattlesnakes. The envenomed victims may present in organ and/or system failure with muscle paralysis, respiratory failure, circulatory instability, acute kidney injury, severe coagulation disorder, and local disability - compartment syndrome and necrosis. Best managed by close collaboration between clinical toxicology and intensive care, most severe envenomings are managed primarily by intensive care physicians. Due to the low incidence of severe envenoming, the clinical course and correct management of these cases are not intrinsically familiar to most physicians. This review article summarizes the clinical syndromes caused by severe envenoming and the therapeutic options available in the intensive care setting.
Topics: Animals; Antivenins; Emergency Treatment; Humans; Physical Examination; Snake Bites; Snake Venoms; Snakes
PubMed: 27930893
DOI: 10.14712/23362936.2016.16 -
PLoS Neglected Tropical Diseases Nov 2020Bungarus multicinctus is the most venomous snake distributed in China and neighboring countries of Myanmar, Laos, north Vietnam and Thailand. The high mortality rate of...
Immunoreactivity and neutralization study of Chinese Bungarus multicinctus antivenin and lab-prepared anti-bungarotoxin antisera towards purified bungarotoxins and snake venoms.
Bungarus multicinctus is the most venomous snake distributed in China and neighboring countries of Myanmar, Laos, north Vietnam and Thailand. The high mortality rate of B. multicinctus envenomation is attributed to the lethal components of α-, β-, γ- and κ- bungarotoxins contained in the venom. Although anti-B. multicinctus sera were produced in Shanghai, Taiwan and Vietnam, the most widely clinic used product was term as B. multicinctus antivenin and manufactured by Shanghai Serum Bio-technology Co. Ltd. In the present investigation, high purity α-, β- and γ-bungarotoxins were separately isolated from B. multicinctus crude venom. Rabbit anti- α-, β- and γ-bungarotoxin antisera were prepared by common methods, respectively. LD50 values of α-, β- and γ-bungarotoxins were systematically determined via three administration pathways (intraperitoneal, intramuscular and intravenous injections) in Kunming mice. LD50 values of β-bungarotoxin were closely related with injection routines but those of both α- and γ-bungarotoxins were not dependent on the injection routines. Commercial B. multicinctus antivenin showed strong immunoreaction with high molecular weight fractions of the B. multicinctus but weakly recognized low molecular weight fractions like α- and γ-bungarotoxins. Although B. multicinctus antivenin showed immunoreaction with high molecular weight fractions of Bungarus fasciatus, Naja atra, Ophiophagus hannah venoms but the antivenin only demonstrated animal protection efficacy against O. hannah venom. These results indicated that the high molecular weight fractions of the O. hannah played an important role in venom lethality but those of B. fasciatus and N. atra did not have such a role.
Topics: Animals; Antivenins; Bungarotoxins; Bungarus; China; Elapid Venoms; Immune Sera; Lethal Dose 50; Male; Mice; Neutralization Tests; Ophiophagus hannah; Rabbits
PubMed: 33253321
DOI: 10.1371/journal.pntd.0008873 -
Ugeskrift For Laeger Aug 2020Limb-shaking transient ischaemic attack (LS-TIA) is a symptom of cerebral haemodynamic failure caused by large vessel disease. LS-TIA often remains unrecognised though... (Review)
Review
Limb-shaking transient ischaemic attack (LS-TIA) is a symptom of cerebral haemodynamic failure caused by large vessel disease. LS-TIA often remains unrecognised though associated with a poor prognosis. The patient presents with irregular hemiform jerks caused by ischaemia. Imaging demonstrating reduced perfusion or/and flow is essential for the diagnosis, and treatment is aimed at reducing development in atherosclerosis and improving perfusion. As described in this review, management is focused optimising secondary prevention, and in selected cases surgical interventions are considered. Evidence remains weak, especially as to surgical interventions.
Topics: Antivenins; Humans; Ischemic Attack, Transient; Snake Bites; Tremor
PubMed: 32800045
DOI: No ID Found -
New Biotechnology Oct 2018In this review, the different approaches that have been employed with the aim of developing novel antivenoms against animal envenomings are presented and discussed.... (Review)
Review
In this review, the different approaches that have been employed with the aim of developing novel antivenoms against animal envenomings are presented and discussed. Reported efforts have focused on the use of innovative immunization strategies, small molecule inhibitors against enzymatic toxins, endogenous animal proteins with toxin-neutralizing capabilities, and recombinant monoclonal antibodies. Harnessing either of these approaches, antivenom development may benefit from an in-depth understanding of venom compositions and the medical importance of individual venom toxins. Focus is thus also directed towards the different omics technologies (particularly venomics, antivenomics, and toxicovenomics) that are being used to uncover novel animal toxins, shed light on venom complexity, and provide directions for how to determine the medical relevance of individual toxins within whole venoms. Finally, techniques for assessing antivenom specificity and cross-reactivity are reviewed, with special focus on antivenomics and high-density peptide microarray technology.
Topics: Animals; Antivenins; Proteomics
PubMed: 28552814
DOI: 10.1016/j.nbt.2017.05.005