Murphy, Christine M; Hong, Jeannie J; Beuhler, Michael C
Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic stability. Despite initial resuscitation, the patient ultimately died 40 h after presentation. Under the right circumstances, L. mactans antivenin remains a safe and effective therapy for severe black widow envenomations. However, anaphylaxis is a risk for those receiving this therapy, even when the antivenin is diluted and given as an infusion. We report the first death related to diluted L. mactans antivenin given as an infusion.
Murphy, Christine M.; Hong, Jeannie J.; Beuhler, Michael C.
Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic ...
Full Text Available Conventional treatment of Naja naja oxiana (NNO envenoming requires large volumes of equine antivenin raised against NNO crude venom. The poor efficiency of this antivenin is assumed to be due to the high molecular weight non-toxic proteins, a strong immunogen, present in the crude venom. These proteins cause depression of antibody formation against the low molecular weight toxic components of venom. In the present study the low molecular weight lethal components were isolated from crude venom of NNO venom by sephadex G50 get filtration chromatography. A sera was prepared by immunizing horses with toxic fraction. One milliliter of this serum neutralized 1.8mg of NNO crude venom. This high titer antivenin is thus 2.2 times more potent than the sera obtained against NNO crude venom.
Hoover, Nancy G; Fortenberry, James D
Black widow spider envenomation (BWSE) is commonly associated with severe abdominal pain, muscle cramping, and hypertension. Treatment is primarily symptomatic with the use of opiates and benzodiazepines. Priapism is a complication of BWSE that has only rarely been reported. We describe a 17-month-old male who developed priapism after known BWSE. His priapism did not respond to opiates or benzodiazepines, and he was treated with black widow spider antivenin. Complete detumescence followed within several hours. The patient required no additional opiates for pain and was discharged from the hospital the following day. The patient's rapid improvement after antivenin suggests its efficacy in treating BWSE-associated priapism.
Goel, Sheila Choudhury; Yabrodi, Mouhammad; Fortenberry, James
Priapism, although uncommon in preadolescent children, is considered a true emergency. Envenomation by a black widow spider bite has been reported to induce priapism as a manifestation of its toxicity. Early recognition and timely administration of antivenin have been reported to be effective in relieving priapism. Clinicians who care for children need to be aware of this unusual presentation. The diagnosis is traditionally from either direct observation of a spider bite or capture of a spider. We report a case of a previously healthy 2-year-old boy who presented with severe irritability, leg cramps, and stomach ache. The diagnosis of a likely black widow spider envenomation was made on the basis of clinical suspicion and suggestive physical findings in absence of demonstrated exposure. This case highlights the importance of early recognition and successful resolution of symptoms with administration of antivenin and supportive care.
Offerman, Steven R; Daubert, G Patrick; Clark, Richard F
Black widow spiders (Latrodectus mactans) are found throughout the US. Though bites are relatively uncommon, they pose a significant health problem with over 2500 reported to American poison control centers annually. Black widow spider bites cause a characteristic envenomation syndrome consisting of severe pain, muscle cramping, abdominal pain, and back pain. The significant pain associated with envenomation is often refractory to traditional analgesics. Antivenom (Antivenin Latrodectus mactans) is available and effective, but is often withheld because of a fear of acute hypersensitivity reactions. We report four cases of symptomatic black widow spider envenomation. One of the reported cases was managed without antivenom, and, in contrast, three were treated successfully with Antivenin Latrodectus mactans. We believe that these cases demonstrate safe and effective use of black widow antivenom. This article presents the rationale for use of antivenom in these cases, and a nonsystematic review of the pertinent literature.
Offerman, Steven R; Daubert, G Patrick; Clark, Richard F
Black widow spiders (Latrodectus mactans) are found throughout the US. Though bites are relatively uncommon, they pose a significant health problem with over 2500 reported to American poison control centers annually. Black widow spider bites cause a characteristic envenomation syndrome consisting of severe pain, muscle cramping, abdominal pain, and back pain. The significant pain associated with envenomation is often refractory to traditional analgesics. Antivenom (Antivenin Latrodectus macta...
Seyedian, Ramin; Pipelzadeh, Mohammad Hassan; Jalali, Amir; Kim, Euikyung; Lee, Hyunkyoung; Kang, Changkeun; Cha, Mijin; Sohn, Eun-Tae; Jung, Eun-Sun; Rahmani, Ali Hassan; Mirakabady, Abbas Zare
Hemiscorpius lepturus envenomation exhibits various pathological changes in the affected tissues, including skin, blood cells, cardiovascular and central nervous systems. The enzymatic activity and protein component of the venom have not been described previously. In the present study, the electrophoretic profile of H. lepturus venom was determined by SDS-PAGE (12 and 15%), resulting in major protein bands at 3.5-5, 30-35 and 50-60 kDa. The enzymatic activities of the venom was, for the first time, investigated using various zymography techniques, which showed the gelatinolytic, caseinolytic, and hyaluronidase activities mainly at around 50-60 kDa, 30-40 kDa, and 40-50 kDa, respectively. Among these, the proteolytic activities was almost completely disappeared in the presence of a matrix metalloproteinase inhibitor, 1, 10-phenanthroline. Antigen-antibody interactions between the venom and its Iranian antivenin was observed by Western blotting, and it showed several antigenic proteins in the range of 30-160 kDa. This strong antigen-antibody reaction was also demonstrated through an enzyme-linked immunosorbent assay (ELISA). The gelatinase activity of the venom was suppressed by Razi institute polyvalent antivenin, suggesting the inhibitory effect of the antivenin against H. lepturus venom protease activities. Prudently, more extensive clinical studies are necessary for validation of its use in envenomed patients. Copyright 2010 Elsevier Ltd. All rights reserved.
Pauli, Isolete; Minozzo, João Carlos; da Silva, Paulo Henrique; Chaim, Olga Meiri; Veiga, Silvio Sanches
Bites by the brown spider (Loxosceles spp.) are an important health problem in South America, where three species predominate (Loxosceles laeta, Loxosceles gaucho, Loxosceles intermedia). Brown spider bites (loxoscelism) induce a block of cutaneous necrosis and, less commonly, may cause fatal systemic poisoning. A variety of controversial protocols are used to treat loxoscelism, while treatment with antivenin is the only venom specific treatment. Here we studied the action of the venom as well as the response to the antivenin for Loxosceles through an experimental study that simulates bites of L. intermedia (bites of this species are the most common in Brazil). Beneficial effects are known for antivenin applied quickly (within 4 h) after envenomation. Here we wished to examine the temporal development of the brown spider bite as well as the temporal patterns of the action of the antivenin to determine the time limits for beneficial use of the antivenin after envenomation. This information is important since most patients only appear for treatment several hours after being bitten. New Zealand rabbits were experimentally exposed to the venom from brown spiders by the injection of venom from L. intermedia (2x minimum necrotic dose), followed at regular time intervals by antivenin. The use of the loxoscelic antivenin--CPPI (4 mL per animal)--minimized the effects of envenomation when applied for up to 12 h after the injection of the venom, as evaluated by cutaneous (erythrema, edema, ecchymosis and necrosis) and systemic (blood cell and platelet counts, hematimetrics and fibrinogen dosage) criteria. Also, antivenin reduced the size of the necrotic area when applied up to 48 h after envenomation. Thus, therapy with loxoscelic antivenin, CPPI, may provide beneficial results by interfering with envenomation well after the bite occurred and therefore may become an important tool for medical treatment of brown spider bites.
Kisangau Daniel P
Full Text Available Abstract The success of snake bite healers is vaguely understood in Kenya, partly due to their unknown materia medica and occult-mystical nature of their practice. A comparison is made of plants used in snake bite treatments by two culturally distinct African groups (the Kamba and Luo. Thirty two plants used for snakebite treatment are documented. The majority of the antidotes are prepared from freshly collected plant material – frequently leaves. Though knowledge of snake bite conditions etiological perceptions of the ethnic groups is similar, field ethnobotanical data suggests that plant species used by the two ethnic groups are independently derived. Antivenin medicinal plants effectively illustrate the cultural context of medicine. Randomness or the use of a variety of species in different families appears to be a feature of traditional snake bite treatments. A high degree of informant consensus for the species was observed. The study indicates rural Kenya inhabitants rely on medicinal plants for healthcare.
Vega-Gonz¨¢lez Luis Roberto
All over the world there is a huge complex problem caused by the sting of poisonous animals. In many countries all around the orb there are some animal species hazardous for human beings. A case from a Mexican University R&D institute- Private firm innovation project about scorpion¡¯s antivenins health area is presented. The scientific-technological allied participant organizations performed a long life cycle innovation project, which includes research and development, knowledge transference,...
Larson, Kenneth W; Schaefer, Keith R; Austin, Cindy; Norton, Rhy; Finley, Phillip J
Although initially created for the treatment of rattlesnake (genus: Crotalus) bites, Crotalidae-Fab antivenin is used to treat many different pit viper envenomations. However, the efficacy of Crotalidae-Fab in preventing tissue loss from copperhead (Agkistrodon contortrix) or cottonmouth (Agkistrodon piscivorus) snakebites remains unclear. Recent reports show that Agkistrodon-related bites rarely require treatment beyond simple observation and pain control. The purpose of this study was to examine the amount of tissue loss in patients who received Crotalidae-Fab compared with those who did not after an Agkistrodon bite. After institutional review board approval, a retrospective study was completed at a Level 1 trauma center. Between 2009 and 2013, a total of 57 snakebites were identified. Of the 57 bites, the snake species was documented in 36 cases including 31 copperheads, 1 cottonmouth, and 4 rattlesnakes. The other 21 bites were from unknown or nonvenomous species. Of the 32 Agkistrodon-related bites, 15 patients received Crotalidae-Fab (average of 3 vials administered) and 17 did not receive Crotalidae-Fab. None of the 32 patients, regardless of treatment option, had tissue loss or required surgical interventions. Only 1 patient received Crotalidae-Fab and debridement of a vesicle associated with the bite. No clinically significant differences were observed between the groups. These findings support previous literature that failed to show added benefit of Crotalidae-Fab treatment for Agkistrodon bites beyond patient comfort and pain control. Evaluation of current protocols for Agkistrodon envenomations is warranted. Snakebite wound education in trauma physicians and nurses may decrease unnecessary use of antivenom medication.
Abohassan, Ahmed Mohammed; Borham, Marwan Mansour; Barshomy, Said
The snakebite envenoming is an important medical emergency. The envenoming is a complex medical emergency involving the site of the bite as well as multiple organ system. The symptoms and signs depend on the type and amount of venom injected, location of bite, victims' age, body size and general health conditions. This study clarified the clinical presentations; factors involved in complications and the outcome in relation to timing of polyvalent snake antivenin administration in 50 Patients were selected from cases admitted to Al-Salam Hospital at Saadah, Republic of Yemen. The manifestations of envenoming and complications were recorded. Treated patients were analyzed to determine the factors involved in complications and the outcomes in relation to the timing of polyvalent snake antivenin administration The bitten patients had envenoming (80%), bitten at night (68%), while walking barefooted (84%), complaining from pain (76%) and limb swelling (56%). The systemic manifestations were common only in severe cases and patients attend to the hospital after six hours from snake bite. All patients had envenoming developed coagulation abnormalities. Two cases (4%) died from cerebral hemorrhage and multi organ failure.
Full Text Available Venomous snakebites are an important health problem in tropical and subtropical countries. King cobra (Ophiophagus hannah is the largest venomous snake found in South and Southeast Asia. In this study, the O. hannah venom proteome and the venom components cross-reactive to N. kaouthia monospecific antivenin were studied. O. hannah venom consisted of 14 different protein families, including three finger toxins, phospholipases, cysteine-rich secretory proteins, cobra venom factor, muscarinic toxin, L-amino acid oxidase, hypothetical proteins, low cysteine protein, phosphodiesterase, proteases, vespryn toxin, Kunitz, growth factor activators and others (coagulation factor, endonuclease, 5’-nucleotidase. N. kaouthia antivenin recognized several functionally different O. hannah venom proteins and mediated paratherapeutic efficacy by rescuing the O. hannah envenomed mice from lethality. An engineered human ScFv specific to N. kaouthia long neurotoxin (NkLN-HuScFv cross-neutralized the O. hannah venom and extricated the O. hannah envenomed mice from death in a dose escalation manner. Homology modeling and molecular docking revealed that NkLN-HuScFv interacted with residues in loops 2 and 3 of the neurotoxins of both snake species, which are important for neuronal acetylcholine receptor binding. The data of this study are useful for snakebite treatment when and where the polyspecific antivenin is not available. Because the supply of horse-derived antivenin is limited and the preparation may cause some adverse effects in recipients, a cocktail of recombinant human ScFvs for various toxic venom components shared by different venomous snakes, exemplified by the in vitro produced NkLN-HuScFv in this study, should contribute to a possible future route for an improved alternative to the antivenins.
Danpaiboon, Witchuda; Reamtong, Onrapak; Sookrung, Nitat; Seesuay, Watee; Sakolvaree, Yuwaporn; Thanongsaksrikul, Jeeraphong; Dong-din-on, Fonthip; Srimanote, Potjanee; Thueng-in, Kanyarat; Chaicumpa, Wanpen
Venomous snakebites are an important health problem in tropical and subtropical countries. King cobra (Ophiophagus hannah) is the largest venomous snake found in South and Southeast Asia. In this study, the O. hannah venom proteome and the venom components cross-reactive to N. kaouthia monospecific antivenin were studied. O. hannah venom consisted of 14 different protein families, including three finger toxins, phospholipases, cysteine-rich secretory proteins, cobra venom factor, muscarinic toxin, L-amino acid oxidase, hypothetical proteins, low cysteine protein, phosphodiesterase, proteases, vespryn toxin, Kunitz, growth factor activators and others (coagulation factor, endonuclease, 5’-nucleotidase). N. kaouthia antivenin recognized several functionally different O. hannah venom proteins and mediated paratherapeutic efficacy by rescuing the O. hannah envenomed mice from lethality. An engineered human ScFv specific to N. kaouthia long neurotoxin (NkLN-HuScFv) cross-neutralized the O. hannah venom and extricated the O. hannah envenomed mice from death in a dose escalation manner. Homology modeling and molecular docking revealed that NkLN-HuScFv interacted with residues in loops 2 and 3 of the neurotoxins of both snake species, which are important for neuronal acetylcholine receptor binding. The data of this study are useful for snakebite treatment when and where the polyspecific antivenin is not available. Because the supply of horse-derived antivenin is limited and the preparation may cause some adverse effects in recipients, a cocktail of recombinant human ScFvs for various toxic venom components shared by different venomous snakes, exemplified by the in vitro produced NkLN-HuScFv in this study, should contribute to a possible future route for an improved alternative to the antivenins. PMID:24828754
Adolfo Rafael de Roodt
. Nevertheless, the treatment of venomous snakebites in domestic animals can turn diffcult due several problems among which, the conspicuous, is the low availability or lack of antivenoms for veterinary use. As commercial pressures on the pharmaceutical industry have led to a reduction in the production of antivenins in several parts of the world, their availability is sometimes rather limited and sometimes these products are impossible to obtain. In this work, we immunized horses with venom of South American vipers to obtain hyperimmune plasma. The plasma was processed to separate whole IgG of F(ab´2 fragments using two conventional methods (caprylic acid fractionation or double saline precipitation and pepsin digestion. The obtained antivenins were tested for their biochemical and immunochemical characteristics and neutralizing potency. The SDS-PAGE of the antivenins showed, in the processed antivenin, bands in the order of 150 and 100 kDa in the whole IgG or F(ab´2 fragments, respectively. The presence of albumin or contaminants of high or low molecular weight was not detected in any of the preparations. No important differences were observed in the neutralizing potency of the antivenins, although production cost was very low with the method used to obtain pure IgG. The low production cost makes the production of antivenins for veterinary use proftable when the production of F(ab´2 fragments is not possible.
Snake-bite is considered a neglected tropical disease that affects thousands of people worldwide. Administration of antivenom is the corner stone in the therapy of snake-bite. The study aimed to improve the production of antivenom using gamma irradiation to detoxify venom and calcium phosphate nanoparticles as alternative adjuvant. This was carried out by studying the toxicological and immunological properties of the Naja haje venom before and after exposure to 2 KGy gamma radiation. Calcium phosphate nanoparticles were selected to be used as adjuvant as they showed better entrapment efficacy than Alum or chitosan nanoparticles. In order to achieve the goal of the present study, the native, γ irradiated and nanoparticles loaded venom as well nanoparticles loaded irradiated venom were used for preparation of their specific antivenom using rabbits. Data revealed that gamma irradiation of Naja haje venom reduced its lethality to one sixth as compared to its native venom. There was no change in the antigenic reactivity between both native and γ irradiated Naja haje venoms. Inhibition in the phospholipase and proteolytic activities after gamma irradiation were shown. Furthermore, injection of γ irradiated Naja haje venom did not significantly change activities of serum LDH, CPK, CK-MB, ALT and AST as well as urea and creatinine levels compared to the normal group. In addition, the immune response of immunized rabbits was evaluated through determination of antibody titer using ELISA technique, serum titer produced with γ irradiated venom loaded on CPN showed highest titer as compared to other sera. Results indicated that the sooner antivenom was injected the higher the neutralizing capacity obtained. All the prepared antivenoms were able to neutralize the toxicological activities of Naja haje snake venom to same extent. Thus, gamma radiation is a reliable tool for detoxification of Naja haje venom without affecting its immunogenicity. Furthermore. Calcium phosphate nanoparticles are promising and safe system when applied as an adjuvant in immunization process
Adolfo Rafael de Roodt; Silvana Litwin; Judith Estevez; Eduardo G Gould; Jorge A Dolab; Jorge Gould
Las mordeduras producidas por serpientes venenosas son un serio problema médico en varias regiones del mundo y sobre las cuales los sistemas de salud actúan en diferentes grados en lo referente a tratamiento y prevención. Sin embargo, el tratamiento de las mordeduras de serpientes venenosas en animales domésticos puede resultar difícil por diversos motivos, siendo uno de estos la baja oferta o ausencia de antivenenos para uso veterinario. Las presiones comerciales en la industria farmacéutica...
Sherman; Groll; Gonzalez; Aerts
Description of a black widow spider (Latrodectus mactans) envenomation in a term pregnancy.Case report conducted at an Air Force tertiary care hospital of a 27-year-old primigravida at 38 1/7 weeks pregnancy.Latrodectus mactans antivenin can be given to treat symptoms of black widow envenomation.Black widow envenomations can cause symptoms associated with acute intra-abdominal processes. In pregnancy, envenomations can result in symptoms and signs similar to those seen in preeclampsia (abdominal pain, headache, hypertension, and proteinuria). Latrodectism should be considered in patients complaining of these symptoms in association with a spider bite. If latrodectism is considered to be the underlying origin for these symptoms, appropriate treatment should be administered. In cases of pregnancy, treatment should include L. mactans antivenin if believed to be clinically indicated. There is no current evidence that this antivenin is contraindicated in pregnancy. (Curr Surg 57:346-348)
Zolfagharian H.; Mohammadpour Dounighi, N.
Antivenoms have been used successfully for more than a century and up to now constitute the only effectivetreatment for snakebites .The production of antivenin started long time ago when the calmette was preparedthe antivenom in 1894.The method currently used to prepare antivenom by most of the manufacturers areoriginated from the method of Pope which was develop in 1938. Several new approaches in the production ofantivenom have been proposed to produce IgG, F(ab)2, F(ab) antivenin to improve...
clinical findings and administration of polyvalent antivenin. This study sought to describe common presentation patterns and treatments offered for snake bites at Kitui District Hospital, and to characterize the causative venomous snakes. Patients and methods. This was a prospective case series carried out over a period of 8 ...
exists. Diagnostic tests for snake species identification are not available and management mainly relies on clinical findings and administration of polyvalent antivenin. This study sought to describe common presentation patterns and treatments offered for snake bites at Kitui District Hospital, and to characterize the causative ...
Objective: Snake bite remains major public health problem worldwide. We present our .... Factors that could delay seeking health care include lack of transport ... transportation.[2,14,17] To overcome this, it has been suggested that snake anti-venin should be made available free of cost, particularly in the remote rural areas.
Xu, Anyi; Shan, Renfei; Huang, Daochao; Zhou, Jiajia; Keenoo, Anaswasseem; Qin, Jie
The most serious complications of the central nervous system that occur after venomous snake bite are intracranial hemorrhage and ischemic stroke.We present a rarely seen central nervous system complication, acute demyelinating encephalomyelitis, after a treated Deinagkistrodon's viper bite.On April 5, 2015, a 50-year-old male farmer was bitten on his right leg by a Deinagkistrodon's viper. The bite rendered the victim unconscious for 14 days, during which he was treated with tetanus toxoid and polyvalent antisnake venom. Acute demyelinating encephalomyelitis (ADEM) was suspected after magnetic resonance imaging of the brain. After a high dose of methylprednisolone was used as diagnostic treatment, the patient started recovering fast.ADEM is a rare complication after snake bite, and is triggered by venom or antivenin. Magnetic resonance imaging helps in the early diagnosis of ADEM, and high-dose corticosteroid therapy appears to be effective in ADEM after viper bite or antivenin management.
Timms, Patrick K.; Gibbons, Robert B.
Latrodectism—envenomation by the black widow spider, Latrodectus mactans—has been reported in virtually every state. The spider is particularly prevalent in the Southwest, Southeast and California, and symptoms from its bite are painful and may be confusing to clinicians. Prompt improvement can be expected in most cases with administration of calcium and muscle relaxant, but some patients may require treatment with antivenin. No deaths occurred in our series of 11 patients, although one case ...
Full Text Available Objective: To study the incidence and epidemiology of scorpion sting cases that were referred to the health services centers of Behbahan County, Khuzistan Province, southwestern Iran, during the two yeare (2007-2008. Methods: In this descriptive retrospective research, the data has come from files of scorpionstung patients referring to the health services centers of Behbahan during study period. A special scorpion sting sheet was prepared and completed for every case of scorpion sting. Analysis of 3441 case sheets received during this period was carried out. The frequencies of medical and entomoepidemiologic parameters were turned to the percentage position. Results: A total of 3 441 cases of scorpion stings were reported during the two-year period from 2007 to 2008. The average incidence of scorpion stings was 8.8‰ in the two years. The frequency of cases was higher during August, September, June and July that 2 056 cases of scorpion stings were reported. Most stings were occurred during summer. Nearly 51.3% of the cases were men. All cases had received antivenin. Majority of scorpion sting cases (56.5% lived in the rural areas. The most common sting site was the hand. About 74.4% have received the antivenin 0-6 h after the sting. The early injection of the antivenin is very important. The most of the cases of scorpion stings (59% were occurred by yellow scorpions. Conclusions: Surveillance for cases of scorpion stings must begin at all regions of Behbahan County. Treatment of cases of scorpion stings is conducted according to a protocol set by the Ministry of Health, Treatment and Medical Education. This protocol included directions for lines of treatment and the dose of antivenin recommended. Thereafter all cases are referred to hospital for further observation and management.
Full Text Available McGee J Leonard,1 Catherine Bresee,2 Andrew Cruikshank1 1Animal Specialty and Emergency Center, Los Angeles, CA, USA; 2The Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA Abstract: This is a retrospective multicenter study (2006–2012 examining a population of dogs with moderate to severe crotalid envenomation for protective effects of the canine rattlesnake vaccine. Five nonacademic emergency and referral veterinary hospitals in Southern California were involved in the study and contributed records regarding a total of 82 client-owned dogs that were treated for naturally occurring rattlesnake envenomation. All dogs received antivenin (Crotalidae polyvalent, with dosages ranging from one to three vials (mean: 1.3±0.6. Fourteen dogs (17% had a history of prior vaccination against crotalid venom. In univariate logistic regression modeling, cases with lower body weight (P=0.0001 or higher snakebite severity scores (P<0.0001 were associated with greater morbidity. No statistically significant difference in morbidity or mortality between vaccinated and unvaccinated dogs was found. The findings of this study did not identify a significantly protective effect of previous vaccination in the cases of moderate to severe rattlesnake envenomation that require treatment with antivenin. Keywords: rattlesnake envenomation, vaccine, antivenin, canine
Tokish, J T; Benjamin, J; Walter, F
To review a regional experience with the treatment of snakebites. Five major southern Arizona hospitals, including two Level I trauma centers. A review of all snakebite admissions over a five-year period was performed. During the period reviewed, 164 patients were admitted for snakebites. Rattlesnakes were responsible for 98 percent of identified envenomations. Thirty-six percent of the patients were transported by air to the admitting facility. Eighty percent of patients were admitted to the intensive care unit for an average of 1.6 days. Total hospital stays averaged 2.8 days. Ninety percent of patients received antivenin, usually only on the day of admission. Of those receiving antivenin, 20 percent had an anaphylactoid reaction, and 1 percent required readmission for serum sickness. Laboratory evaluation indicated abnormalities in platelet count, coagulation parameters, and fibrinogen levels, but these rarely required treatment. Thirteen percent of patients underwent surgical intervention, including a 4 percent fasciotomy rate, and a single amputation. The use of field treatment, including "cut and suck," tourniquets, and cryotherapy, increased the likelihood of surgery. The authors concluded that the intensive care unit and helicopter transport system were overused. They recommend that established objective envenomation severity scores be used to dictate patient treatment, specifically the use of antivenin.
Lee, H F; Lee, J D; Lee, Y C
In course of immunizing horses with snake venoms, tetanus and diphtheria toxoids, a new serum component, T-globulin, was formed and migrated between the beta- and gamma-globulins. The T-globulin content was parallel with the antibody titre after the middle course of immunization. There were many components in snake antivenin and T-globulin was composed of most of those components. The components of diphtheria T-globulin were the same as those of crude antitoxin and tetanus T-globulin except one precipitin.
Arjun Datt Law
Full Text Available Neuroparalytic snake bite is a common emergency situation encountered in India. Common krait (Bungarus caeruleus and cobra (Naja naja are important snakes causing neuroparalysis in North India. Despite severe neuroparalysis, patients who receive antivenin and ventilator support in time recover completely. Autonomic disturbances resulting in resting tachycardia, labile hypertension and sweating have been described in common krait envenomation. We present a case of common krait (B. caeruleus envenomation presenting in the locked-in state and severe hypertension that remained in such a state for over 96 h before a gradual and sustained recovery.
Warrell, David A
This article discusses the epidemiology, prevention, clinical features, first aid and medical treatment of venomous bites by snakes, lizards, and spiders; stings by fish, jellyfish, echinoderms, and insects; and poisoning by fish and molluscs, in all parts of the world. Of these envenoming and poisonings, snake bite causes the greatest burden of human suffering, killing 46,000 people each year in India alone and more than 100,000 worldwide and resulting in physical handicap in many survivors. Specific antidotes (antivenoms/antivenins) are available to treat envenoming by many of these taxa but supply and distribution is inadequate in many tropical developing countries. Copyright © 2012. Published by Elsevier Inc.
Timms, Patrick K.; Gibbons, Robert B.
Latrodectism—envenomation by the black widow spider, Latrodectus mactans—has been reported in virtually every state. The spider is particularly prevalent in the Southwest, Southeast and California, and symptoms from its bite are painful and may be confusing to clinicians. Prompt improvement can be expected in most cases with administration of calcium and muscle relaxant, but some patients may require treatment with antivenin. No deaths occurred in our series of 11 patients, although one case was complicated by serum sickness. PMID:3962294
Latrodectus mactans has now invaded towns and cities. The spider's venom is a neurotoxin that causes little local reaction but produces pain and spasm in large skeletal muscle groups within 30 minutes to three hours after the bite. Severe envenomation may result in respiratory failure and coma. First aid is of no value. Muscle relaxants are useful in treatment, as is calcium gluconate. Antivenin is indicated for high-risk victims, such as those with hypertension and persons younger than 16 or older than 60 years of age.
Full Text Available Antivenoms have been used successfully for more than a century and up to now constitute the only effectivetreatment for snakebites .The production of antivenin started long time ago when the calmette was preparedthe antivenom in 1894.The method currently used to prepare antivenom by most of the manufacturers areoriginated from the method of Pope which was develop in 1938. Several new approaches in the production ofantivenom have been proposed to produce IgG, F(ab2, F(ab antivenin to improve their quality .Theseimprovement include complete or partial modification in the antivenom production regarding animal,immunization protocols , new adjuvants in hyperimmunization of animals , purification processes ( caprylicacid ,chromatography , diafiltration and ulterafiltration ,enzymatic digestion of IgG (pepsin, papain andfractionation of venom .When the IgG is digested enzymatically, different fragments are obtained depending on the enzyme used, that is, if papain is used, three fragments are obtained, the crystallizing fragment (Fc and two antigen-binding fragments F(ab and, if pepsin is used, one F(ab'2 fragment is obtained, while thecrystallizing fragment is digested. Fab and F(ab2 fragments conserve their capacity to specifically bind to the antigen that gave rise to them.
Su, H Y; Wang, M J; Li, Y H; Tang, C N; Tsai, M J
To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation. This case series was conducted in the only tertiary care centre in eastern Taiwan. Patients who presented to the emergency department with Naja atra bite between January 2008 and September 2014 were included. Clinical information was collected and compared between surgical and non-surgical patients. A total of 28 patients with Naja atra envenomation presented to the emergency department during the study period. Of these, 60.7% (n=17) required surgery. Necrotising fasciitis (76.5%) was the main finding in surgery. Comparisons between surgical and non-surgical patients showed skin ecchymosis (odds ratio=34.36; 95% confidence interval, 2.20-536.08; P=0.012) and a high total dose of antivenin (≥6 vials; odds ratio=14.59; 95% confidence interval, 1.10-192.72; P=0.042) to be the most significant predictors of surgery. The rate of bacterial isolation from the surgical wound was 88.2%. Morganella morganii (76.5%), Enterococcus faecalis (58.8%), and Bacteroides fragilis (29.4%) were the most common pathogens involved. Bacterial susceptibility testing indicated that combined broad-spectrum antibiotics were needed to cover mixed aerobic and anaerobic bacterial infection. Patients with Naja atra envenomation who present with skin ecchymosis or the need for a high dose of antivenin may require early surgical assessment. Combined broad-spectrum antibiotics are mandatory.
Full Text Available Aim: Evaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2% of patients were male and 28 (37.8% were female. Mean age of the study population was 34.85±19.17 (min 7- max 80 years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%. 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose. Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.
Chawla, Payal; Chawla, Amit; Vasudeva, Neeru; Sharma, Surendra Kumar
There are approximately 28 species of Aerva genus, but only a few species are medicinal of which A. persica, A. lanata and A. javanica are of great value. A number of flavonol glycosides (e.g., aervanone, kaempferol-3-galactoside, isorhamnetin-3-O-β-D-glucoside) have been reported from Aerva persica as major phytoconstituents and the minor constituents are β-cyanins (glycine betaine and trigonelline), sterols and carbohydrates. This plant is used as medicinal herb in several traditional systems of medicine all over the world, like diuretic, demulcent, purgative, emetic and tinder. Aerva plants are used to cure ulcer, lithiasis, dropsical affections, eye affection, toothache, headache, in disorders of abdomen and inflammation of internal organs. Roots and flowers are reported to possess hypoglycemic, antioxidant, anthelmintic, analgesic, antimalarial, antivenin activities and medicinal properties against rheumatism and kidney troubles.
Al-Mohareb, F; Al-Sadoon, M
Eighty-two patients with snakebites were seen at King Fahad Hospital (KFH) in Al Baha during the period from 1983G to 1989G and were retrospectively reviewed. Most common symptoms were pain (80.5%) and swelling (77%). Hemostatic abnormalities were found in 36 patients (44%) and were usually present on admission but may be delayed up to 20 hours after snakebite. All of these patients had local swellings, 17 had low hemoglobin and 29 had leukocytosis, suggesting systemic envenomation. Five patients had local skin necrosis, and three had to have fasciotomy for compartment syndrome. All patients, except one death, responded to treatment (antivenin, plasma products, or both). These data emphasize that hemostatic abnormality is the major complication of snakebite in the Al Baha District of Saudi Arabia.
Full Text Available Snakebite envenomation is a neglected global health problem, causing substantial mortality, disability, and psychological morbidity, especially in rural tropical and subtropical zones. Antivenin is currently the only specific medicine for envenomation. However, it is restricted by cold storage, snakebite diagnosis, and high price. Snake venom phospholipase A2s (svPLA2s are found in all kinds of venomous snake families (e.g., Viperidae, Elapidae, and Colubridae. Along with their catalytic activity, svPLA2s elicit a wide variety of pharmacological effects that play a pivotal role in envenomation damage. Hence, neutralization of the svPLA2s could weaken or inhibit toxic damage. Here we overviewed the latest knowledge on the distribution, pathophysiological effects, and inhibitors of svPLA2s to elucidate the potential for a novel, wide spectrum antivenom drug targeting svPLA2s.
Bodio, Mauro; Junghanss, Thomas
Central Europe is largely safe from accidents with venomous and poisonous animals. The regions where European vipers are regularly found are shrinking. Today accidents with jellyfish and stings of venomous fish afflicted during leisure activities at the sea side play the dominant role. Life threatening accidents in Europe are mainly due to exotic snakes held in captivity. A system useful in daily medical practice is explained to classify and stage accidents due to poisonous and venomous animals. The important poisonous and venomous animals of Central Europe and the specific therapeutics, the antivenoms, are covered. The antivenom depot "Antivenin-CH" of the Swiss Toxicology Information Centre in Zurich and the MRITox in Munich with the antivenom registry Munich AntiVenom INdex (MAVIN) are presented.
Chippaux, J P; Alagón, A
The incidence of scorpion stings and spider bites is high in Latin America. This is particularly true for Mexico, part of Amazonia, and southern and eastern Brazil. Centruroides and Tityus scorpion stings present a real danger for humans, especially children. Envenomation results in intense pain, neurological signs, and cardiorespiratory manifestations that can lead to death by acute pulmonary edema or heart failure. In the event of confirmed envenomation, antivenin must be administered as soon as possible in association with symptomatic treatment and, if necessary, cardiorespiratory resuscitation. Spider bites are a less frequent and severe. Envenomation by Loxosceles is extremely painful and necrotizing. Severe visceral complications can develop. An effective antivenim has recently become available for local and systemic envenomation. Envenomation by Latrodectus leads to neurological symptoms that can also be treated with antivenom. Envenomation by other spiders is less frequent and generally harmless.
Katzenbach, Julia E; Foy, Daniel S
To compare the effect of antivenom administration on mortality, hospitalization duration, and cost of hospitalization for dogs envenomated by Crotalus viridis. Retrospective study (January 2004-December 2012). Private veterinary emergency and referral center. One hundred thirteen dogs with confirmed C. viridis envenomation. None. Dogs were divided into groups treated with either supportive care only (group 1) or supportive care plus antivenin crotalidae polyvalent (group 2). A modified snakebite severity score was used to compare patients from group 1 and group 2. Patients in group 2 received one 10 mL vial of antivenin crotalidae polyvalent over 4-6 hours. The mortality rate was 1.8% (2/113). Group 1 had a median duration of hospitalization of 20 hours (range, 8-50 hours), while group 2 had a median duration of hospitalization of 24 hours (range, 1.5-74 hours). Group 1 had a median cost of hospitalization of 1050.00 USD (range, 423.52-2266.09 USD) while group 2 had a median cost of hospitalization of 2002.19 USD (range, 1139.91-6908.01 USD). Both the duration of hospitalization (P dogs receiving antivenom. Both the cost and the duration of hospitalization were significantly greater in the group of dogs that received antivenom. The difference in cost between the groups was approximately the cost of the antivenom vial and administration. Amongst the parameters evaluated, no significant benefit was associated with antivenom administered to dogs envenomated by C. viridis. © Veterinary Emergency and Critical Care Society 2015.
Lee, Chi-Hsin; Lee, Yu-Ching; Liang, Meng-Huei; Leu, Sy-Jye; Lin, Liang-Tzung; Chiang, Jen-Ron; Yang, Yi-Yuan
Snake venom protein from Deinagkistrodon acutus (DA protein), one of the major venomous species in Taiwan, causes hemorrhagic symptoms that can lead to death. Although horse-derived antivenin is a major treatment, relatively strong and detrimental side effects are seen occasionally. In our study, yolk immunoglobulin (IgY) was purified from eggs, and DA protein was recognized using Western blotting and an enzyme-linked immunosorbent assay (ELISA), similar to therapeutic horse antivenin. The ELISA also indicated that specific IgY antibodies were elicited after the fifth booster, plateaued, and lasted for at least 3 months. To generate monoclonal single-chain variable fragment (scFv) antibodies, we used phage display technology to construct two libraries with short or long linkers, containing 6.24 × 10(8) and 5.28 × 10(8) transformants, respectively. After four rounds of biopanning, the eluted phage titer increased, and the phage-based ELISA indicated that the specific clones were enriched. Nucleotide sequences of 30 individual clones expressing scFv were analyzed and classified into four groups that all specifically recognized the DA venom protein. Furthermore, based on mass spectrometry, the scFv-bound protein was deduced to be snake venom metalloproteinase proteins. Most importantly, both IgY and mixed scFv inhibited the lethal effect in mice injected with the minimum lethal dosage of the DA protein. We suggest that together, these antibodies could be applied to the development of diagnostic agents or treatments for snakebite envenomation in the future. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
Envenenamiento de Chelydra serpentina (Reptilia: Testudines por Tityus trivittatus (Scorpionida: Buthidae Envenomation of Chelydra serpentina (Reptilia: Testudines by Tityus trivittatus (Scorpionida: Buthidae
Adolfo R de Roodt
Full Text Available Se describe el caso de un ejemplar de tortuga mordedora (Chelydra serpentina que fue hallada con los miembros tetanizados en extensión, midriasis y poca respuesta a estímulos externos, en cuyo recinto se encontró un ejemplar de escorpión Tityus trivittatus. Ante el claro cuadro de envenenamiento, se trató al quelonio con antiveneno escorpiónico específico retornando a un estado de relajación muscular a las seis horas y encontrándoselo totalmente normal a las 24 horas sin mostrar secuelas posteriores. Este es el primer comunicado sobre el envenenamiento de quelonios por escorpiones. Se discuten algunos aspectos de este envenenamiento escorpiónico y su tratamiento con antiveneno específico.We report the case of a snapping turtle (Chelydra serpentina found tetanized, with the limbs in extension, mydriasis and poor response to external stimuli, in whose terrarium was found a Tityus trivittatus scorpion. Based on the clear clinical picture of envenoming, the turtle was treated with a specific scorpion antivenin, returning to a state of muscle relaxation after six hours of treatment and it was found totally normal at 24 hours, without envenoming sequelae. This is the first report on turtle envenomation by scorpion. The scorpion envenomation in reptiles and the treatment with specific antivenom is discussed.
Santhosh, M Sebastin; Sundaram, M Shanmuga; Sunitha, K; Jnaneshwari, S; Devaraja, S; Kemparaju, K; Girish, K S
Viper envenomation results in inflammation at the bitten site as well as target organs. Neutrophils and other polymorphonuclear leukocytes execute inflammation resolving mechanism and will undergo apoptosis after completing the task. However, the target specific toxins induce neutrophil apoptosis at the bitten site and in circulation prior to their function, thus reducing their number. Circulating activated neutrophils are major source of inflammatory cytokines and leakage of reactive oxygen species (ROS)/other toxic intermediates resulting in aggravation of inflammatory response at the bitten/target site. Therefore, neutralization of venom induced neutrophil apoptosis reduces inflammation besides increasing the functional neutrophil population. Therefore, the present study investigates the venom induced perturbances in isolated human neutrophils and its neutralization by crocin (Crocus sativus) a potent antioxidant carotenoid. Human neutrophils on treatment with venom resulted in altered ROS generation, intracellular Ca(2+) mobilization, mitochondrial membrane depolarization, cyt-c translocation, caspase activation, phosphatidylserine externalization and DNA damage. On the other hand significant protection against oxidative stress and apoptosis were evidenced in crocin pre-treated groups. In conclusion the viper venom induces neutrophil apoptosis and results in aggravation of inflammation and tissue damage. The present study demands the necessity of an auxiliary therapy in addition to antivenin therapy to treat secondary/overlooked complications of envenomation.
R V Bharath
Full Text Available Introduction: The present study was aimed to describe our experience with epidemiological characteristics, management options, and outcome of scorpion envenomation in children. Materials and Methods: The present retrospective study was conducted at Narayana Medical College and Hospital. The epidemiologic details including geographical locality of the event, age distribution, gender, and sting sites were noted in all hospitalized children with scorpion bite injury. Results: During the study period, a total 52 children were managed for scorpion sting. Mean age was 8.87 years. Male children were commoner victims of scorpion sting. Scorpion sting had bimodal pattern. Prazocin was used in 25 children. There was evidence of pulmonary edema in 23 cases. Seven patients required elective ventilation, and 5 of them could be weaned off within 72 hours. Mean hospital stay was 3.69 days. Two children expired in the present series. Conclusion: In present study, there was bimodal distribution of the scorpion sting cases, male children were more affected, and almost all of them improved with good outcome. We did not use anti-venin in the present study. The data from the study will serve not only to create heightened public awareness about scorpion envenomation but also to develop public awareness strategies and preventive measures.
Strimple, P D; Tomassoni, A J; Otten, E J; Bahner, D
Human envenomations by Heloderma species are a rare but clinically important medical problem. We report a case of an adult male bitten on the left hand by a 50-cm male, captive specimen of Heloderma suspectum (Gila monster). Immediate signs and symptoms included pain at the bite site radiating into the arm and axilla and swelling of the hand and forearm. Systemic complaints of nausea, diaphoresis, and dizziness (without a decrease in blood pressure) lasted approximately 1 hour, and laboratory studies were normal. The patient's course was uneventful except for persistent hyperesthesia, which eventually abated. Two types of helodermatid bites produce distinct clinical pictures. The chewing bite potentially causes more envenomation than the slashing bite. The venom contains a number of protein and nonprotein components including serotonin, a bradykinin-releasing substance, protease, hyaluronidase, helodermin, and gilatoxin. The clinical presentation of a helodermatid bite can include pain, edema, hypotension, nausea, vomiting, weakness, and diaphoresis. No antivenin is commercially available. Treatment is supportive, and although first aid measures such as suction or compression may impede venom movement, they are unproved. Cryotherapy, tourniquet, and excision are dangerous and should not be used.
Lynch Vincent J
Full Text Available Abstract Background Gene duplication followed by functional divergence has long been hypothesized to be the main source of molecular novelty. Convincing examples of neofunctionalization, however, remain rare. Snake venom phospholipase A2 genes are members of large multigene families with many diverse functions, thus they are excellent models to study the emergence of novel functions after gene duplications. Results Here, I show that positive Darwinian selection and neofunctionalization is common in snake venom phospholipase A2 genes. The pattern of gene duplication and positive selection indicates that adaptive molecular evolution occurs immediately after duplication events as novel functions emerge and continues as gene families diversify and are refined. Surprisingly, adaptive evolution of group-I phospholipases in elapids is also associated with speciation events, suggesting adaptation of the phospholipase arsenal to novel prey species after niche shifts. Mapping the location of sites under positive selection onto the crystal structure of phospholipase A2 identified regions evolving under diversifying selection are located on the molecular surface and are likely protein-protein interactions sites essential for toxin functions. Conclusion These data show that increases in genomic complexity (through gene duplications can lead to phenotypic complexity (venom composition and that positive Darwinian selection is a common evolutionary force in snake venoms. Finally, regions identified under selection on the surface of phospholipase A2 enzymes are potential candidate sites for structure based antivenin design.
Kamyab, Mostafa; Kim, Euikyung; Hoseiny, Seyed Mehdi; Seyedian, Ramin
Snakebite is a common problem especially in tropical areas all over the world including Iran. Echis carinatus as one of the most dangerous Iranian snakes is spreading in this country excluding central and northwest provinces. In this study gelatinase and fibrinogenolytic properties as two disintegrating matrix metalloproteinase enzymes were evaluated by a strong clear halo between 56-72 kDa in addition to another band located 76-102 kDa for gelatinase and one major band around 38 kDa for fibrinogenolytic enzyme respectively. The electrophorectc profile of our venom demonstrated at least one protein band between 24-31 kDa like previous reports and another two bands between 52-76 kDa and below 17 kDa stemmed probably due to the effect of natural selection in one species. According to our results Razi institute antivenin could neutralize in-vitro effects of gelatinase enzyme comprehensively. The electrophoretic profile of Iranian commercial antivenom as the main intravenous treatment of envenomed patients showed impurities in addition to F (ab') 2 weighing 96 kDa in SDS-PAGE analysis. It proposes more efforts for refinement to avoid short and long unwanted effects in envenomed patients.
Aspectos epidemiológicos e clínicos dos acidentes ofídicos ocorridos nos municípios do Estado do Amazonas Epidemiological and clinical aspects of snake accidentes in the municipalities of the State of Amazonas, Brazil
Célio Campos Borges
municipality (70.2%. The local signs and symptoms most frequently observed in those who received medical care more than 6 hours after the accident (57.3% were edema (76.9%, pain (68.7%, erithema (10.2% and hemorrhage (9.3%. The systemic manifestation most frequently observed was hemorrhage (18.8%. Serotherapy was administered in only 65.9% of patients, the intravenous route being the route most commonly used to administer the antivenin (52.3%, while other non- recommended routes were widely used. In the majority of patients the antivenin given was antibotropic. The most frequent complications were: abscess 13.7%, necrosis 12.3%, secondary infection 8.3%, renal insufficiency 2.5% and gangrene 2.5%. The medical procedures most used in the treatment of these complications were drainage 52.6%, debridement 28.9%, amputation 10.5%, surgical cleaning 5.3% and peritoneal dialysis 2.6%. The fatality rate was 1%.
Josef E Jolissaint
Full Text Available History of present illness: While watering his lawn, a 36-year-old man felt two sharp bites to his bilateral ankles. He reports that he then saw a light brown, 2-foot snake slither away from him. He came to the emergency department because of pain and swelling in his ankles and inability to bear weight. Physical examination revealed bilateral ankle swelling and puncture marks on his left lateral heel and medial right ankle. Palpation, passive flexion and extension elicited severe pain bilaterally. Blood work including prothrombin time (PT, partial thromboplastin time (PTT, international normalized ratio (INR, and fibrinogen were within normal limits. Consultation with Poison Control indicated the snake was likely a copperhead, which is a venomous snake whose bites rarely require antivenin. Significant findings: In this case, ultrasonography of the lateral surface of the left foot revealed soft tissue edema (red arrow and fluid collection (white asterisk adjacent to the extensor tendon (white arrow. The edematous area resembles cobblestones, with hypoechoic areas of fluid spanning relatively hyperechoic fat lobules. The tendon is surrounded by anechoic fluid, expanding the potential space in the sheath. No hyperechoic foreign objects were noted. Discussion: The patient was diagnosed with soft tissue injury and extensor tenosynovitis after a snake envenomation. Snake venom contains metalloproteinases and other enzymatic proteins that cause local tissue edema and necrosis.1 After a snake bite, ultrasound can be used to assess for retained fangs, soft tissue edema, tendon sheath fluid, muscle fasciculation, and injury to deeper musculature that may not be readily apparent on physical exam.2,3 Most patients with tenosynovitis will recover with immobilization of the joint and non-steroidal anti-inflammatory medications.4 Rarely, the tendon may become infected requiring antibiotics and surgical intervention.4 Topics: Ultrasound, snake envenomation
Since ancient times poisoning has been treated medicinally. Clinical toxicology, in the narrow sense of the term, developed from the foundation of specialized medical treatment units for poisoning and the formation of the first poison information centers in the second half of the twentieth century. Historically, the first poison information centers were often localized at pediatric clinics or departments of internal medicine. It became increasingly more obvious that this pooling of competences made sense. This article gives a general introduction in clinical toxicology and presents the functions and key activities of emergency poison centers. The organisation and work of a poisons centre is demonstrated on the basis of the Poisons Information Center (GIZ) North annual report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the primary removal of poisons by gastric lavage and administration of activated charcoal, secondary removal of poisons by enhanced elimination using hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular adsorbent recirculating systems (MARS) and the indications for administration of specific antidotes or antivenins (antisera against poisoning by poisonous animals). Gastric lavage is indicated within 1 h after ingestion of a potentially life-threatening dose of a poison. In cases of poisoning with substances which penetrate the central nervous system (CNS) gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of poisoned patients by emergency medicine personnel out of hospital and on the way to hospital is presented. The Bremen list, a compilation of the five antidotes, atropine, 4-dimethylaminophenol (4-DMAP), tolonium chloride, naloxone and activated charcoal for out of hospital treatment by emergency doctors is presented. In all, even questionable cases of poisoning consultation at emergency poison centers is
Peterson, Michael E
Black widow spiders are found throughout the continental United States and north into the southern Canadian provinces. Male black widow spiders are of little medical importance. Female black widow spiders can be 20 times larger than males. The female can be identified by the hourglass pattern, red or orange in color, on the ventral aspect of her shiny, globose black abdomen. Black widow spiders control the amount of venom they inject; an estimated 15% of bites to humans are non-envenomating. Cats are very sensitive to the venom and deaths are common. Dogs have severe clinical signs but are considered more resistant than cats. A single bite is capable of delivering a lethal dose of venom to companion animals. There are several toxic components consisting of five or six biologically active proteins. These include a potent mammalian neurotoxin called alpha-latrotoxin, which induces neurotransmitter release from nerve terminals. Acetylcholine, noradrenalin, dopamine, glutamate, and enkephalin systems are all susceptible to the toxin. Onset of clinical signs usually occurs during the first 8 hours post envenomation. The condition is extremely painful in moderate to severe envenomations. Abdominal rigidity without tenderness is a hallmark sign of Latrodectus envenomation. In cats, paralytic signs may occur early and are particularly marked. Hypertension is a significant threat. First aid is of no value in the treatment. The primary treatment for black widow spider envenomation is the administration of specific antivenin, which provides the most permanent and quickest relief of the envenomation syndrome, usually within 30 minutes of infusion. The prognosis of Latrodectus envenomation is uncertain of several days, and complete recovery may take weeks.
Nordt, Sean Patrick; Clark, Richard F; Lee, Angie; Berk, Kacie; Lee Cantrell, F
Following widow spider (Latrodectus sp.) envenomation, local pain, erythema, abdominal pain, rigidity, hypertension, and diaphoresis can be seen. While an effective specific antivenom (AV) is available, its use is limited due to concern of possible severe allergic reaction. We performed the current study to determine rate of adverse effects and the efficacy of AV in patients treated for widow spider envenomation. Observational case series of the California Poison Control System electronic database from January 1999 to December 2009. All cases of widow spider envenomation treated with AV were included. Age, gender, signs, and symptoms, adjunctive therapy, number of vials of AV given, and adverse reaction to AV were recorded. Descriptive statistical methods were used. Ninety-six patients received AV, mean age 26 years (0.12-74 years), 76% male. Following widow spider envenomation generalized pain was reported in 91%, erythema at site in 57%, hypertension (≥ 140/90 mmHg) in 43%, muscle rigidity/cramping in 43%, abdominal pain in 41%, tachycardia (≥ 100 bpm) in 23% and diaphoresis in 21%. No patient required more than one vial of AV. One patient developed urticaria to AV halfway through infusion which was immediately discontinued. Another patient developed generalized flushing following completion of infusion but had no other effects. Two other patients reported myalgia and paresthesia. There were no deaths in any patients receiving AV. There was no shortness of breath or respiratory distress, no hypotension or chest pain following AV administration. All patients reported pain relief with AV and did not require additional AV doses. Our results suggest that Black Widow Spider Antivenin® (Merck) administration is relatively safe with mild to moderate adverse effects seen in only a small percentage of patients. There were no deaths, or severe allergic reactions identified. The retrospective use of poison control system data is a limitation of our study. Further
Optimization and preliminary characterization of venom isolated from 3 medically important jellyfish: the box (Chironex fleckeri), Irukandji (Carukia barnesi), and blubber (Catostylus mosaicus) jellyfish.
Wiltshire, C J; Sutherland, S K; Fenner, P J; Young, A R
To optimize venom extraction and to undertake preliminary biochemical studies of venom from the box jellyfish (Chironex fleckeri), the Irukandji jellyfish (Carukia barnesi), and the blubber jellyfish (Catostylus mosaicus). Lyophilized crude venoms from box jellyfish tentacles and whole Irukandji jellyfish were prepared in water by homogenization, sonication, and rapid freeze thawing. A second technique, consisting of grinding samples with a glass mortar and pestle and using phosphate-buffered saline, was used to prepare crude venom from isolated nematocysts of the box jellyfish, the bells of Irukandji jellyfish, and the oral lobes of blubber jellyfish. Venoms were compared by use of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot test. Toxicity of some venoms was determined by intravenous median lethal dose assay in mice. Different venom extraction techniques produced significantly different crude venoms for both box and Irukandji jellyfish. Irukandji and blubber venom SDS-PAGE protein profiles were established for the first time. Analysis of Western blot tests revealed that box jellyfish antivenin reacted specifically with the venom of each jellyfish. Toxicity was found in Irukandji jellyfish venom derived by use of the mortar-and-pestle method, but not in the lyophilized venom. Glass mortar-and-pestle grinding and use of an appropriate buffer was found to be a simple and suitable method for the preparation of venom from each jellyfish species studied. This study contributes to biochemical investigations of jellyfish venoms, particularly the venom of the Irukandji jellyfish, for which there are, to our knowledge, no published studies. It also highlights the importance of optimizing venom extraction as the first step toward understanding the complex biological effects of jellyfish venoms.
Full Text Available The most important health-threatening scorpions found in Turkey are; Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus species, all of which belong to the Buthidae family. The epidemiological and clinical findings of scorpion stings in Turkey were evaluated between the years 1995 and 2004 based on data recorded in the National Poison Information Center (NPIC. A total of 930 cases were recorded. The cases mostly occurred in the month of July. The gender distribution was 50.22% female and 45.48% male. It was shown that the 20-29 age group presented more scorpion stings. Most of the stings occurred in Central Anatolia and Marmara regions of Turkey. Patients at the hospital showed signs of localized (pain, hyperemia, edema and numbness and systemic effects (hyperthermia, nausea and vomiting, tachycardia, shivering and lethargy but no lethality was notified. According to records, 33% of the poisoned patients were treated with antivenin in healthcare facilities.Os mais importantes escorpiões que comprometem a saúde na Turquia são: Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus e M. eupeus, todos eles pertencentes à família Buthidae. Os achados clínicos e epidemiológicos da picada de escorpiões na Turquia foram avaliados no período entre os anos de 1995 a 2004 baseados em dados do Centro Nacional de Informações de Envenenamentos (NPIC. Foram registrados 930 casos que ocorreram principalmente no mês de julho. A distribuição por sexo foi 50,22% femininos e 45,48% masculinos. Demonstrou-se que o grupo etário de 20 a 29 anos apresentou maior número de picadas de escorpião. A maior parte das picadas ocorreu na Anatólia Central e na região de Marmara, na Turquia. Os pacientes hospitalizados mostraram sinais localizados (dor, hiperemia, edema e confusão mental e sistêmicos (hipertermia, náusea e vômitos, taquicardia, arrepios de frio e letargia, mas não houve notificação de
Full Text Available Background: The hemotoxic and neurotoxic factors of snake venoms is the main responsible for necrosis and tissue sloughing. Envenomations are common in rural areas in all provinces of Iran caused by snake species which causes local swelling, ecchymosis and alterations in blood profile in case of hemotoxic venom. In this study some in vivo and in vitro properties (Hemorrhagic, edematogenic and coagualant of Iranian Vipera lebetina venom in addition to neutralizing capacity of pepsin derived Razi Institute polyvalent antivenin were assayed. Material and Methods: Escalating doses of Vipera lebetina venom dissolved in Normal saline (2.5-50 µg/ml were injected (100µl subcutaneously to dorsal area of rats (n=3 to investigate mean hemorrhagic amount after 24 hours.Groups of three mice were injected subcutaneously in the right foodpad with various amounts of venom (10-150µg.The left foodpad received the same amount (100µl ofnormal saline alone (negative control to evaluate the edematogenic property of this venom. To determine the coagulant activity, various amounts of venom dissolved in normal saline (50µl were added to human plasma (200µl and coagulation time was measured. Razi Institute antivenom was used for neutralization of all three measured biological parameters. Results: Mean hemorrhagic, procoagulant and edematous amounts (increasing 30% in hind paw edema were 8.5, 1.1 and 70 microgram, respectively. Preincubation with polyvalent antibody (30 and 200 microliter decreased hemorrhagic and procoagulant activity. Edematogenic property of this venom decreased significantly by incubation with antivenom (78% to 38% by incubation with 1000 microliter of polyvalent antivenom. Intra peritoneal injection of this remedy following envenomation had no effect in relieving symptoms. Myonecrotic effects were seen by intramuscular injection of Vipera lebetina venom in rats. Conclusion: Our study shows that Iranian antivenom could neutralize some in vivo
Gerardo González V.
medicine section of the Ramón González Valencia Universitary Hospital in Bucaramanga (Colombia from 1983 – 1993.40 children with diagnosis of snake bite were selected. Resulte: The major frecuency was found in the school age with a little male predominance. 95% of children carne from the rural area. The most snake genus was Bothrops (85%, we had just one case for Micrurus and the rest of them were not identified. 91%of the snake hites were in feet and legs distal thirC:. 65% of people assist for medical attention in the first 24 hours. Every patient had eye-teeth marks, and localized oedema and pain in the bite; most common haemorrhagic manifestations were ecchymosis (80% and gingival bleeding. 69% of cases were Grade II and lII. 33% of them had complicationsj the most common one was Disseminated Intravascular Coagulation. We found.prolongued PT and PTT in 85% and 63% of cases respectively. BC was not specific. 97.5% of our children received especific antivenin for treatment, 28% transfusions and 100% antibiotic and antitetanic prophylaxis.
Hospitalization average days were 5. Three of our patients (7.5% had sorne sequel andjust one died.
In conclussion there not be a good education in the community on risk about appropiatte use of shoes,
first aid, avoidiry empire treatments that to yatrogene and inmediately a consultation to the nearest clinical center should be done. The medical and paramedical personnel should be prepared about attention of patients with snake bite. It was included a protocol for the management, easy to apply in our health centers.