Background: Snakebite is considered a global health issue, especially in the Southeast Asian region. However, data regarding snakebite cases in Indonesia are still very limited. This study aimed to ...explore the venomous snakebite cases and the serum anti bisa ular (SABU) antivenom effect in treating venomous snakebite caused by other than the snake species indicated in currently available SABU antivenom formulas. Methods: The analytical descriptive method with a cross-sectional study design was conducted in 2021 using a total sampling from the medical records of 63 patients diagnosed with snakebite at Dr. Hasan Sadikin General Hospital Bandung from 2015 to 2019. Characteristics of patients, clinical manifestation, and correlation between snakes species and outcomes after treatment with or without administration of SABU antivenom were collected. Results: Out of 63 patients, males (79%) were predominant with an average age of 39 years. Fifty-six patients arrived at the Emergency Room less than 24 hours after the occurrence (89%). Most cases were categorized as grade 2 (41.%) where the upper extremities were commonly bitten the body area (64%). Edema (83%) was the most common manifestation. There was no correlation between snake antivenom administered to a specific snake species and the stated outcome (p=0.053), meaning that SABU antivenom might be an effective alternative to treat more types of snakebites. Conclusions: Snakebites are most common in males, attack the upper extremities, categorized as grade 2 with edema. Administration of SABU antivenom provides the similar outcome compared to the group caused by the Javan spitting cobra, Banded krait, and Malayan pit viper.
Introductory Editorial Hardcastle, T
South African medical journal,
05/2023, Letnik:
113, Številka:
5
Journal Article
Recenzirano
Odprti dostop
This is the introduction article and editorial that will address the latest approaches to safe management of snakebite in South Africa and shares the evidence and expert consensus from the recent ...South African Snakebite Symposium (SASS) meeting held in July 2022.
Although envenoming by a small East European species of viper is rarely severe, and only exceptionally fatal, lack of specific antivenom stocks in a few areas within this region and possible severe ...side effects of antivenom application leave most bites to be treated only with antihistamines and supportive therapy. Varespladib is an effective inhibitor of snake phospholipase, and, as such, it could be considered as first-line therapy. The Nikolsky’s viper venom contains an extremely high concentration of phospholipase A2 (PLA2), responsible for the toxic effects of the venom, as well as minor amounts of other toxins. If Varespladib can successfully inhibit PLA2 activity, the Nikolsky’s viper could be one of the first venomous snakes having an antitoxin-specific treatment regimen. To assess that, Varespladib was administered alone subcutaneously to adult male CD-1 mice (8 mg/kg) and compared to mice exposed to Vipera berus nikolskii crude venom (8 mg/kg = 10 LD50) or a combination of Varespladib and the same amount of the venom. Experimental animals were monitored for the presence of envenoming symptoms and mortality for 48 h after injection. Eighty percent of mice receiving both Varespladib and venom survived, while 100% of the control group receiving venom alone died within 4 h. Experimental results are consistent with Varespladib acting as an effective antitoxin in the mouse model against Nikolsky’s viper venom. Further studies are needed under experimental conditions that more closely resemble natural envenoming (i.e., delayed administration).
O ofidismo é considerado um importante problema de saúde pública, sendo classificado pela Organização Mundial da Saúde como uma Doenças Tropical Negligenciada (NTD) de Categoria A. No Brasil, os ...casos se concentram na região Norte, tendo Roraima e Amazonas como as maiores incidências de envenenamentos ofídicos. Ainda, este agravo tem gerado altos custos para a saúde pública do país, uma vez que muitos apresentam alta gravidade, necessitando de procedimentos e tratamentos prolongados que culminam em muitos dias de internação. Este estudo relata um caso de vítima de acidente ofídico em indivíduo de 28 anos do sexo masculino, cujo acidente botrópico ocorreu no dia 26/04/2023 (dia 0) às 18h em membro inferior direito (pé). O paciente foi admitido no Hospital geral de Roraima Rubens de Souza em Boa Vista (RR) às 23h do mesmo dia, com queixa de dor de intensidade 10/10, edema extenso e gengivorragia, classificando o acidente como grave. Logo após a avaliação, o paciente recebeu 12 ampolas de soro antibotrópico (SAB). Nos 5 primeiros dias de internação, o paciente evolui com dor, equimose e febre, mesmo em uso de Amicacina e Piperacilina + Tazobactam, sem sucesso terapêutico, apresentando edema com sinais de piora com rubor significativo. Aos exames laboratoriais, apresentou-se com leucocitose, PCR elevado e incoagubilidade. A partir desses dados, o paciente foi encaminhado no dia 02/05/2023 (dia 7) para cirurgia de fasciotomia e desbridamento extenso, na qual ocorreu instabilidade hemodinâmica (choque hipovolêmico) com internação na UTI por 3 dias. No dia 08/05/2023 (dia 13) foi instalada a terapia inovadora com curativo à vácuo, buscando redução do tempo de internação, aceleração da cicatrização, angiogênese e redução de infecção. O tratamento com o curativo também é capaz de drenar o excesso de exsudato e reduzir o líquido intersticial, com trocas semanais. O paciente manteve-se com curativo a vácuo até o dia 23/05/2023 (15 dias de uso), demostrando rápida granulação tecidual e evolução satisfatória. Posteriormente, passou a utilizar curativo diário com colagenase a cada 12 horas. No dia 12/06/2023 (dia 44) realizou enxertia. O paciente evoluiu bem, sendo realizados apenas curativos simples após enxertia. No dia 26/06/2023 (60 dias após o acidente), o paciente teve alta com orientações de acompanhamento ambulatorial e de cuidados da ferida.
Abstract
Background
India's National Health Profile (NHP) documents snakebite cases and deaths based on hospital-based reports, hence underrepresenting the actual burden. We describe secular trends ...of NHP data using population denominators for 2009–2018.
Methods
We abstracted the data on snakebite cases and deaths and calculated incidence and case fatality rate (CFR) by gender and by states using population denominators. We estimated the change in incidence and CFR over time by using a Poisson regression model. We computed the incidence rate ratio (IRR) and 95% confidence interval (CI) using Stata 14.0.
Results
The incidence of snakebites ranged from 89 to 141 per million population and without any specific pattern during 2009–2018 as per NHP reports. The incidence increased by 3% per year (IRR 1.03 95% CI 0.99 to 1.07). The incidence was higher among males (range 97–163) than females (range 71–115) and there was no difference in trends by gender (IRR 1.07 95% CI 0.37 to 3.12). The CFR was 5–13 deaths per 1000 cases, with an annual decline of 12% (IRR 0.88 95% CI 0.85 to 0.92). The CFR did not differ by gender (male 5–12, female 6–13; IRR 0.48 95% CI 0.20 to 1.17).
Conclusion
India's NHP snakebite data, representing an underestimate of the actual burden, suggests no specific secular trend and points to areas documenting consistent and significant burden.
Traditional healers are a valuable source of information about community-level treatment of snakebite. Snakebite victims in Nepal depend on traditional healers for treatment, but their practices have ...not been well-documented.
This was a cross-sectional study of 50 traditional snakebite healers (TSHs) who were selected using a snowball sampling method representing eight districts and four provinces of Nepal. Data were collected using face-to-face-interviews and semi-structured questionnaires.
About half of the respondents liked to gain knowledge on modern care for snakebite management and nearly all respondents (94%) wished to cooperate closely with the local healthcare system to support snakebite management. People's ingrained faith in traditional healing of snakebite (84%), unaffordable modern care of snakebite (60%) and wishes for early treatment of snakebites (44-48%) were the main causes of their dependency on TSHs. Rauvolfia serpentina, Piper nigrum, Momordica charantia and Tinospora cordifolia were commonly used plants in traditional treatment of snakebite.
Easily accessible and affordable healthcare facilities provided by TSHs, public beliefs in traditional healing and inadequate knowledge of antivenom therapy caused dependency on TSHs. The introduction of snakebite treatment centres in snakebite-prone regions and educational interventions are essential to minimize this kind of dependency and associated deaths and disabilities.
This work compared the presence of phospholipase A2 inhibitors (PLIs) in the serum of 19 snake species maintained at Instituto Butantan to better understand the mechanisms of venom resistance in ...snakes and improve the treatment of snakebite. PLI was isolated from blood of 19 snake species by one-step chromatography and identified in all samples, besides its identity was confirmed through the interaction with both phospholipase A2 and anti-γPLI. These findings highlight the diversity of snake serum PLIs and emphasize the importance of structure-function studies.
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•Isolation and characterization of the PLIs in 8 new Bothrops snake species.•PLIs showed only one or two bands of 25 kDa monomers in all Bothrops, Crotalus and Boa, differing to N. kaouthia pattern.•Variable numbers of the spots in 2D electrophoresis suggested a variable isoform composition of the PLIs in snake blood.•The immunoreactivity assays confirmed the proteins as PLIs, evidencing the interaction with the PLA2 from C. d. terrificus.
Objective:
To conduct a bibliometric analysis of the global snakebite literature to provide a reference for the future development of snakebite research.
Methods:
The Web of Science citation analysis ...tools, VOSviewer and CiteSpace V were used to carry out the bibliometric analysis of the literature and generate visualization maps.
Results:
The number of publications has increased at a considerably accelerated rate in the past 8 years. Nine distinct cooperation clusters were formed between institutions and countries. Keyword clustering yielded nine well-structured clusters covering two major topics, i.e., snakebite envenoming and antivenom. Burstiness detection revealed eight keywords with strong emergence, including neglected tropical diseases, Elapidae, Viperidae, and Russell’s viper, which have sustained popularity up to the present.
Conclusion:
Current research on snakebites has gradually garnered attention from the academic community. Cooperation papers between nations severely affected by snakebite and those with higher economic status received more attention. The continued exploration of therapeutic mechanisms, the development of antivenoms or alternative medicines, and primary prevention of snakebites to ensure the safety of populations in impoverished regions should be prioritized by international scholars. The epidemiological evidence and the timely translation of research findings should be valued by policymakers.
Introduction: Neuroparalytic snake bite is a serious life-threatening hazard all over the world, especially in tropical countries of South-East Asia. But it is one of the most neglected tropical ...diseases. Patients can present with envenomation signs without a history of snakebite or an identifiable bite mark. Apart from neuroparalysis, symptoms of autonomic dysfunction can also be seen with krait envenomation. Case Report: 11-year-old girl presented with early morning sudden onset altered sensorium. On examination found to have absent spontaneous respirations, severe hypertension, dilated pupils, and absent brainstem reflexes, so labeled as probable brain death. Later with control of hypertension, she was able to respond by blinking but had severe neuroparalysis. There was no evidence of snakebite but with a strong suspicion of krait envenomation, anti-snake venom was given empirically and continued ventilatory support, following which child had a complete recovery. Discussion: As the majority of krait bites occur during sleep and due to its painless nature, they often go unnoticed. Also, krait bite leaves very fine puncture marks and the local reaction is markedly absent, so fang marks couldn’t be easily identified. Autonomic dysfunction following krait envenomation can present as abdominal pain, vomiting, sweating, mydriasis, fluctuation of heart rate and blood pressure, and paralytic ileus. In severe krait envenomation, complete paralysis of all voluntary muscles leads to quadriplegia and anathria which resembles locked-in syndrome. Locked-in syndrome when associated with internal ophthalmoplegia can mimic brain death. Conclusion: Snakebite should be considered in the differential diagnosis of unexplained neuroparalysis and hypertension. Envenomation should not be excluded by the absence of a history of snakebite or identifiable bite mark.
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