A Study of Cardiac Profile in Patients with Snake Envenomation and Its Complications

Snake envenomation can result in hemorrhage, local necrosis, swelling, and if not treated properly can lead to adverse systemic effects such as coagulopathy, nephrotoxicity, neurotoxicity, and cardiotoxicity, which can result in death. As such, snake venom metalloproteinases (SVMPs) and disintegrins are two toxic components that contribute to hemorrhage and interfere with the hemostatic system. Administration of a commercial antivenom is the common antidote to treat snake envenomation, but the high-cost, lack of efficacy, side effects, and limited availability, necessitates the development of new strategies and approaches for therapeutic treatments. Herein, we describe the neutralization ability of anti-disintegrin polyclonal antibody on the activities of isolated disintegrins, P-II/P-III SVMPs, and crude venoms. Our results show disintegrin activity on platelet aggregation in whole blood and the migration of the SK-Mel-28 cells that can be neutralized with anti-disintegrin polyclonal antibody. We characterized a SVMP and found that anti-disintegrin was also able to inhibit its activity in an in vitro proteolytic assay. Moreover, we found that anti-disintegrin could neutralize the proteolytic and hemorrhagic activities from crude Crotalus atrox venom. Our results suggest that anti-disintegrin polyclonal antibodies have the potential for a targeted approach to neutralize SVMPs in the treatment of snakebite envenomations.

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Sea‐snake envenomation

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1986.tb113687.x ◽

1986 ◽

Vol 144 (2) ◽

pp. 112-112

Author(s):

Geoffrey J. Dobb

Keyword(s):

Sea Snake ◽

Snake Envenomation

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Protection against sea snake envenomation: comparative potency of four antivenenes

Toxicon ◽

10.1016/0041-0101(76)90082-9 ◽

1976 ◽

Vol 14 (5) ◽

pp. 347-355 ◽

Cited By ~ 18

Author(s):

E.H. Baxter ◽

Heather A. Gallichio

Keyword(s):

Sea Snake ◽

Snake Envenomation

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Thrombocytopenia after brown snake envenomation (for editorial comment, see page 610)

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1989.tb139634.x ◽

1989 ◽

Vol 151 (11-12) ◽

pp. 627-628 ◽

Cited By ~ 12

Author(s):

Alan C. Morling ◽

Lorraine R. Marshall ◽

Richard P. Herrmann

Keyword(s):

Editorial Comment ◽

Snake Envenomation

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Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139021 ◽

2021 ◽

pp. postgradmedj-2020-139021

Author(s):

Manoj Kumar ◽

Maasila Arcot Thanjan ◽

Natarajan Gopalakrishnan ◽

Dhanapriya Jeyachandran ◽

Dineshkumar Thanigachalam ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Long Term Outcomes ◽

Urine Protein ◽

Renal Outcomes ◽

Snake Envenomation ◽

The Mean ◽

New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

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Liver gene regulation of hemostasis-related factors is altered by experimental snake envenomation in mice

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0008379 ◽

2020 ◽

Vol 14 (6) ◽

pp. e0008379

Author(s):

Ana Teresa Azevedo Sachetto ◽

José Ricardo Jensen ◽

Marcelo Larami Santoro

Keyword(s):

Gene Regulation ◽

Related Factors ◽

Snake Envenomation ◽

Liver Gene

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Snake Envenomation

50 Landmark Papers ◽

10.1201/9780429316944-75 ◽

2019 ◽

pp. 229-232

Author(s):

Anne Rizzo ◽

Peter Rhee

Keyword(s):

Snake Envenomation

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Management of Eastern Brown and Tiger Snake Envenomation in Domestic Animals in South Australia

Annual Research & Review in Biology ◽

10.9734/arrb/2018/40513 ◽

2018 ◽

Vol 25 (4) ◽

pp. 1-12

Author(s):

Madeleine Wright ◽

Suong Ngo

Keyword(s):

South Australia ◽

Domestic Animals ◽

Snake Envenomation

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BITES study: A qualitative analysis among emergency medicine physicians on snake envenomation management practices

PLoS ONE ◽

10.1371/journal.pone.0262215 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262215

Author(s):

Anna Tupetz ◽

Loren K. Barcenas ◽

Ashley J. Phillips ◽

Joao Ricardo Nickenig Vissoci ◽

Charles J. Gerardo

Keyword(s):

United States ◽

Emergency Medicine ◽

Financial Burden ◽

The United States ◽

Poison Center ◽

Functional Impairments ◽

Major Barrier ◽

Snake Envenomation ◽

Depth Interviews

Introduction Antivenom is currently considered standard treatment across the full spectrum of severity for snake envenomation in the United States. Although safe and effective antivenoms exist, their use in clinical practice is not universal. Objective This study explored physicians’ perceptions of antivenom use and experience with snake envenomation treatment in order to identify factors that influence treatment decisions and willingness to administer. Methods We conducted a qualitative study including in-depth interviews via online video conferencing with physicians practicing in emergency departments across the United States. Participants were selected based on purposive sampling methods. Data analysis followed inductive strategies, conducted by two researchers. The codebook and findings were discussed within the research team. Findings Sixteen in-depth interviews with physicians from nine states across the US were conducted. The participants’ specialties include emergency medicine (EM), pediatric EM, and toxicology. The experience of treating snakebites ranged from only didactic education to having treated over 100 cases. Emergent themes for this manuscript from the interview data included perceptions of antivenom, willingness to administer antivenom and influencing factors to antivenom usage. Overall, cost-related concerns were a major barrier to antivenom administration, especially in cases where the indications and effectiveness did not clearly outweigh the potential financial burden on the patient in non-life- or limb-threatening cases. The potential to decrease recovery time and long-term functional impairments was not commonly reported by participants as an indication for antivenom. In addition, level of exposure and perceived competence, based on prior education and clinical experience, further impacted the decision to treat. Resources such as Poison Center Call lines were well received and commonly used to guide the treatment plan. The need for better clinical guidelines and updated treatment algorithms with clinical and measurable indicators was stated to help the decision-making process, especially among those with low exposure to snake envenomation patients. Conclusions A major barrier to physician use of antivenom is a concern about cost, cost transparency and cost–benefit for the patients. Those concerns, in addition to the varying degrees of awareness of potential long-term benefits, further influence inconsistent clinical treatment practices.

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