DOCSLIB.ORG

Snake Bite Protocol

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Snake Bite Protocol Lavonas et al. BMC Emergency Medicine 2011, 11:2 Page 4 of 15 http://www.biomedcentral.com/1471-227X/11/2 and other Rocky Mountain Poison and Drug Center treatment of patients bitten by coral snakes (family Ela- staff. The antivenom manufacturer provided funding pidae), nor by snakes that are not indigenous to the US. support. Sponsor representatives were not present dur- At the time this algorithm was developed, the only ing the webinar or panel discussions. Sponsor represen- antivenom commercially available for the treatment of tatives reviewed the final manuscript before publication pit viper envenomation in the US is Crotalidae Polyva- ® for the sole purpose of identifying proprietary informa- lent Immune Fab (ovine) (CroFab , Protherics, Nash- tion. No modifications of the manuscript were requested ville, TN). All treatment recommendations and dosing by the manufacturer. apply to this antivenom. This algorithm does not con- sider treatment with whole IgG antivenom (Antivenin Results (Crotalidae) Polyvalent, equine origin (Wyeth-Ayerst, Final unified treatment algorithm Marietta, Pennsylvania, USA)), because production of The unified treatment algorithm is shown in Figure 1. that antivenom has been discontinued and all extant The final version was endorsed unanimously. Specific lots have expired. This antivenom also does not consider considerations endorsed by the panelists are as follows: treatment with other antivenom products under devel- opment. Because the panel members are all hospital- Role of the unified treatment algorithm (general based physicians, the panel did not evaluate field first considerations and box 16) aid or other prehospital therapy. This algorithm pertains to the treatment of human In order to create an algorithm that was simple patients bitten by pit viper snakes (family Viperidae, enough to be used effectively, the panel decided not to subfamily Crotalinae) in the US, including the rattle- include specific recommendations for the management snakes (genus Crotalus), pygmy rattlesnakes (Sistrurus), of certain rare manifestations of crotaline snakebite. and moccasin snakes (genus Agkistrodon). Within the These included snakebites to the head and neck, snake- Agkistrodon genus are the copperhead snakes (A. contor- bites causing rhabdomyolysis, and apparent anaphylactic trix) and the water moccasin (cottonmouth) snake or anaphylactoid reactions to venom. In addition the (A. piscivorus). This algorithm does not apply to panelrecognizedthatnotreatment algorithm could Emergency Department and Hospital Management of Pit Viper Snakebite Includes: Rattlesnakes, Copperheads, and Cottonmouths (Water Moccasins) 12 15 When to Call a Physician-Expert Treatments to Avoid in 1 Direct consultation with a physician-expert is recommended in Pit Viper Snakebite Assess Patient certain high-risk clinical situations: Mark leading edge of swelling and tenderness every 15-30 minutes Cutting and/or suctioning of the wound Life-threatening envenomation Immobilize and elevate extremity Ice Shock Treat pain (IV opioids preferred) NSAIDs Serious active bleeding Obtain initial lab studies (protime, Hgb, platelets, fibrinogen) Prophylactic antibiotics Facial or airway swelling Update tetanus Prophylactic fasciotomy Contact poison control center (1-800-222-1222) Hard to control envenomation Routine use of blood products Envenomation that requires more than 2 doses of Shock therapy (electricity) antivenom for initial control Steroids (except for allergic phenomena) Tourniquets Recurrence or delayed-onset of venom effects 2 9 Apparent Dry Bite / No Bite Check for Signs of Envenomation Worsening swelling or abnormal labs (protime, Swelling, tenderness, redness, ecchymosis, or blebs at the bite site, or None Do not administer antivenom fibrinogen, platelets, or hemoglobin) on follow-up visits Observe patient 8 hours Elevated protime; decreased fibrinogen or platelets, or Allergic reactions to antivenom 16 Notes: Systemic signs, such as hypotension, bleeding beyond the puncture site, Repeat labs prior to discharge refractory vomiting, diarrhea, angioedema, neurotoxicity If patient develops signs of If transfusion is considered All treatment recommendations in this algorithm refer to envenomation, return to box 2 Uncommon clinical situations crotalidae polyvalent immune Fab (ovine) (CroFab®). Present Bites to the head and neck This worksheet represents general advice from a panel of US Rhabdomyolysis snakebite experts convened in May, 2010. No algorithm can 3 10 Check for Indications for Antivenom Apparent Minor Envenomation Suspected compartment syndrome anticipate all clinical situations. Other valid approaches exist, None Venom-induced hives and angioedema Swelling that is more than minimal and that is progressing, or Do not administer antivenom and deviations from this worksheet based on individual patient Elevated protime; decreased fibrinogen or platelets, or Observe patient 12-24 hours Complicated wound issues needs, local resources, local treatment guidelines, and patient preferences are expected. This document is not intended to Any systemic signs Repeat labs at 4-6 hours and prior to If no local expert is available, a physician-expert can be reached represent a standard of care. For more information, please see discharge through a certified poison center (1-800-222-1222) or the the accompanying manuscript, available at Present If patient develops progression of any antivenom manufacturer’s line (1-877-377-3784). signs of envenomation, return to box 3 www.biomedcentral.com. 4 Administer Antivenom Establish IV access and give IV fluids 13 Pediatric antivenom dose = adult dose Mix 4-6 vials of crotaline Fab antivenom (CroFab®) in 250 ml NS and infuse IV over 1 Maintenance Antivenom Therapy hour Maintenance therapy is additional antivenom given after For patients in shock or with serious active bleeding initial control to prevent recurrence of limb swelling Increase initial dose of antivenom to 8-12 vials Maintenance therapy is 2 vials of antivenom Q6H x 3 Call physician expert (see box 12) (given 6, 12, and 18 hours after initial control) Initiate first dose of antivenom in ED or ICU For suspected adverse reaction: hold infusion, treat accordingly, and call Maintenance therapy may not be indicated in certain physician-expert situations, such as Re-examine patient for treatment response within 1 hour of completion of antivenom Minor envenomations infusion Facilities where close observation by a physician- expert is available. Follow local protocol or contact a poison center or physician-expert for advice. 5 11 Determine if Initial Control of Envenomation Repeat antivenom until has been Achieved No initial control is achieved. Swelling and tenderness not progressing If initial control is not achieved after 2 14 Protime, fibrinogen, and platelets normal or clearly improving doses of antivenom, call physician expert Clinically stable (not hypotensive, etc.) (see box 12) Post-Discharge Planning Neurotoxicity resolved or clearly improving Instruct patient to return for Yes Worsening swelling that is not relieved by elevation Abnormal bleeding (gums, easy bruising, melena, etc.) 6 Monitor Patient Instruct patient where to seek care if symptoms of serum Perform serial examinations sickness (fever, rash, muscle/joint pains) develop Maintenance antivenom therapy may be indicated Bleeding precautions (no contact sports, elective surgery or Read Box 13 (Maintenance Antivenom Therapy) dental work, etc.) for 2 weeks in patients with Observe patient 18-24 hours after initial control for progression of any venom effect Rattlesnake envenomation Follow-up labs 6-12 hours after initial control and prior to discharge Abnormal protime, fibrinogen, or platelet count at any If patient develops new or worsening signs of envenomation, administer additional time antivenom per box 4 Follow-up visits: Antivenom not given: PRN only 7 Antivenom given: Determine if Patient Meets Discharge Criteria Copperhead victims: PRN only No progression of any venom effect during the specified observation period Other snakes: Follow up with labs (protime, No unfavorable laboratory trends in protime, fibrinogen, or platelets fibrinogen, platelets, hemoglobin) twice (2- 3 days and 5-7 days), then PRN Yes 8 See Post-Discharge Planning (box 14) Figure 1 Unified Treatment Algorithm for the Management of Pit Viper Snakebite in the United States. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop Lavonas et al. Lavonas et al. BMC Emergency Medicine 2011, 11:2 http://www.biomedcentral.com/1471-227X/11/2 (3 February 2011) Lavonas et al. BMC Emergency Medicine 2011, 11:2 http://www.biomedcentral.com/1471-227X/11/2 RESEARCHARTICLE Open Access Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop Eric J Lavonas1,2*, Anne-Michelle Ruha3, William Banner4,5†, Vikhyat Bebarta6†, Jeffrey N Bernstein7,8†, Sean P Bush9†, William P Kerns II10†, William H Richardson11,12†, Steven A Seifert13,14†, David A Tanen15,16†, Steve C Curry3, Richard C Dart1,2 Abstract Background: Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists. Methods: A geographically diverse panel of experts was convened
Load more

Recommended publications
  • Pressure and Duration of Constriction in Boa Constrictor Is Influenced by a Simulated Prey Heartbeat Allison Elizabeth Hall Dickinson College
    Dickinson College Dickinson Scholar Student Honors Theses By Year Student Honors Theses 5-23-2010 Pressure and Duration of Constriction in Boa Constrictor is Influenced by a Simulated Prey Heartbeat Allison Elizabeth Hall Dickinson College Follow this and additional works at: http://scholar.dickinson.edu/student_honors Part of the Biology Commons Recommended Citation Hall, Allison Elizabeth, "Pressure and Duration of Constriction in Boa Constrictor is Influenced by a Simulated Prey Heartbeat" (2010). Dickinson College Honors Theses. Paper 86. This Honors Thesis is brought to you for free and open access by Dickinson Scholar. It has been accepted for inclusion by an authorized administrator. For more information, please contact [email protected]. Pressure and Duration of Constriction in Boa constrictor is Influenced by a Simulated Prey Heartbeat By Allison E. Hall With the collaboration of Amanda Hayes and Katelyn McCann Submitted in partial fulfillment of Honors Requirements for the Department of Biology Dr. Scott Boback, Supervisor Dr. Charles Zwemer, Supervisor Dr. David Kushner, Reader May 18, 2010 Abstract Constricting prey is energetically costly for snakes and therefore it would be beneficial to minimize this cost. However, the consequences of arresting a constriction event too soon could be deadly. Thus, the duration of constriction is bounded by competing demands to kill prey and conserve energy. Snakes possess mechanoreceptors within their ventral and dorsal skin that are used for detecting approaching predators and prey. This experiment sought to determine whether Boas (Boa constrictor) can sense a simulated heartbeat in their prey. It was predicted that if snakes possess this ability, those constricting rats with a simulated heart would constrict with greater pressure and increased duration than snakes constricting rats without a simulated heartbeat.
    [Show full text]
  • Approach to the Poisoned Patient
    PED-1407 Chocolate to Crystal Methamphetamine to the Cinnamon Challenge - Emergency Approach to the Intoxicated Child BLS 08 / ALS 75 / 1.5 CEU Target Audience: All Pediatric and adolescent ingestions are common reasons for 911 dispatches and emergency department visits. With greater availability of medications and drugs, healthcare professionals need to stay sharp on current trends in medical toxicology. This lecture examines mind altering substances, initial prehospital approach to toxicology and stabilization for transport, poison control center resources, and ultimate emergency department and intensive care management. Pediatric Toxicology Dr. James Burhop Pediatric Emergency Medicine Children’s Hospital of the Kings Daughters Objectives • Epidemiology • History of Poisoning • Review initial assessment of the child with a possible ingestion • General management principles for toxic exposures • Case Based (12 common pediatric cases) • Emerging drugs of abuse • Cathinones, Synthetics, Salvia, Maxy/MCAT, 25I, Kratom Epidemiology • 55 Poison Centers serving 295 million people • 2.3 million exposures in 2011 – 39% are children younger than 3 years – 52% in children younger than 6 years • 1-800-222-1222 2011 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System Introduction • 95% decline in the number of pediatric poisoning deaths since 1960 – child resistant packaging – heightened parental awareness – more sophisticated interventions – poison control centers Epidemiology • Unintentional (1-2
    [Show full text]
  • Approach and Management of Spider Bites for the Primary Care Physician
    Osteopathic Family Physician (2011) 3, 149-153 Approach and management of spider bites for the primary care physician John Ashurst, DO,a Joe Sexton, MD,a Matt Cook, DOb From the Departments of aEmergency Medicine and bToxicology, Lehigh Valley Health Network, Allentown, PA. KEYWORDS: Summary The class Arachnida of the phylum Arthropoda comprises an estimated 100,000 species Spider bite; worldwide. However, only a handful of these species can cause clinical effects in humans because many Black widow; are unable to penetrate the skin, whereas others only inject prey-specific venom. The bite from a widow Brown recluse spider will produce local symptoms that include muscle spasm and systemic symptoms that resemble acute abdomen. The bite from a brown recluse locally will resemble a target lesion but will develop into an ulcerative, necrotic lesion over time. Spider bites can be prevented by several simple measures including home cleanliness and wearing the proper attire while working outdoors. Although most spider bites cause only local tissue swelling, early species identification coupled with species-specific man- agement may decrease the rate of morbidity associated with bites. © 2011 Elsevier Inc. All rights reserved. More than 100,000 species of spiders are found world- homes and yards in the southwestern United States, and wide. Persons seeking medical attention as a result of spider related species occur in the temperate climate zones across bites is estimated at 50,000 patients per year.1,2 Although the globe.2,5 The second, Lactrodectus, or the common almost all species of spiders possess some level of venom, widow spider, are found in both temperate and tropical 2 the majority are considered harmless to humans.
    [Show full text]
  • Snake Bite Prevention What to Do If You Are Bitten
    SNAKE BITE PREVENTION It has been estimated that 7,000–8,000 people per year are bitten by venomous snakes in the United States, and for around half a dozen people, these bites are fatal. In 2015, poison centers managed over 3,000 cases of snake and other reptile bites during the summer months alone. Approximately 80% of these poison center calls originated from hospitals and other health care facilities. Venomous snakes found in the U.S. include rattlesnakes, copperheads, cottonmouths/water moccasins, and coral snakes. They can be especially dangerous to outdoor workers or people spending more time outside during the warmer months of the year. Most snakebites occur when people accidentally step on or come across a snake, frightening it and causing it to bite defensively. However, by taking extra precaution in snake-prone environments, many of these bites are preventable by using the following snakebite prevention tips: Avoid surprise encounters with snakes: Snakes tend to be active at night and in warm weather. They also tend to hide in places where they are not readily visible, so stay away from tall grass, piles of leaves, rocks, and brush, and avoid climbing on rocks or piles of wood where a snake may be hiding. When moving through tall grass or weeds, poke at the ground in front of you with a long stick to scare away snakes. Watch where you step and where you sit when outdoors. Shine a flashlight on your path when walking outside at night. Wear protective clothing: Wear loose, long pants and high, thick leather or rubber boots when spending time in places where snakes may be hiding.
    [Show full text]
  • Avoiding and Treating Timber Rattlesnake Bites Updated 2020
    Avoiding and Treating Timber Rattlesnake Bites Updated 2020 Timber rattlesnakes live in the blufflands of southeastern Minnesota. They are not found anywhere else in the state. They can be distinguished from nonvenomous snakes by a pronounced off white rattle at the end of a black tail; by their head, which is solid brown/tan, triangular shaped, and noticeably larger than their slender neck; and by the dark, black bands or chevrons running across their body. The bands often resemble the black stripe on the cartoon character Charlie Brown’s shirt. The question that often arises when the word rattlesnake comes up is, “What if one bites me?” The likelihood of being bitten by a rattlesnake is quite small. Timber rattlesnakes are generally very docile snakes and typically bite as a last resort. Instead, its instincts are to avoid danger by retreating to cover or by hiding using its camouflage coloration to blend into its surroundings. If cornered and provoked, a timber rattlesnake may respond aggressively. It will usually rattle its tail to let you know it is getting agitated. The snake may even puff itself up to appear bigger. Upon further provocation, the snake may bluff strike, where it lunges out, but doesn’t open its mouth or it may strike with an open mouth. Because venom is costly for a rattlesnake to produce, and you are not considered food, a snake often will not actively inject venom when it bites. In fact, nearly half of all timber rattlesnake bites to humans contain little to no venom, commonly referred to as dry or medically insignificant bites.
    [Show full text]
  • Bites and Stings [Poisonous Animals and Plants]
    Poisonous animals and plants Dr Tim Healing Dip.Clin.Micro, DMCC, CBIOL, FZS, FRSB Course Director, Course in Conflict and Catastrophe Medicine Worshipful Society of Apothecaries of London Faculty of Conflict and Catastrophe Medicine Animal and plant toxins • In most instances the numbers of people affected will be small • There are a few instances where larger numbers may be involved – mainly due to food-borne toxins Poisonous species (N.B. Venomous species use poisons for attack, poisonous animals and plants for passive defence) Venomous and poisonous animals – Reptiles (snakes) – Amphibians (dart frogs) – Arthropods (scorpions, spiders, wasps, bees, centipedes) – Aquatic animals (fish, jellyfish, octopi) Poisonous plants – Contact stinging (nettles, poison ivy, algae) – Poisonous by ingestion (fungi, berries of some plants) – Some algae Snakes Venomous Snakes • About 600 species of snake are venomous (ca. 25% of all snake species). Four main groups: – Elapidae (elapids). Mambas, Cobras, King cobras, Kraits, Taipans, Sea snakes, Brown snakes, Coral snakes. – Viperidae (viperids). True vipers and pit vipers (including Rattlesnakes, Copperheads and Cottonmouths) – Colubridae (colubrids). Mostly harmless, but includes the Boomslang – Atractaspididae (atractaspidids). Burrowing asps, Mole vipers, Stiletto snakes. Geographical distribution • Elapidae: – On land, worldwide in tropical and subtropical regions, except in Europe. – Sea snakes occur in the Indian Ocean and the Pacific • Viperidae: – The Americas, Africa and Eurasia. • Boomslangs
    [Show full text]
  • Venom Week 2012 4Th International Scientific Symposium on All Things Venomous
    17th World Congress of the International Society on Toxinology Animal, Plant and Microbial Toxins & Venom Week 2012 4th International Scientific Symposium on All Things Venomous Honolulu, Hawaii, USA, July 8 – 13, 2012 1 Table of Contents Section Page Introduction 01 Scientific Organizing Committee 02 Local Organizing Committee / Sponsors / Co-Chairs 02 Welcome Messages 04 Governor’s Proclamation 08 Meeting Program 10 Sunday 13 Monday 15 Tuesday 20 Wednesday 26 Thursday 30 Friday 36 Poster Session I 41 Poster Session II 47 Supplemental program material 54 Additional Abstracts (#298 – #344) 61 International Society on Thrombosis & Haemostasis 99 2 Introduction Welcome to the 17th World Congress of the International Society on Toxinology (IST), held jointly with Venom Week 2012, 4th International Scientific Symposium on All Things Venomous, in Honolulu, Hawaii, USA, July 8 – 13, 2012. This is a supplement to the special issue of Toxicon. It contains the abstracts that were submitted too late for inclusion there, as well as a complete program agenda of the meeting, as well as other materials. At the time of this printing, we had 344 scientific abstracts scheduled for presentation and over 300 attendees from all over the planet. The World Congress of IST is held every three years, most recently in Recife, Brazil in March 2009. The IST World Congress is the primary international meeting bringing together scientists and physicians from around the world to discuss the most recent advances in the structure and function of natural toxins occurring in venomous animals, plants, or microorganisms, in medical, public health, and policy approaches to prevent or treat envenomations, and in the development of new toxin-derived drugs.
    [Show full text]
  • Long-Term Effects of Snake Envenoming
    toxins Review Long-Term Effects of Snake Envenoming Subodha Waiddyanatha 1,2, Anjana Silva 1,2 , Sisira Siribaddana 1 and Geoffrey K. Isbister 2,3,* 1 Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 50008, Sri Lanka; [email protected] (S.W.); [email protected] (A.S.); [email protected] (S.S.) 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka 3 Clinical Toxicology Research Group, University of Newcastle, Callaghan, NSW 2308, Australia * Correspondence: [email protected] or [email protected]; Tel.: +612-4921-1211 Received: 14 March 2019; Accepted: 29 March 2019; Published: 31 March 2019 Abstract: Long-term effects of envenoming compromise the quality of life of the survivors of snakebite. We searched MEDLINE (from 1946) and EMBASE (from 1947) until October 2018 for clinical literature on the long-term effects of snake envenoming using different combinations of search terms. We classified conditions that last or appear more than six weeks following envenoming as long term or delayed effects of envenoming. Of 257 records identified, 51 articles describe the long-term effects of snake envenoming and were reviewed. Disability due to amputations, deformities, contracture formation, and chronic ulceration, rarely with malignant change, have resulted from local necrosis due to bites mainly from African and Asian cobras, and Central and South American Pit-vipers. Progression of acute kidney injury into chronic renal failure in Russell’s viper bites has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects.
    [Show full text]
  • Venom Evolution Widespread in Fishes: a Phylogenetic Road Map for the Bioprospecting of Piscine Venoms
    Journal of Heredity 2006:97(3):206–217 ª The American Genetic Association. 2006. All rights reserved. doi:10.1093/jhered/esj034 For permissions, please email: [email protected]. Advance Access publication June 1, 2006 Venom Evolution Widespread in Fishes: A Phylogenetic Road Map for the Bioprospecting of Piscine Venoms WILLIAM LEO SMITH AND WARD C. WHEELER From the Department of Ecology, Evolution, and Environmental Biology, Columbia University, 1200 Amsterdam Avenue, New York, NY 10027 (Leo Smith); Division of Vertebrate Zoology (Ichthyology), American Museum of Natural History, Central Park West at 79th Street, New York, NY 10024-5192 (Leo Smith); and Division of Invertebrate Zoology, American Museum of Natural History, Central Park West at 79th Street, New York, NY 10024-5192 (Wheeler). Address correspondence to W. L. Smith at the address above, or e-mail: [email protected]. Abstract Knowledge of evolutionary relationships or phylogeny allows for effective predictions about the unstudied characteristics of species. These include the presence and biological activity of an organism’s venoms. To date, most venom bioprospecting has focused on snakes, resulting in six stroke and cancer treatment drugs that are nearing U.S. Food and Drug Administration review. Fishes, however, with thousands of venoms, represent an untapped resource of natural products. The first step in- volved in the efficient bioprospecting of these compounds is a phylogeny of venomous fishes. Here, we show the results of such an analysis and provide the first explicit suborder-level phylogeny for spiny-rayed fishes. The results, based on ;1.1 million aligned base pairs, suggest that, in contrast to previous estimates of 200 venomous fishes, .1,200 fishes in 12 clades should be presumed venomous.
    [Show full text]
  • Snakes of the Prairie
    National Park Service Scotts Bluff U.S. Department of the Interior Scotts Bluff National Monument Nebraska Snakes of the Prairie Wildlife and Scotts Bluff National Monument is a unique historic landmark which preserves both cultural and Landscapes natural resources. Sweeping from the river valley woodlands, to the mixed-grass prairie, to pine studded bluffs, Scotts Bluff contains a wide variety of wildlife and landscapes. The 3,000 acres com- prising Scotts Bluff conserves one of the last areas of the Great Plains which has not been significant- ly changed by human occupation. Biological Four different species of snakes are known to live at Scotts Bluff National Monument, and may be Diversity of seen by park visitors during the warm months of the year. Though many people regard these rep- the Prairie tiles with feelings of fear and loathing, snakes are generally undeserving of their bad reputation. All snakes are exclusively carniverous and often feed on rodents and insects and should be considered beneficial to humans. They are cold-blooded animals and must avoid extremes of heat and cold. For this reason, you are unlikely to see snakes in the open on hot summer days. If a snake of any kind is encountered, the best advice is to give it plenty of room and a chance to escape. All snakes avoid humans whenever possible and should not be provoked. Prairie Rattlesnake Photo by Steve Thompson Prairie Rattlesnake (Crotalus viridis viridis) The prairie rattlesnake is the only venomous snake found at Scotts Bluff National Monument. Rat- tlesnakes belong to the Pit Viper family of snakes, characterized by temperature sensitive “pits” on either side of the face between the eye and the nostril.
    [Show full text]
  • Snakebite: the World's Biggest Hidden Health Crisis
    Snakebite: The world's biggest hidden health crisis Snakebite is a potentially life-threatening neglected tropical disease (NTD) that is responsible for immense suffering among some 5.8 billion people who are at risk of encountering a venomous snake. The human cost of snakebite Snakebite Treatment Timeline Each year, approximately 5.4 million people are bitten by a snake, of whom 2.7 million are injected with venom. The first snake antivenom This leads to 400,000 people being permanently dis- produced, against the Indian Cobra. abled and between 83,000-138,000 deaths annually, Immunotherapy with animal- mostly in sub-Saharan Africa and South Asia. 1895 derived antivenom has continued to be the main treatment for snakebite evenoming for 120 years Snakebite: both a consequence and a cause of tropical poverty The Fav-Afrique antivenom, 2014 produced by Sanofi Pasteur (France) Survivors of untreated envenoming may be left with permanently discontinued amputation, blindness, mental health issues, and other forms of disability that severely affect their productivity. World Health Organization Most victims are agricultural workers and children in 2018 (WHO) lists snakebite envenoming the poorest parts of Africa and Asia. The economic as a neglected tropical disease cost of treating snakebite envenoming is unimaginable in most communities and puts families and communi- ties at risk of economic peril just to pay for treatment. WHO launches a strategy to prevent and control snakebite envenoming, including a program targeting affected communities and their health systems Global antivenom crisis 2019 The world produces less than half of the antivenom it The Scientific Research Partnership needs, and this only covers 57% of the world’s species for Neglected Tropical Snakbites of venomous snake.
    [Show full text]
  • Bitis Arietans) Venom, and Their Neutralization by Antivenom
    Toxins 2014, 6, 1586-1597; doi:10.3390/toxins6051586 OPEN ACCESS toxins ISSN 2072-6651 www.mdpi.com/journal/toxins Article In Vitro Toxic Effects of Puff Adder (Bitis arietans) Venom, and Their Neutralization by Antivenom Steven Fernandez 1, Wayne Hodgson 1, Janeyuth Chaisakul 2, Rachelle Kornhauser 1, Nicki Konstantakopoulos 1, Alexander Ian Smith 3 and Sanjaya Kuruppu 3,* 1 Department of Pharmacology, Monash University, Building 13E, Wellington Road, Clayton, Vic 3800, Australia; E-Mails: [email protected] (S.F.); [email protected] (W.H.); [email protected] (R.K.); [email protected] (N.K.) 2 Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; E-Mail: [email protected] 3 Department of Biochemistry & Molecular Biology, Monash University, Building 77, Wellington Road, Clayton, Vic 3800, Australia; E-Mail: [email protected] * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel: +61-3-9902-9372; Fax: + 61-3-9902-9500. Received: 24 November 2013; in revised form: 6 April 2014 / Accepted: 4 May 2014 / Published: 19 May 2014 Abstract: This study investigated the in vitro toxic effects of Bitis arietans venom and the ability of antivenom produced by the South African Institute of Medical Research (SAIMR) to neutralize these effects. The venom (50 µg/mL) reduced nerve-mediated twitches of the chick biventer muscle to 19% ± 2% of initial magnitude (n = 4) within 2 h. This inhibitory effect of the venom was significantly attenuated by prior incubation of tissues with SAIMR antivenom (0.864 µg/µL; 67% ± 4%; P < 0.05; n = 3–5, unpaired t-test).
    [Show full text]