SRPNTS Snakebite
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WHO Guidance on Management of Snakebites
GUIDELINES FOR THE MANAGEMENT OF SNAKEBITES 2nd Edition GUIDELINES FOR THE MANAGEMENT OF SNAKEBITES 2nd Edition 1. 2. 3. 4. ISBN 978-92-9022- © World Health Organization 2016 2nd Edition All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications, whether for sale or for noncommercial distribution, can be obtained from Publishing and Sales, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110 002, India (fax: +91-11-23370197; e-mail: publications@ searo.who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. -
An in Vivo Examination of the Differences Between Rapid
www.nature.com/scientificreports OPEN An in vivo examination of the diferences between rapid cardiovascular collapse and prolonged hypotension induced by snake venom Rahini Kakumanu1, Barbara K. Kemp-Harper1, Anjana Silva 1,2, Sanjaya Kuruppu3, Geofrey K. Isbister 1,4 & Wayne C. Hodgson1* We investigated the cardiovascular efects of venoms from seven medically important species of snakes: Australian Eastern Brown snake (Pseudonaja textilis), Sri Lankan Russell’s viper (Daboia russelii), Javanese Russell’s viper (D. siamensis), Gaboon viper (Bitis gabonica), Uracoan rattlesnake (Crotalus vegrandis), Carpet viper (Echis ocellatus) and Puf adder (Bitis arietans), and identifed two distinct patterns of efects: i.e. rapid cardiovascular collapse and prolonged hypotension. P. textilis (5 µg/kg, i.v.) and E. ocellatus (50 µg/kg, i.v.) venoms induced rapid (i.e. within 2 min) cardiovascular collapse in anaesthetised rats. P. textilis (20 mg/kg, i.m.) caused collapse within 10 min. D. russelii (100 µg/kg, i.v.) and D. siamensis (100 µg/kg, i.v.) venoms caused ‘prolonged hypotension’, characterised by a persistent decrease in blood pressure with recovery. D. russelii venom (50 mg/kg and 100 mg/kg, i.m.) also caused prolonged hypotension. A priming dose of P. textilis venom (2 µg/kg, i.v.) prevented collapse by E. ocellatus venom (50 µg/kg, i.v.), but had no signifcant efect on subsequent addition of D. russelii venom (1 mg/kg, i.v). Two priming doses (1 µg/kg, i.v.) of E. ocellatus venom prevented collapse by E. ocellatus venom (50 µg/kg, i.v.). B. gabonica, C. vegrandis and B. -
Year of the Snake News No
Year of the Snake News No. 3 March 2013 www.yearofthesnake.org The Value of Snakes - By: Polly Conrad, The Orianne Society Snake Venom Can Save Your Life or disorders, you should support • A southern Copperhead snake conservation! In this article, I (Agkistrodon contortrix) venom present a brief overview of some of protein, called contortrostatin, pre- the medicinal values of snakes. Who vents cancer cells from attaching to would have thought snake venom other cells and also prevents them could be life-saving? from producing the signals neces- It all starts with living, breathing, sary to prompt new blood vessels venomous snakes, which are milked to sprout and support the spread by professionals for their venom. of cancer. Contortrostatin curbed The venom samples are then sent to the spread of cancer by 90% in laboratories for various analyses and mice implanted with breast cancer testing. Venom is a blend of mol- tumors! Copperhead, Agkistrodon contortrix. ecules, including enzymes, peptides, Photo © John White. • A novel King Cobra (Ophiophagus and proteins. Many studies have hannah) venom protein, haditoxin, Even if you don’t like snakes, identified several benefits provided may be useful as a ‘molecular chances are that you or someone you by snake venom proteins. I’ve listed probe’ which will help researchers know can benefit from the research some below. study neurotransmitter receptors and applications surrounding snake • The protein, ancrod, from the and their roles in neurodegenera- venom proteins. These proteins are Malayan Pit Viper (Callaselasma tive conditions such as Alzheimer’s being used to study, treat and cure rhodostoma) is being studied to and Parkinson’s diseases, as well as heart disease, high blood pressure, treat patients suffering from deep schizophrenia, anxiety, and depres- stroke, Alzheimer’s disease and vein blood clots or stroke, and to sive disorders and even nicotine cancer. -
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. -
Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan
University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln US Army Research U.S. Department of Defense 2013 Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan Jason D. Heiner University of Washington - Seattle Campus, [email protected] Vikhyat S. Bebarta San Antonio Military Medical Center Shawn M. Varney San Antonio Military Medical Center Jason D. Bothwell Madigan Army Medical Center Aaron J. Cronin Womack Army Medical Center Follow this and additional works at: https://digitalcommons.unl.edu/usarmyresearch Heiner, Jason D.; Bebarta, Vikhyat S.; Varney, Shawn M.; Bothwell, Jason D.; and Cronin, Aaron J., "Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan" (2013). US Army Research. 198. https://digitalcommons.unl.edu/usarmyresearch/198 This Article is brought to you for free and open access by the U.S. Department of Defense at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in US Army Research by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. WILDERNESS & ENVIRONMENTAL MEDICINE, ], ]]]–]]] (2013) BRIEF REPORT Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan Jason D. Heiner, MD; Vikhyat S. Bebarta, MD; Shawn M. Varney, MD; Jason D. Bothwell, MD; Aaron J. Cronin, PA-C From the University of Washington, Seattle, WA (Dr Heiner); the San Antonio Military Medical Center, Fort Sam Houston, TX (Drs Heiner, Bebarta, and Varney); the Madigan Army Medical Center, Joint Base Lewis-McCord, WA (Dr Bothwell); and the Womack Army Medical Center, Fort Bragg, NC (Mr Cronin). -
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. -
Venom Proteomics and Antivenom Neutralization for the Chinese
www.nature.com/scientificreports OPEN Venom proteomics and antivenom neutralization for the Chinese eastern Russell’s viper, Daboia Received: 27 September 2017 Accepted: 6 April 2018 siamensis from Guangxi and Taiwan Published: xx xx xxxx Kae Yi Tan1, Nget Hong Tan1 & Choo Hock Tan2 The eastern Russell’s viper (Daboia siamensis) causes primarily hemotoxic envenomation. Applying shotgun proteomic approach, the present study unveiled the protein complexity and geographical variation of eastern D. siamensis venoms originated from Guangxi and Taiwan. The snake venoms from the two geographical locales shared comparable expression of major proteins notwithstanding variability in their toxin proteoforms. More than 90% of total venom proteins belong to the toxin families of Kunitz-type serine protease inhibitor, phospholipase A2, C-type lectin/lectin-like protein, serine protease and metalloproteinase. Daboia siamensis Monovalent Antivenom produced in Taiwan (DsMAV-Taiwan) was immunoreactive toward the Guangxi D. siamensis venom, and efectively neutralized the venom lethality at a potency of 1.41 mg venom per ml antivenom. This was corroborated by the antivenom efective neutralization against the venom procoagulant (ED = 0.044 ± 0.002 µl, 2.03 ± 0.12 mg/ml) and hemorrhagic (ED50 = 0.871 ± 0.159 µl, 7.85 ± 3.70 mg/ ml) efects. The hetero-specifc Chinese pit viper antivenoms i.e. Deinagkistrodon acutus Monovalent Antivenom and Gloydius brevicaudus Monovalent Antivenom showed negligible immunoreactivity and poor neutralization against the Guangxi D. siamensis venom. The fndings suggest the need for improving treatment of D. siamensis envenomation in the region through the production and the use of appropriate antivenom. Daboia is a genus of the Viperinae subfamily (family: Viperidae), comprising a group of vipers commonly known as Russell’s viper native to the Old World1. -
Polyvalent Horse F(Ab`)2 Snake Antivenom: Development of Process to Produce Polyvalent Horse F(Ab`)2 Antibodies Anti-African Snake Venom
African Journal of Biotechnology Vol. 9 (16), pp. 2446-2455, 19 April, 2010 Available online at http://www.academicjournals.org/AJB ISSN 1684–5315 © 2009 Academic Journals Full Length Research Paper Polyvalent horse F(Ab`)2 snake antivenom: Development of process to produce polyvalent horse F(Ab`)2 antibodies anti-african snake venom R. G. Guidlolin1, R. M. Marcelino1, H. H. Gondo1, J. F. Morais1, R. A. Ferreira2, C. L. Silva2, T. L. Kipnis2, J. A. Silva2, J. Fafetine3 and W. D. da Silva2* 1Divisao Bioindustrial, Instituto Butantan, Sao Paulo, SP, Brazil. 2Laboratório de Biologia do Reconhecer, Centro de Biociencias e Biotecnologia, Universidade Estadual do Norte Fluminense – Darcy Ribeiro, Campos dos Goytacazes, RJ, Brazil. 3Universidade Eduardo Mondlane, Maputo, Mozambique. Accepted 23 March, 2010 A method to obtain polyvalent anti-Bitis and polyvalent-anti-Naja antibodies was developed by immunizing horses with B. arietans, B. nasicornis, B. rhinoceros, N. melanoleuca and N. mossambica crude venoms. Antibody production was followed by the ELISA method during the immunization procedure. Once the desired anti-venom antibody titers were attained, horses were bled and the immunoglobulins were separated from the sera by (NH4)2SO4 precipitation, cleaved with pepsin and filtered through a 30 kDa ultrafiltration membrane. F(ab´)2 fragments were further purified by Q-Fast Flow chromatography, concentrated by molecular ultrafiltration and sterilized by filtration through 0.22 m membranes. The resulting F(ab´)2 preparations were rich in intact L and in pieces of H IgG(T) chains, as demonstrated by electrophoresis and Western blot and exhibited high antibody titers, as assayed by the ELISA method. -
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Use of Snake Antivenom and Outcomes H. L. Chen et al. ORIGINAL ARTICLE Use of Snake Antivenom and Clinical Outcomes in Snake Envenomation: A Retrospective Study in a Tertiary Hospital in Penang, Malaysia HOOI LI CHEN1,*, YING QI CHUAH1, KER LOON ENG1, YENN YEOH LYNN MICHELLE 1, AHMAD ROZIANA BINTI 1 1Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health Malaysia, Penang, Malaysia Abstract Backgrounds: Snake antivenom (SAV) is the definitive treatment for snake envenomation. But SAVs are specific, expensive and limited in supply. SAVs also come with risk of adverse reactions. Hence, this study was conducted to assess the use of SAV, adverse reactions to SAV and its clinical outcomes in snakebite patients. Methods: This was a retrospective study. Medical records of snakebite patients for the period from January 2014 to September 2017 were reviewed and study data was extracted. Clinical outcomes were measured by mortality rate in those receiving SAV. Results: Among 165 subjects, only 9 patients (5%) were treated with SAV after presenting with envenomation symptoms in which five cases with identified snakes were given monovalent SAV namely pit viper (two cases), king cobra, sea snake and cobra with one case each. Meanwhile, three cases of unidentified snake received polyvalent SAV and one case received pit viper SAV. Most of the patients (8/9, 88.9%) received SAV within 24 hours after snakebite. The average time gap to first administration was 7.23 hours. In patients receiving SAV, six out of 9 cases required two to four vials of SAV. All the patients receiving SAV did not encounter any adverse effects except a child who had pyrogenic reaction. -
THE PUFF ADDER (BITIS ARIETANS) J.L. CLOUDSLEY-THOMPSON Department of Biology (Medawar Building), University College, University
British Herpetological Society Bulletin, No. 26, 1988. THE PUFF ADDER (BITIS ARIETANS) J.L. CLOUDSLEY-THOMPSON Department of Biology (Medawar Building), University College, University of London, Gower Street, London WCIE 6BT The Puff Adder (Bitis arietans) is one of the largest of the African vipers and probably the species most frequently seen by travellers in that continent. It receives its English name from the habit of inflating its body and hissing loudly when disturbed. The sound is produced both when the breath is inhaled as well as during exhalation. This behaviour is characteristic of all true vipers, but is particularly evident in the case of the Puff Adder. Unlike the Gaboon Viper (Bitis gabonica), which is a forest snake, the Puff Adder inhabits subdeserts and savannas, and is also to be found in mountainous regions. Except in rain forests, Puff Adders are widespread southward to the Cape from Morocco in the west and the Sudan in the east. They occur as near to Khartoum as Jebel Aulia. This is their northernmost limit in Sudan, but they range also into western and southern Arabia. Puff Adders may exceed 1.4m in length, and have a girth of 25cm. Although they do not attain the weight of a full-grown Gaboon Viper they are, nevertheless, formidable snakes. There may be considerable variation in the coloration of Puff Adders. In some specimens, the chevrons are sooty black and the crescents cream coloured while, in others, the chevrons are dark brown or grey and the crescents dull buff. The blotched pattern of dark chevrons separated by yellow crescents (Plate 1) is cryptic. -
A Formal Five-Way Division of the Gaboon Viper Species Complex: Bitis
Australasian Journal of Herpetology Australasian Journal of Herpetology 16:25-31. ISSN 1836-5698 (Print)25 Published 10 July 2013. ISSN 1836-5779 (Online) A formal five-way division of the Gaboon Viper Species Complex: Bitis (Macrocerastes) gabonica (Duméril, Bibron and Duméril, 1854) and a two-way division of the Nose-horned Viper species complex Bitis (Macrocerastes) nasicornis (Shaw, 1802) (Serpentes:Viperidae:Bitisini). RAYMOND T. HOSER 488 Park Road, Park Orchards, Victoria, 3114, Australia. Phone: +61 3 9812 3322 Fax: 9812 3355 E-mail: [email protected] Received 21 April 2013, Accepted 4 June 2013, Published 10 July 2013. ABSTRACT The Gaboon Viper Bitis gabonica (Duméril, Bibron and Duméril, 1854) as a species complex has had a fairly stable taxonomic history since being described at the species level, although the species as generally recognized was transferred to the genus Bitis Gray, 1842 shortly after the original description. Likewise for the Nose-horned Viper species complex Bitis (Macrocerastes) nasicornis (Shaw, 1802). The species known as the Rhinoceros Viper Bitis rhinoceros (Schlegel, 1855) was synonymised with Bitis gabonica by virtually all herpetologists beyond 1855 until 1999 (see McDiarmid et al. 1999), when Lenk et al. (1999) provided a molecular basis to recognize the western population, (then known as Bitis gabonica rhinoceros) identified in 1999 on the basis of allopatric distribution as opposed to any consistent morphological divergence. Chippaux (2006), showed that consistent differences in the markings on the side of the head could be used to identify and separate Bitis rhinoceros from the nominate species. Meanwhile the Gaboon Viper as popularly recognized since 1999 comprises the main population centred on the wetter parts of west-central Africa (the type locality Gabon) including several countries and then three quite distant and unconnected outlier populations. -
Bull World Health Organ 2014;92:526–532 | Doi: Policy & Practice José María Gutiérrez Et Al
Policy & practice A multicomponent strategy to improve the availability of antivenom for treating snakebite envenoming José María Gutiérrez,a Thierry Burnouf,b Robert A Harrison,c Juan J Calvete,d Ulrich Kuch,e David A Warrellf & David J Williams,g for the Global Snakebite Initiative Abstract Snakebite envenoming is a common but neglected public health problem, particularly in impoverished rural regions of sub- Saharan Africa, Asia and Latin America. The only validated treatment for this condition is passive immunotherapy with safe and effective animal-derived antivenoms. However, there is a long-lasting crisis in the availability of these life-saving medications, particularly in sub- Saharan Africa and parts of Asia. We herein advocate a multicomponent strategy to substantially improve the availability of safe and effective antivenoms at the global level. This strategy is based on: (i) preparing validated collections of representative venom pools from the most medically dangerous snakes in high-risk regions of the world; (ii) strengthening the capacity of national antivenom manufacturing and quality control laboratories and their regulatory authorities and establishing new facilities in developing countries through technology transfer, as an integral part of efforts to develop their biological products industry; (iii) getting established laboratories to generate antivenoms for various regions of the world; and (iv) getting governments and relevant organizations to give snakebite envenoming due recognition within national and international public health policy frameworks. These ways of making antivenom available should be complemented by actions to improve health information systems, the accessibility of antivenoms, the training of medical and nursing staff, and community-based education. Such a multicomponent strategy involving stakeholders on many levels could help consolidate sustainable improvements in antivenom availability worldwide.