Antivenom Update
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Marine Envenomations
Environmental Marine envenomations Ingrid Berling Geoffrey Isbister Background The majority of marine envenomings are minor and do Marine stings are common but most are minor and do not not require medical intervention. Jellyfish stings are a require medical intervention. Severe and systemic marine frequent reason for presentation to first aid and primary envenoming is uncommon, but includes box jellyfish stings, healthcare providers. A knowledge of the variety of stings Irukandji syndrome, major stingray trauma and blue-ringed and envenoming syndromes that occur in Australia, octopus envenoming. Almost all marine injuries are caused including those that are clinically significant, and available by jellyfish stings, and penetrating injuries from spiny fish, treatments, is necessary for practitioners, particularly those stingrays or sea urchins. working in coastal regions. Objective This article describes the presentation and management Marine envenoming can be considered in two broad categories: of marine envenomations and injuries that may occur in jellyfish stings and penetrating venomous marine injuries. Jellyfish Australia. stings range from the life-threatening major box jellyfish (Chironex Discussion fleckeri) to painful, but generally benign, bluebottle stings common First aid for jellyfish includes tentacle removal, application to most southeastern Australian beaches (Figure 1). Penetrating of vinegar for box jellyfish, and hot water immersion (45°C venomous marine injuries often occur when handling fish, but can for 20 min) for bluebottle jellyfish stings. Basic life support occur to anyone involved in water activities, fresh water or marine. is essential for severe marine envenomings that result in They are typically more painful than just the trauma of the wound, and cardiac collapse or paralysis. -
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 -
Traveler Information
Traveler Information QUICK LINKS Marine Hazards—TRAVELER INFORMATION • Introduction • Risk • Hazards of the Beach • Animals that Bite or Wound • Animals that Envenomate • Animals that are Poisonous to Eat • General Prevention Strategies Traveler Information MARINE HAZARDS INTRODUCTION Coastal waters around the world can be dangerous. Swimming, diving, snorkeling, wading, fishing, and beachcombing can pose hazards for the unwary marine visitor. The seas contain animals and plants that can bite, wound, or deliver venom or toxin with fangs, barbs, spines, or stinging cells. Injuries from stony coral and sea urchins and stings from jellyfish, fire coral, and sea anemones are common. Drowning can be caused by tides, strong currents, or rip tides; shark attacks; envenomation (e.g., box jellyfish, cone snails, blue-ringed octopus); or overconsumption of alcohol. Eating some types of potentially toxic fish and seafood may increase risk for seafood poisoning. RISK Risk depends on the type and location of activity, as well as the time of year, winds, currents, water temperature, and the prevalence of dangerous marine animals nearby. In general, tropical seas (especially the western Pacific Ocean) are more dangerous than temperate seas for the risk of injury and envenomation, which are common among seaside vacationers, snorkelers, swimmers, and scuba divers. Jellyfish stings are most common in warm oceans during the warmer months. The reef and the sandy sea bottom conceal many creatures with poisonous spines. The highly dangerous blue-ringed octopus and cone shells are found in rocky pools along the shore. Sea anemones and sea urchins are widely dispersed. Sea snakes are highly venomous but rarely bite. -
The Polyp and the Medusa Life on the Move
The Polyp and the Medusa Life on the Move Millions of years ago, unlikely pioneers sparked a revolution. Cnidarians set animal life in motion. So much of what we take for granted today began with Cnidarians. FROM SHAPE OF LIFE The Polyp and the Medusa Life on the Move Take a moment to follow these instructions: Raise your right hand in front of your eyes. Make a fist. Make the peace sign with your first and second fingers. Make a fist again. Open your hand. Read the next paragraph. What you just did was exhibit a trait we associate with all animals, a trait called, quite simply, movement. And not only did you just move your hand, but you moved it after passing the idea of movement through your brain and nerve cells to command the muscles in your hand to obey. To do this, your body needs muscles to move and nerves to transmit and coordinate movement, whether voluntary or involuntary. The bit of business involved in making fists and peace signs is pretty complex behavior, but it pales by comparison with the suites of thought and movement associated with throwing a curve ball, walking, swimming, dancing, breathing, landing an airplane, running down prey, or fleeing a predator. But whether by thought or instinct, you and all animals except sponges have the ability to move and to carry out complex sequences of movement called behavior. In fact, movement is such a basic part of being an animal that we tend to define animalness as having the ability to move and behave. -
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. -
The Bug Beneath the Bathing Suit: a Case Report and Discussion of Seabather’S Eruption Versus Cutaneous Larva Migrans
The bug beneath the bathing suit: A case report and discussion of seabather’s eruption versus cutaneous larva migrans Andrew Jensen, BS,* Marcus Goodman, DO, FAOCD** *Medical Student, 4th year, Philadelphia College of Osteopathic Medicine - Georgia Campus, Suwanee, GA **Dermatology Residency Program Director, PCOM/North Fulton Hospital Medical Campus, Roswell, GA Abstract Seabather’s eruption is an important differential diagnosis when a patient who has recently swum in a subtropical ocean presents with a pruritic rash in the distribution of their swimwear. Treatment with systemic corticosteroids is indicated in severe cases and can successfully reduce symptoms. Oral steroid therapy in general has proven to be an effective treatment for many acute and chronic diseases but has long been associated with increased risk for infections. In this report, we present an atypical case of cutaneous larva migrans and discuss its clinical unmasking after systemic steroid treatment was given for an initial diagnosis of seabather’s eruption. Introduction Case Report Figure 2 Seabather’s eruption is a benign, superficial A 52-year-old female presented to her reaction to toxins from marine-animal larvae. dermatologist complaining of an itchy rash on It is the most common marine-related problem her groin and upper leg for one week. The patient in the waters south of the United States.1 stated she recently traveled to Mexico, where she It was reported in Florida as early as 1903 spent several days on the beach and swimming in as a “rash which set up an intense itching” the ocean. Physical exam revealed erythematous, shortly after bathing in ocean water.2 In 1949, edematous papules on her lower abdomen and Sams postulated the eruption was caused by groin, assuming a location directly beneath her “some living, microorganism, in the nature of swimsuit (Figure 1). -
Marine Mammals and Sea Turtles of the Mediterranean and Black Seas
Marine mammals and sea turtles of the Mediterranean and Black Seas MEDITERRANEAN AND BLACK SEA BASINS Main seas, straits and gulfs in the Mediterranean and Black Sea basins, together with locations mentioned in the text for the distribution of marine mammals and sea turtles Ukraine Russia SEA OF AZOV Kerch Strait Crimea Romania Georgia Slovenia France Croatia BLACK SEA Bosnia & Herzegovina Bulgaria Monaco Bosphorus LIGURIAN SEA Montenegro Strait Pelagos Sanctuary Gulf of Italy Lion ADRIATIC SEA Albania Corsica Drini Bay Spain Dardanelles Strait Greece BALEARIC SEA Turkey Sardinia Algerian- TYRRHENIAN SEA AEGEAN SEA Balearic Islands Provençal IONIAN SEA Syria Basin Strait of Sicily Cyprus Strait of Sicily Gibraltar ALBORAN SEA Hellenic Trench Lebanon Tunisia Malta LEVANTINE SEA Israel Algeria West Morocco Bank Tunisian Plateau/Gulf of SirteMEDITERRANEAN SEA Gaza Strip Jordan Suez Canal Egypt Gulf of Sirte Libya RED SEA Marine mammals and sea turtles of the Mediterranean and Black Seas Compiled by María del Mar Otero and Michela Conigliaro The designation of geographical entities in this book, and the presentation of the material, do not imply the expression of any opinion whatsoever on the part of IUCN concerning the legal status of any country, territory, or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The views expressed in this publication do not necessarily reflect those of IUCN. Published by Compiled by María del Mar Otero IUCN Centre for Mediterranean Cooperation, Spain © IUCN, Gland, Switzerland, and Malaga, Spain Michela Conigliaro IUCN Centre for Mediterranean Cooperation, Spain Copyright © 2012 International Union for Conservation of Nature and Natural Resources With the support of Catherine Numa IUCN Centre for Mediterranean Cooperation, Spain Annabelle Cuttelod IUCN Species Programme, United Kingdom Reproduction of this publication for educational or other non-commercial purposes is authorized without prior written permission from the copyright holder provided the sources are fully acknowledged. -
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. -
A Guide to Harmful and Toxic Creatures in the Goa of Jordan
Published by the Royal Marine Conservation Society of Jordan. P. O. Box 831051, Abdel Aziz El Thaalbi St., Shmesani 11183. Amman Copyright: © The Royal Marine Conservation Society of Jordan Reproduction of this publication for educational and other non- commercial purposes is authorized without prior written approval from the copyright holder provided the source is fully acknowledged. ISBN: 978-9957-8740-1-8 Deposit Number at the National Library: 2619/6/2016 Citation: Eid, E and Al Tawaha, M. (2016). A Guide to Harmful and Toxic Creature in the Gulf of Aqaba of Jordan. The Royal Marine Conservation Society of Jordan. ISBN: 978-9957-8740-1-8. Pp 84. Material was reviewed by Dr Nidal Al Oran, International Research Center for Water, Environment and Energy\ Al Balqa’ Applied University,and Dr. Omar Attum from Indiana University Southeast at the United State of America. Cover page: Vlad61; Shutterstock Library All photographs used in this publication remain the property of the original copyright holder, and it should not be reproduced or used in other contexts without permission. 1 Content Index of Creatures Described in this Guide ......................................................... 5 Preface ................................................................................................................ 6 Part One: Introduction ......................................................................................... 8 1.1 The Gulf of Aqaba; Jordan ......................................................................... 8 1.2 Aqaba; -
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. -
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. -
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).