Deinagkistrodon acutus envenomation: a report of three cases

Cheng, Chin-Lung; Mao, Yan‐Chiao; Liu, Po‐Yu; Chiang, Liao-Chun; Liao, Shih‐Chieh; Yang, Chen-Chang

doi:10.1186/s40409-017-0111-1

Cited by 30 publications

(23 citation statements)

References 21 publications

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“…A report described the case of a 41-year-old woman who developed necrotizing fasciitis following De. acutus envenomation in Taiwan [14]. A 60-year-old man was reported to develop respiratory failure after a T. mucrosquamatus bite; the bite site, on the occipital lobe, demonstrated severe edema, which was followed by acute airway obstruction and respiratory failure [31].…”

Section: Clinical Manifestations Of Snake Envenomation In Taiwanmentioning

confidence: 99%

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Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan

Huang

Hsieh

2020

Toxins

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Herein, we review the characteristics of the six predominant venomous snakes in Taiwan and the effects of traditional Chinese medicine on the long-term outcomes of snakebite venom. We electronically searched databases, including PubMed, ClinicalKey, China National Knowledge Infrastructure, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library, from their inception to November 2019 by using the following Medical Subject Headings’ keywords: snakebite, long-term, chronic, Chinese medicine, CAM, herb, and Taiwan. The most common long-term effects of snakebite envenomation include “migraine-like syndrome”, brain injuries caused by hypoxia or intracranial hemorrhage, and chronic kidney disease. In addition, hypopituitarism is also worth mentioning. Traditional Chinese medicine can potentially be used in a complementary or alternative treatment for these effects, but additional studies are needed.

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Section: Clinical Manifestations Of Snake Envenomation In Taiwanmentioning

confidence: 99%

“…acutus is mainly composed of snake venom metalloproteinase (SVMPs), C-type lectins, PLA2s, and snake venom serine protease (SVSPs). The hemotoxic-type venoms exhibit both anticoagulant and coagulant effects, which would induce ischemic or hemorrhagic symptoms [13,14]. B. multicinctus and N. atra venoms are neurotoxic.…”

Section: Introductionmentioning

confidence: 99%

Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan

Huang

Hsieh

2020

Toxins

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“…The neurovirulent component of D. acutus bite will damage brain tissues and cause coagulation disorders and vascular endothelial cell injury, accompanied with severe cerebral hemorrhage or ischemic stroke, which could be life-threatening. [ 2 3 4 ] However, studies to reverse these toxicities have seldom been performed. One potential mechanism to reduce the toxicity may be through the proliferation of neural stem cells (NSCs) in the subventricular zone (SVZ) that could differentiate toward the neurons, thereby repairing damaged nerve.…”

Section: Introductionmentioning

confidence: 99%

Increased Efficacy of Antivenom Combined with Hyperbaric Oxygen on Deinagkistrodon acutus Envenomation in Adult Rats

2018

Chinese Medical Journal

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Background:Snakebites are a neglected threat to global human health with a high morbidity rate. The present study explored the efficacy of antivenom with hyperbaric oxygen (HBO) intervention on snakebites, which could provide the experimental basis for clinical adjuvant therapy.Methods:Male Sprague–Dawley rats (n = 96) were randomized into four groups: the poison model was established by injecting Deinagkistrodon acutus (D. acutus) venom (0.8 LD50) via the caudal vein; the antivenom group was injected immediately with specific antivenom via the caudal vein after successful establishment of the envenomation model; and the antivenom + HBO group was exposed to HBO environment for 1 h once at predetermined periods of 0 h, 4 h, 12 h, and 23 h after antivenin administration. Each HBO time point had six rats; the control group was left untreated. The rats in the experimental group were euthanized at the corresponding time points after HBO therapy, and brain tissue and blood were harvested immediately. Hematoxylin and eosin (H&E) staining was used to investigate the pathological changes in the rat brain. Immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), and Western blotting were used to detect the expression of Nestin mRNA and protein in the subventricular zone (SVZ) of the brain. The levels of coagulation function (prothrombin time, activated partial thromboplastin time [APTT], and fibrinogen) and oxidation/antioxidation index (malondialdehyde [MDA] and superoxide dismutase [SOD]) were analyzed. Data were analyzed using one-way analysis of variance.Results:The brain tissue from rats in the poison model was observed for pathological changes using H&E staining. Tissues showed edema, decreased cell number, and disordered arrangement in the SVZ in the snake venom group. The antivenom − HBO intervention significantly alleviated these observations and was more prominent in the antivenom + HBO group. The serum levels of SOD and MDA in the snake venom group were increased and the antivenom − HBO intervention further increased the SOD levels but significantly decreased the MDA levels; however, this was enhanced within 1 h after HBO administration (MDA: F = 5.540, P = 0.008, SOD: F = 7.361, P = 0.000). Activated partial thromboplastin time (APTT) was significantly abnormal after venom administration but improved after antivenom and was even more significant in the antivenom + HBO group 5 h after envenomation (F = 25.430, P = 0.000). Only a few nestin-positive cells were observed in the envenomation model. The expression levels were significant in the antivenom and antivenom + HBO groups within 1 and 5 h after envenomation and were more significant in the antivenom + HBO group as determined by IHC, real-time PCR, and Western blotting (P < 0.05). D. acutus envenomation has neurotoxic effects in the brain of rats.Conclusions:Antivenin and HBO, respectively, induced a neuroprotective effect after D. acutus envenomation by attenuating brain edema, upregulating nestin expression in SVZ, and improving coagulopathy a...

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“…In contrast, the transient, weak fibrin clots shown in this study for D. acutus venom, consistent with previous reports would have a short half-life due to their inherent instability. Thus the effects upon both prey and humans envenomated by D. acutus venoms would therefore be similar: a rapid decrease in fibrinogen levels leading to an anticoagulant state (Cheng et al, 2017;Teng, 1976, 1978), with death resulting from haemorrhagic shock, like has been shown for the Protobothrops genus (Debono et al, 2019c). Both D. acutus and H. hypnale venoms displayed similar biochemistry for their pseudo-procoagulant action, which required calcium for full action (Nielsen, 2016b;Nielsen and Bazzell, 2017).…”

Section: Discussionmentioning

confidence: 80%

“…The functional variation extended to the patterns of fibrinogen chain cleavage as revealed in the SDS PAGE gels ( Just as the neurotoxicity exhibited by some species in this clade of snakes are unique, so too is the thrombin generating activity of C. rhodostoma. In contrast, D. acutus was more like the typical Asian pit-viper, which are broadly known for their haemorrhagic-shock inducing venoms (Cheng et al, 2017;Debono et al, 2019c;Hutton et al, 1990;Joseph et al, 2007;Maduwage et al, 2013a;Rojnuckarin et al, 1998;Warrell et al, 1986;Withana et al, 2014). Haemorrhagic effects are a result of anticoagulation mechanisms, or a net anticoagulant outcome.…”

Section: Discussionmentioning

confidence: 98%

A blood bond: evolutionary, pathophysiological and biodiscovery implications of coagulotoxic snake venoms

Debono¹

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Snakebite is a massive global burden and is a neglected area of tropical diseases. Snake venom neurotoxins have been the subject of intense research efforts, albeit significantly less is known about coagulotoxins. Venoms can deleteriously affect any physiological system reachable by the bloodstream, including being able to directly interfere with the coagulation cascade. Such coagulopathic toxins may be either anticoagulant or procoagulant and snake venoms are unique in their use of procoagulant toxins for predatory purposes. Our limited knowledge into the mechanisms of action of snake venom hinders our understanding of the clinical pathologies and also restricts our use of these powerful natural products as lead compounds in drug design and development. Two snake families which exhibit coagulant properties and lead to a range of clinical pathologies are vipers, Viperidae, and non-front-fanged snakes, Colubridae. The primary focus of this thesis was to investigate and compare the coagulotoxicity effects and mechanisms of various species of known venomous snakes that effect coagulation. Species chosen for this investigation have had limited previous research conducted, thus a knowledge gap in the literature remains. These coagulant properties were investigated through a multi-disciplinary approach, highlighting key results from both families.Data chapters 2 and 3 explore venom from the boomslang (Dispholidus typus) and the twig snakes (Thelotornis species) -iconic African snakes belonging to the family Colubridae. Both species produce strikingly similar lethal procoagulant pathologies. Despite these similarities, antivenom is only produced for treating bites by D. typus, and the mechanisms of action of both venoms have been understudied. We found that T. mossambicanus produced a significantly stronger coagulation response compared to D. typus, governed by strong prothrombin activation through PIII-SVMPs.Despite similarities in symptoms and clinical manifestations, venom composition differs widely between the two species, recovered from a combined approach of venomics and transcriptomics. The neutralising capability of the available boomslang antivenom was also investigated on both species, with it being 11.3 times more effective upon D. typus venom than T. mossambicanus. Envenomation by Crotalinae such as Asian pit vipers can induce multiple clinical complications resulting from coagulopathic and neuropathic effects. Data chapters 4 -8 investigate the Asian Pit Viper clade. While intense research has been undertaken for some species, such as Calloselasma rhodostoma, functional coagulopathic effects have been neglected. As these species' venoms affect the blood coagulation cascade and are known to produce haemorrhagic shock in envenomed patients, we investigated their effects upon coagulation using venoms of 33 species from the Asian pit viper clade including Azemiops, Calloselasma, Deinagkistrodon, Gloydius, Hypnale, Protobothrops, Trimeresurus and Tropidolaemus. Fibrinogen was the main coagulation target among th...

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Deinagkistrodon acutus envenomation: a report of three cases

Cited by 30 publications

References 21 publications

Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan

Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan

Increased Efficacy of Antivenom Combined with Hyperbaric Oxygen on Deinagkistrodon acutus Envenomation in Adult Rats

A blood bond: evolutionary, pathophysiological and biodiscovery implications of coagulotoxic snake venoms

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