A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China

Lam, Ka Keung; Crow, Paul; Ng, Kenneth H. L.; Shek, Kam Chuen; Fung, Hin Tat; Ades, Gary; Grioni, Alessandro; Tan, Kit; Yip, K. T.; Lung, David Christopher; Que, Tak Lun; Lam, Tommy Shing Kit; Simpson, Ian D.; Tsui, Kwok Leung; Kam, CW

doi:10.1136/emj.2009.086694

Cited by 46 publications

(70 citation statements)

References 21 publications

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“…This finding is consistent with the bacterial cultures taken from oral swabs of N atra in Hong Kong. 16 Similar results were also described in a previous study in western Taiwan. 17 Hence, the use of adequate antibiotics is important in N atra envenomation management.…”

Section: Discussionsupporting

confidence: 88%

“…Overall, the surgical patients received significantly higher doses of antivenin (9.2 ± 4.9 vials vs 3.8 ± 2.4 vials; P=0.002) and had significantly higher white blood cell counts (11.0 ± 3.7 × 10 9 /L vs 8.2 ± 2.4 × 10 9 /L; P=0.043). A higher respiratory rate was also evident in surgical patients (median [interquartile range]: 20 [20-21] vs 18 [16][17][18] breaths/min; P=0.015), but the incidence of missing data in both groups for this factor was high (Table …”

Section: Demographic and Clinical Characteristics Associated With Surmentioning

confidence: 99%

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Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Wang

et al. 2016

Hong Kong Med J

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Objectives:To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation.Methods: This case series was conducted in the only tertiary care centre in eastern Taiwan. Patients who presented to the emergency department with Naja atra bite between January 2008 and September 2014 were included. Clinical information was collected and compared between surgical and non-surgical patients.Results: A total of 28 patients with Naja atra envenomation presented to the emergency department during the study period. Of these, 60.7% (n=17) required surgery. Necrotising fasciitis (76.5%) was the main finding in surgery. Comparisons between surgical and non-surgical patients showed skin ecchymosis (odds ratio=34.36; 95% confidence interval, 2.20-536.08; P=0.012) and a high total dose of antivenin (≥6 vials; odds ratio=14.59; 95% confidence interval, 1.10-192.72; P=0.042) to be the most significant predictors of surgery. The rate of bacterial isolation from the surgical wound was 88.2%. Morganella morganii (76.5%), Enterococcus faecalis (58.8%), and Bacteroides fragilis (29.4%) were the most common pathogens involved. Bacterial susceptibility testing indicated that combined broadspectrum antibiotics were needed to cover mixed aerobic and anaerobic bacterial infection.

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Section: Discussionsupporting

confidence: 88%

Section: Demographic and Clinical Characteristics Associated With Surmentioning

confidence: 99%

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Wang

et al. 2016

Hong Kong Med J

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“…7,8 In our study, M. morganii was the most predominant bacteria isolated from bite wounds, followed by Enterococcus spp., Proteus spp., A. hydrophila, P. aeruginosa, and Providencia spp., in descending order. Our human case study is largely consistent with the experimental findings of Shek and others, with the exception of anaerobic pathogen species.…”

mentioning

confidence: 49%

“…3 In Taiwan, bacteriology studies of N. atra bite wounds remain scarce and fragmented. [4][5][6] Although studies of the oral bacteriology of N. atra have been conducted in Hong Kong,7,8 little is known about snakebite wound bacteriology and the effects of geographic differences in the same species. [9][10][11] To better understand the bacteriology of N. atra bite wounds, we retrospectively analyzed 112 cases from two referring medical centers: Taichung Veterans General Hospital (VGH-TC) in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan.…”

Section: Introductionmentioning

confidence: 99%

Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy

Mao¹,

Liu²,

Hung³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. A total of 112 cases of Naja atra envenomation were examined at two referring hospitals: Taichung Veterans General Hospital in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan. Overall, 77% (86/112) of cases developed clinically suspected wound infections and 54% (61/112) required surgery secondary to tissue necrosis, finger or toe gangrene, and/or necrotizing fasciitis. Morganella morganii was the most abundant gramnegative bacterial strain isolated from bite wounds, followed by Proteus spp., Aeromonas hydrophila, Pseudomonas aeruginosa, and Providencia spp. in descending order; Enterococcus spp. were the most common gram-positive bacteria and Bacteroides spp. were the only anaerobic bacteria. A few episodes of bacteremia were caused by Bacteroides and Shewanella spp. There were no significant variations in the distribution of bacterial species between these two hospitals except for a higher incidence of M. morganii, Enterococcus spp., and polymicrobial infection observed at VGH-TP, which may have been related to variations in the fecal flora of prey and oral flora of individual snakes in different geographic areas in Taiwan. According to the susceptibility test involving various pathogens, first-line drug options for the management of N. atra snakebite wound infections may include monotherapy with ureidopenicillin or combination therapy with aminopenicillin and a third-generation cephalosporin or fluoroquinolone. A prospective evaluation of empiric antibiotic therapy for the management of N. atra snakebite should be considered.

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“…Investigations into the oral bacterial flora of various snakes and their venom have revealed a mixture of both aerobic and anaerobic bacterial species (94,141,201,211). Studies of the oral flora bacteriology of Chinese cobras, bamboo pit vipers (201), and Malayan pit vipers (211) have yielded a plethora of aerobic and anaerobic organisms, such as coagulase-negative staphylococci, Proteus species, Morganella morganii, Aeromonas hydrophila, Enterococcus faecalis, and Clostridium species.…”

Section: Reptilesmentioning

confidence: 99%

Microbiology of Animal Bite Wound Infections

2011

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SUMMARY The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans.

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A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China

Cited by 46 publications

References 21 publications

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy

Microbiology of Animal Bite Wound Infections

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