Appropriate antivenom doses for six types of envenomations caused by snakes in taiwan

Abstract

ABSTRACT:Six of the 15 species of venomous snakes found in Taiwan are responsible for most of the clinically significant envenomations in the country. These species are: Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Naja atra, Bungarus multicinctus, Deinagkistrodon acutus and Daboia russelii siamensis, which together can be subdivided into three groups based on their venom effects. Primary treatment consists of rapid administration of appropriate antivenoms. The present study aimed to identify a proper dose of antivenom for each snake group as well as to describe hemorrhagic, neurotoxic, and mixed effects of their venoms. A retrospective chart review identified 72 snakebite cases referred to an emergency department. Data on epidemiology, examination findings, snake identification, treatment, antivenom dose and complications were collected. After excluding 14 patients, data from 58 victims were analyzed. Most studied cases were male (86%). Significantly higher doses of antivenom were administered against neurotoxic envenomations (mean dose: three vials) compared with the other two (p < 0.05). Moreover, patients affected by neurotoxic bites were more likely to develop blurred vision and other complications (p < 0.05). Multivariate logistic regression analysis indicated that neurotoxic envenomation was a risk factor for complications (OR: 8.84,. Neurotoxic envenomations and complication occurrence were positively correlated with antivenom dosage. In conclusion, patients affected by neurotoxic envenomations received higher doses of antivenom than others whereas incidence of complications was associated with higher antivenom doses.

Pathogenesis of local necrosis induced by Naja atra venom: Assessment of the neutralization ability of Taiwanese freeze-dried neurotoxic antivenom in animal models

“…Whether FNAV has the potential to prevent local necrosis extension induced by N. atra venom has been debated for more than a decade in Taiwan [9,[11][12][13][14]. Following the standard protocol described previously [61,62] has failed to yield a mouse model of N. atra venominduced necrosis for investigating the neutralization potential of FNAV in vivo.…”

“…After a series of improvements and refinements in the production process, there are now four types of antivenoms against the six most clinically significant snakebites available for clinical use. All are in the form of lyophilized F(ab) 2 from equine serum-two as bivalent antivenoms, and two as monovalent antivenoms [5,9]. The first two are freeze-dried hemorrhagic antivenom (FHAV) against T. stejnegeri and P. mucrosquamatus and freeze-dried neurotoxic antivenom (FNAV) against B. multicinctus and N. atra, whereas the latter two are freeze-dried D. acutus antivenom against D. acutus and freeze-dried D. russelii siamensis antivenom against D. russelii siamensis.…”

Translational Venomics: Third-Generation Antivenomics of Anti-Siamese Russell’s Viper, Daboia siamensis, Antivenom Manufactured in Taiwan CDC’s Vaccine Center

“…Six of the 15 species of venomous snakes found in Taiwan are responsible for most of the clinically significant envenomations in the country [ 2 ]. These species are Protobothrops mucrosquamatus (Taiwan habu) (32.9% of envenomings), Trimeresurus stejnegeri (green habu) (24.2%), Naja atra (Chinese cobra) (12.1%), Bungarus multicinctus (Taiwan banded krait) (10.1%), Deinagkistrodon acutus (hundred-pace snake) (3.9%), and D. siamensis [ 3 ]. With a rate of 1.6% of total snakebites [ 3 ], D. siamensis represents the sixth most frequent cause of snakebite envenomings in Taiwan.…”

“…These species are Protobothrops mucrosquamatus (Taiwan habu) (32.9% of envenomings), Trimeresurus stejnegeri (green habu) (24.2%), Naja atra (Chinese cobra) (12.1%), Bungarus multicinctus (Taiwan banded krait) (10.1%), Deinagkistrodon acutus (hundred-pace snake) (3.9%), and D. siamensis [ 3 ]. With a rate of 1.6% of total snakebites [ 3 ], D. siamensis represents the sixth most frequent cause of snakebite envenomings in Taiwan. Restricted to the south-eastern part of the country, Russell’s viper envenomings are a rare but severe medical problem [ 2 , 4 , 5 ].…”

Analysis of the efficacy of Taiwanese freeze-dried neurotoxic antivenom against Naja kaouthia, Naja siamensis and Ophiophagus hannah through proteomics and animal model approaches

“…There are four types of available antivenom against the six most clinically significant snakebites in Taiwan; two are bivalent antivenoms, and the other two are monovalent antivenoms [ 15 , 16 ]. One of the bivalent antivenoms is freeze-dried neurotoxic antivenom (FNAV), raised against Bungarus multicinctus and N .…”