Bite by a juvenile Bothrops venezuelensis (Venezuelan lancehead) resulting in severe envenomation: A case report

Fuchs, Joan; Faber, Katrin; Tuchscherer, Daniel; Tsakiris, Dimitrios Α.; Weiler, Stefan; Hofer, Katharina E.

doi:10.1016/j.toxicon.2020.04.002

Cited by 5 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Coagulopathy resolved within 12-24 h after antivenom infusion, whereas the features associated with TMA (thrombocytopenia, hemolytic anemia with presence of schistocytes in blood smears, decreased haptoglobin level, increased lacticodehydrogenase (LDH) level and AKI) tended to start 1-3 days post-bite despite antivenom and persisted for longer. In the case of B. venezuelensis bite, hyperfibrinogenemia began at day 2 and persisted over 2 weeks despite the administration of antivenom 4.5 h after the bite [55]. When assayed, ADAMTS13 activity and C3/C4 complement levels were within the normal range [54].…”

Section: Thrombosis 221 Thrombotic Microangiopathymentioning

confidence: 96%

“…Thrombotic microangiopathy (TMA) was recently described in envenomation cases by B. jararaca [53,54], B. venezuelensis [55] and B. erythromelas [56]. These patients presented on admission a classic local syndrome with pain, edema, local ecchymosis or bleeding at the fang punctures, but no systemic bleeding.…”

Section: Thrombosis 221 Thrombotic Microangiopathymentioning

confidence: 99%

“…Bothrops bite-related TMA occur despite specific antivenom but still have a good prognosis [53,55,56,60].…”

Section: Response To Antivenommentioning

confidence: 99%

See 2 more Smart Citations

Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders

Larréché

Chippaux

Chevillard

et al. 2021

IJMS

View full text Add to dashboard Cite

Toxins from Bothrops venoms targeting hemostasis are responsible for a broad range of clinical and biological syndromes including local and systemic bleeding, incoagulability, thrombotic microangiopathy and macrothrombosis. Beyond hemostais disorders, toxins are also involved in the pathogenesis of edema and in most complications such as hypovolemia, cardiovascular collapse, acute kidney injury, myonecrosis, compartmental syndrome and superinfection. These toxins can be classified as enzymatic proteins (snake venom metalloproteinases, snake venom serine proteases, phospholipases A2 and L-amino acid oxidases) and non-enzymatic proteins (desintegrins and C-type lectin proteins). Bleeding is due to a multifocal toxicity targeting vessels, platelets and coagulation factors. Vessel damage due to the degradation of basement membrane and the subsequent disruption of endothelial cell integrity under hydrostatic pressure and tangential shear stress is primarily responsible for bleeding. Hemorrhage is promoted by thrombocytopenia, platelet hypoaggregation, consumption coagulopathy and fibrin(ogen)olysis. Onset of thrombotic microangiopathy is probably due to the switch of endothelium to a prothrombotic phenotype with overexpression of tissue factor and other pro-aggregating biomarkers in association with activation of platelets and coagulation. Thrombosis involving large-caliber vessels in B. lanceolatus envenomation remains a unique entity, which exact pathophysiology remains poorly understood.

show abstract

Section: Thrombosis 221 Thrombotic Microangiopathymentioning

confidence: 96%

Section: Thrombosis 221 Thrombotic Microangiopathymentioning

confidence: 99%

See 1 more Smart Citation

Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders

Larréché

Chippaux

Chevillard

et al. 2021

IJMS

View full text Add to dashboard Cite

show abstract

“…Depending on species and geographic region, a multitude of different antivenoms is used to treat Bothrops envenomations. These antivenoms include, among others, Antivipmyn (Instituto Bioclon, Mexico) [20], Central American polyspecific antivenom (PoliVal-ICP; Instituto Clodomiro Picado, Costa Rica) [21,22], Antivipmyn-Tri (Instituto Bioclon, Mexico) [21,23,24], Soro Antibotrópico (SAB; Instituto Butantan, Brazil) [25], and Bothrofav (MicroPharm, United Kingdom) [21]. Despite antivenom being available to treat envenomations, a fundamental, life-threatening issue with antivenom efficacy arises due to the natural extreme complexity of venoms that have been shaped by a myriad of selection pressures.…”

Section: Introductionmentioning

confidence: 99%

Pan-American Lancehead Pit-Vipers: Coagulotoxic Venom Effects and Antivenom Neutralisation of Bothrops asper and B. atrox Geographical Variants

Bourke

Zdenek

Neri-Castro

et al. 2021

Toxins

View full text Add to dashboard Cite

The toxin composition of snake venoms and, thus, their functional activity, can vary between and within species. Intraspecific venom variation across a species’ geographic range is a major concern for antivenom treatment of envenomations, particularly for countries like French Guiana that lack a locally produced antivenom. Bothrops asper and Bothrops atrox are the most medically significant species of snakes in Latin America, both producing a variety of clinical manifestations, including systemic bleeding. These pathophysiological actions are due to the activation by the venom of the blood clotting factors Factor X and prothrombin, thereby causing severe consumptive coagulopathy. Both species are extremely wide-ranging, and previous studies have shown their venoms to exhibit regional venom variation. In this study, we investigate the differential coagulotoxic effects on human plasma of six venoms (four B. asper and two B. atrox samples) from different geographic locations, spanning from Mexico to Peru. We assessed how the venom variation of these venom samples affects neutralisation by five regionally available antivenoms: Antivipmyn, Antivipmyn-Tri, PoliVal-ICP, Bothrofav, and Soro Antibotrópico (SAB). The results revealed both inter- and intraspecific variations in the clotting activity of the venoms. These variations in turn resulted in significant variation in antivenom efficacy against the coagulotoxic effects of these venoms. Due to variations in the venoms used in the antivenom production process, antivenoms differed in their species-specific or geographical neutralisation capacity. Some antivenoms (PoliVal-ICP, Bothrofav, and SAB) showed species-specific patterns of neutralisation, while another antivenom (Antivipmyn) showed geographic-specific patterns of neutralisation. This study adds to current knowledge of Bothrops venoms and also illustrates the importance of considering evolutionary biology when developing antivenoms. Therefore, these results have tangible, real-world implications by aiding evidence-based design of antivenoms for treatment of the envenomed patient. We stress that these in vitro studies must be backed by future in vivo studies and clinical trials before therapeutic guidelines are issued regarding specific antivenom use in a clinical setting.

show abstract

“…One patient bitten by a Bothrops venezuelensis developed microangiopathic haemolysis, severe thrombocytopenia and disseminated intravascular coagulopathy, complicated by acute respiratory distress syndrome and acute kidney injury. He recovered with antivenom and symptomatic treatment [32]. Neurological symptoms after elapid bites manifested as fasciculations resulting in severely elevated creatine kinase in the case of a bite by a Dendroaspis polylepis, which is typical for this particular snake [18].…”

Section: Discussionmentioning

confidence: 99%

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

et al. 2022

View full text Add to dashboard Cite

OBJECTIVE: The private keeping of exotic venomous snakes is legally permitted in Switzerland. The aim of the present study was to characterise the epidemiological and clinical features of bites by exotic venomous snakes over a period of 22 years in Switzerland. METHODS: We included all calls related to exotic snakebites recorded at the Swiss National Poisons Information Centre (Tox Info Suisse) from 1997 to 2018. Exclusion criteria comprised indigenous snakes, non-venomous exotic snakes such boas or pythons, clinical courses incompatible with a snakebite or calls from abroad. Follow-up information was graded according to the Poisoning Severity Score. RESULTS: Within the study period, 1,364 calls related to snakebites were recorded at Tox Info Suisse; 148 (11%) cases were attributed to exotic venomous snakes and fulfilled the study criteria. A total of 112 (98%) of 114 patients with medical follow-up information exhibited sufficient causality between exposure and clinical effects. Only adult patients were affected. The median age was 40 years (range 16–71) and the male gender was predominant (n = 136, 92%). Viperidae were involved in 87 (78%) and Elapidae in 25 (22%) patients. Overall, the main affected body part was the hand (89 patients, 79%). In the majority of the patients the clinical course was mild (46, 41%) or moderate (40, 36%), in a lower proportion asymptomatic (6, 5%) or with severe symptoms (20, 18%). No fatalities were reported in the study period. Severe symptoms were observed after elapid bites in six patients (24%) and after viper bites in 14 patients (16%). Besides local effects, neurological disorders after elapid bites and haematological disorders after viper bites were most frequently reported. Antivenom was administered in 24% (27 patients: 18 Viperidae, 21% and 9 Elapidae, 36%; 5 patients (4%) required multiple doses), overall, with good resolution of symptoms. CONCLUSION: Exotic snakebite is a rare occurrence in Switzerland but has led to medically relevant morbidity, sometimes requiring antivenom treatment. Over half of the envenomed patients required symptomatic or specific treatment. No fatalities or bites in children were reported.

show abstract

Bite by a juvenile Bothrops venezuelensis (Venezuelan lancehead) resulting in severe envenomation: A case report

Cited by 5 publications

References 19 publications

Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders

Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders

Pan-American Lancehead Pit-Vipers: Coagulotoxic Venom Effects and Antivenom Neutralisation of Bothrops asper and B. atrox Geographical Variants

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

Contact Info

Product

Resources

About