Bothrops lanceolatus Bites: Guidelines for Severity Assessment and Emergent Management

Résière, Dabor; Mégarbane, Bruno; Valentino, Ruddy; Mehdaoui, Hossein; Thomas, Laurent

doi:10.3390/toxins2010163

Cited by 44 publications

(64 citation statements)

References 24 publications

(53 reference statements)

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“…In virtue of elevated FDP/fdp levels, thrombocytopenia, prolonged prothrombin time and fibrinogen consumption, which were also observed herein, snake envenomation has been associated with or may evolve to DIC [80]. Since high plasma TF levels have been described in patients with DIC [81], our results suggest that raised TF levels may have an important role in activating the blood coagulation cascade, especially in more severely envenomed patients, in which the local lesion is more extensive [2].…”

Section: Discussionsupporting

confidence: 77%

Bothrops jararaca Venom Metalloproteinases Are Essential for Coagulopathy and Increase Plasma Tissue Factor Levels during Envenomation

et al. 2014

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Background/AimsBleeding tendency, coagulopathy and platelet disorders are recurrent manifestations in snakebites occurring worldwide. We reasoned that by damaging tissues and/or activating cells at the site of the bite and systemically, snake venom toxins might release or decrypt tissue factor (TF), resulting in activation of blood coagulation and aggravation of the bleeding tendency. Thus, we addressed (a) whether TF and protein disulfide isomerase (PDI), an oxireductase involved in TF encryption/decryption, were altered in experimental snake envenomation; (b) the involvement and significance of snake venom metalloproteinases (SVMP) and serine proteinases (SVSP) to hemostatic disturbances.Methods/Principal FindingsCrude Bothrops jararaca venom (BjV) was preincubated with Na2-EDTA or AEBSF, which are inhibitors of SVMP and SVSP, respectively, and injected subcutaneously or intravenously into rats to analyze the contribution of local lesion to the development of hemostatic disturbances. Samples of blood, lung and skin were collected and analyzed at 3 and 6 h. Platelet counts were markedly diminished in rats, and neither Na2-EDTA nor AEBSF could effectively abrogate this fall. However, Na2-EDTA markedly reduced plasma fibrinogen consumption and hemorrhage at the site of BjV inoculation. Na2-EDTA also abolished the marked elevation in TF levels in plasma at 3 and 6 h, by both administration routes. Moreover, increased TF activity was also noticed in lung and skin tissue samples at 6 h. However, factor VII levels did not decrease over time. PDI expression in skin was normal at 3 h, and downregulated at 6 h in all groups treated with BjV.ConclusionsSVMP induce coagulopathy, hemorrhage and increased TF levels in plasma, but neither SVMP nor SVSP are directly involved in thrombocytopenia. High levels of TF in plasma and TF decryption occur during snake envenomation, like true disseminated intravascular coagulation syndrome, and might be implicated in engendering bleeding manifestations in severely-envenomed patients.

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Section: Discussionsupporting

confidence: 77%

Bothrops jararaca Venom Metalloproteinases Are Essential for Coagulopathy and Increase Plasma Tissue Factor Levels during Envenomation

et al. 2014

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“…Bothrops lanceolatus, known as Fer-de-lance is endemic to the island of Martinique. 1 Without adequate antivenom treatment, B. lanceolatus envenoming is characterized by local tissue damage and delayed multifocal systemic thrombotic occlusions causing cerebral, myocardial, and pulmonary infarctions. [1][2][3] Bothrops lanceolatus venom contains five types of toxins, which belong to the families of zinc-dependent snake venom metalloproteinases (SVMPs), snake venom serine proteinases, acidic phospholipases A2 (PLA2), L-amino acid oxidases, and a specific C-type lectin-like protein.…”

Section: Discussionmentioning

confidence: 99%

“…Bothrops lanceolatus is a snake, member of the Crotalidae family, and is endemic to the island of Martinique (French Caribbean), where approximately 30 cases of envenoming are managed yearly. 1 Although rare, envenoming by B. lanceolatus is a serious medical emergency due to major toxic activities of venom mixture. Snakebite by Bothrops species typically induces local tissue damage, systemic bleeding, and hemodynamic alterations.…”

Section: Introductionmentioning

confidence: 99%

“…Snakebite by Bothrops species typically induces local tissue damage, systemic bleeding, and hemodynamic alterations. 1,2 By contrast to other Bothrops species, the unique systemic effect of B. lanceolatus envenoming is multiple systemic thrombosis, which in absence of antivenom administration, leads to cerebral, pulmonary, or myocardial infarctions, occurring in the first 48 hours. 3 Although antivenom administration can significantly decrease systemic toxic effects of Bothrops venom, it is largely ineffective in preventing tissue destruction and secondary wound infections.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Bothrops lanceolatus Snakebite Surgical Management—Relevance of Fasciotomy

Severyns

Nevière

Resiere

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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is an endemic species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy. Surgery exploration revealed soft tissue necrosis, friability of the deep fascia, and myonecrosis. The patient needed multiple debridement procedures and fasciotomy of all leg compartments and anterior compartment of the thigh. Diagnosis of necrotizing fasciitis was confirmed by positive blood cultures. This clinical case illustrates that major soft tissue infection, including necrotizing fasciitis may occur after snakebite. Abnormal coagulation tests should not delay surgical management, as severe envenoming is a life-threatening condition.

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“…Lancehead bites can result in partial paralysis and death [5]. Approximately 20 -30 people are bitten annually in Martinique [6].…”

Section: Introductionmentioning

confidence: 99%

Living with or Eradicating Poisonous Snakes in Densely Populated Caribbean Islands—A Socio-Ecological Challenge for the French West Indies

Gros-Désormeaux¹,

Lagabrielle²,

Lesales³

et al. 2017

OJAS

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The lancehead (Bothrops lanceolatus) is a poisonous snake endemic to Martinique, an island in the Lesser Antilles arc. Today, this snake is on the verge of extinction. The recorded number of snakes killed yearly between 1970 and 2002 decreased by 97%. Despite the production of an antivenom in 1993, the local authorities set up a financial reward to encourage the eradication of lancehead snakes. Today the local population still perceives the snake as a threat, due to its fatal venom and its fierce behaviour. The case study of the lancehead in Martinique highlights the need to develop integrated strategies to conserve species of poisonous snakes on densely populated islands. This requires innovative, cross-sectoral strategies that involve decision-makers working along with multi-disciplinary scientists. Approaching the complexity of ecosystems through the socio-ecological prism implies, conversely, linking up the domains of science and technology, life and environmental sciences, and human and social sciences, through interactions based on sharing common assumptions.

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Bothrops lanceolatus Bites: Guidelines for Severity Assessment and Emergent Management

Cited by 44 publications

References 24 publications

Bothrops jararaca Venom Metalloproteinases Are Essential for Coagulopathy and Increase Plasma Tissue Factor Levels during Envenomation

Bothrops jararaca Venom Metalloproteinases Are Essential for Coagulopathy and Increase Plasma Tissue Factor Levels during Envenomation

Case Report: Bothrops lanceolatus Snakebite Surgical Management—Relevance of Fasciotomy

Living with or Eradicating Poisonous Snakes in Densely Populated Caribbean Islands—A Socio-Ecological Challenge for the French West Indies

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