Crotalus durissus terrificus (viperidae; crotalinae) envenomation: Respiratory failure and treatment with antivipmyn TRI® antivenom

Baum, Regan A.; Bronner, Jonathan; Akpunonu, Peter; Plott, J.; Bailey, Abby M.; Keyler, Daniel E.

doi:10.1016/j.toxicon.2019.03.009

Cited by 13 publications

(19 citation statements)

References 27 publications

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“…Clinical studies have demonstrated that victims that received antivenoms in the first hours after the bite have a far better prognosis. A case report regarding C. d. terrificus severe envenomation demonstrated that the efficacy of an antivenom was better and faster when the patient received it 25 min after the snakebite (17 ampoules of Antivipmyn TRI ® antivenom still in the ambulance on the way to the hospital), since the victim showed significant improvement with normal vital signs immediately after finishing antivenom administration (after 5-6 h of admission time) [65]. On the other hand, another study performed with Australian snakebite victims demonstrated that independent of the set time of the initiation of the antivenom therapy (before or after 6 h of snakebite), the serum was unable to inhibit venom-induced coagulopathy [66].…”

Section: Discussionmentioning

confidence: 99%

“…Although the patient received administration of antivenom (Antivipmyn-TRI ® ), he presented respiratory failure and required mechanical ventilation. Fortunately, the patient was discharged 55 h after the accident [65]. Azevedo-Marques and colleagues (1987) reported three cases of patients of different ages (27,24, and 9 years old) bitten by rattlesnakes.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview

Medeiros

Oliveira

Ferreira

et al. 2020

Reports

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Snakebite envenomations are classified as Category A Neglected Tropical Diseases by the World Health Organization. In Brazil, 405 snake species are distributed among 11 families, with the genera Bothrops and Crotalus being the most studied and main responsible for severe and lethal envenomations. In the country, Crotalus genus (i.e., rattlesnakes) is represented by Crotalus durissus species, showing seven different subspecies distributed along the country, including Crotalus durissus ruruima, which inhabits Roraima, the Brazilian nothermost state from Amazon forest. Here, we report a fatal case of a severe envenomation following a rattlesnake bite. The patient presented classic crotalic neurological signs and symptoms such as ptosis, drooling of saliva, sluggishness, macroscopic hematuria, and oliguria, which evolved to acute kidney failure (AKF) and hemodynamic instability. Although the patient was treated with the specific antivenom therapy, the severe envenomation resulted in three cardiac arrests and death of the victim in less than 38 h. This study discusses the causes of the patient death, the features of rattlesnake venom-induced AKF, and shows evidences that the Brazilian crotalic antivenom should be improved to treat rattlesnake envenomations caused by C. d. ruruima venom in Roraima state.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview

Medeiros

Oliveira

Ferreira

et al. 2020

Reports

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“…The systemic effects of C. durissus venom are stronger than its local effects, and are mainly characterized by neurotoxicity, systemic myotoxicity, and respiratory and acute renal failure [24][25][26]. Respiratory failure only occurs in severe cases of envenomation by rattlesnake bite [27][28][29][30][31]. As the major venom component, CTX plays a significant role on Crotalus accidents, including neuromuscular blockade and systemic myotoxicity as the main toxicological effects, associated with other alterations.…”

Section: Discussionmentioning

confidence: 99%

“…The late phase lung injuries were characterized by inflammatory alterations that peaked 12 h after CTX administration, including neutrophil infiltrate composed of Ly6G + cells, associated with increased levels of myeloperoxidase activity, an indirect indicator of tissue neutrophil content [58], total proteins, and the pro-inflammatory cytokines/chemokines IL-6, TNF-α, IL-1β, and CXCL-1. High CTX doses promote local and systemic pro-inflammatory effects, such as paw edema, local and systemic muscle necrosis with neutrophil infiltration, and blood neutrophilia associated with increased serum levels of IL-6 and IL-10 [31,[59][60][61]. Although CTX induced an inflammatory pattern with increased leukocyte infiltration and production of pro-inflammatory cytokines and lipid mediators, its intensity was not as strong as that found in infectious disease [62] and was restricted to parenchyma; these findings unveil a new pathophysiologic scenario in the experimental model studied herein.…”

Section: Discussionmentioning

confidence: 99%

Crotoxin-Induced Mice Lung Impairment: Role of Nicotinic Acetylcholine Receptors and COX-Derived Prostanoids

et al. 2020

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Respiratory compromise in Crotalus durissus terrificus (C.d.t.) snakebite is an important pathological condition. Considering that crotoxin (CTX), a phospholipase A2 from C.d.t. venom, is the main component of the venom, the present work investigated the toxin effects on respiratory failure. Lung mechanics, morphology and soluble markers were evaluated from Swiss male mice, and mechanism determined using drugs/inhibitors of eicosanoids biosynthesis pathway and autonomic nervous system. Acute respiratory failure was observed, with an early phase (within 2 h) characterized by enhanced presence of eicosanoids, including prostaglandin E2, that accounted for the increased vascular permeability in the lung. The alterations of early phase were inhibited by indomethacin. The late phase (peaked 12 h) was marked by neutrophil infiltration, presence of pro-inflammatory cytokines/chemokines, and morphological alterations characterized by alveolar septal thickening and bronchoconstriction. In addition, lung mechanical function was impaired, with decreased lung compliance and inspiratory capacity. Hexamethonium, a nicotinic acetylcholine receptor antagonist, hampered late phase damages indicating that CTX-induced lung impairment could be associated with cholinergic transmission. The findings reported herein highlight the impact of CTX on respiratory compromise, and introduce the use of nicotinic blockers and prostanoids biosynthesis inhibitors as possible symptomatic therapy to Crotalus durissus terrificus snakebite.

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“…C. durissus terrificus venoms from newly captured snakes and already-captured animals (kept in captivity) from the Botucatu region (SP, Brazil) were characterized comparatively and the results demonstrated high variability in the concentrations and decreased toxic activity in animals (LD 50 ) during the captivity period; however, the chromatographic profiles did not present variation of venom proteins when considering the captivity time [54]. Baum et al [55] reported a case of envenomation to a professional herpetologist in the United States by a captive-born specimen of C. durissus terrificus of Paraguay lineage and resulted in respiratory failure and therapeutic improvement following antivenom administration. Laboratory parameters all remained within normal limits from the time of hospital admission through the time of discharge, except for CK and the patient did not experience any coagulopathy during the hospital course of stay.…”

Section: Clinical and Laboratory Aspectsmentioning

confidence: 99%

Clinical, Laboratory, and Therapeutic Aspects of Crotalus durissus (South American Rattlesnake) Victims: A Literature Review

Frare

Resende

Dornelas

et al. 2019

BioMed Research International

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Snakebite envenoming is a neglected public health issue in many tropical and subtropical countries. To diagnosis and treat snakebites may be challenging to health care personnel since sufficient information has not been yet provided. This review presents the clinical, therapeutic, and laboratory aspects of Crotalus durissus (South American rattlesnakes) victims. The clinical setting may show local effects such as little or no pain, mild edema, and recurrent erythema. In contrast, the systemic effects may be quite remarkable, such as changes due to neurological damage, intense rhabdomyolysis, incoagulability of the blood, and variations in the peripheral blood elements. The main complication is acute kidney injury. The appropriate treatment depends mainly on the correct recognition of the aggressor snake and the symptoms expressed by the victim. Rattlesnake venom can cause irreparable damage and lead to death. Therefore, a prompt diagnosis allows the immediate onset of proper serotherapy.

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Crotalus durissus terrificus (viperidae; crotalinae) envenomation: Respiratory failure and treatment with antivipmyn TRI® antivenom

Cited by 13 publications

References 27 publications

Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview

Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview

Crotoxin-Induced Mice Lung Impairment: Role of Nicotinic Acetylcholine Receptors and COX-Derived Prostanoids

Clinical, Laboratory, and Therapeutic Aspects of Crotalus durissus (South American Rattlesnake) Victims: A Literature Review

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