Detection of venom after antivenom administration is largely due to bound venom

O’Leary, Margaret A.; Maduwage, Kalana

doi:10.1016/j.toxicon.2014.11.221

Cited by 13 publications

(13 citation statements)

References 19 publications

(27 reference statements)

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“…When the venom molecules are partially covered by the antivenom, probably at small doses of antivenom, partially bound venom can still bind to the ELISA plate and express as positive venom. Series of different immunological experiments confirmed this venom recurrence phenomenon as detection of partially bound venom in ELISA 42 . This partially bound venom in not biologically active: its active epitopes are blocked by the antivenom, which is why the recurrence of venom is not associated with the worsening of coaguopathy.…”

Section: Indian Antivenom Used In Sri Lankan Snake Envenomingsupporting

confidence: 55%

Snakebite coagulopathy: controversies in understanding and management

Maduwage

2018

SL J. Med.

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Section: Indian Antivenom Used In Sri Lankan Snake Envenomingsupporting

confidence: 55%

Snakebite coagulopathy: controversies in understanding and management

Maduwage

2018

SL J. Med.

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“…We have previously shown that venom, if detected in a post-antivenom sample, is largely in bound form, as venom-antivenom complexes [ 9 ]. However, for none of the patients in series 1 was venom detectable in untreated post-antivenom samples.…”

Section: Discussionmentioning

confidence: 99%

“…These venom antigens are then detected by labelled anti-snake antibodies, a technique referred to as a sandwich EIA [ 5 , 7 ]. A recent study has shown that this venom specific EIA can also detect venom which is bound to antivenom [ 8 , 9 ]. However, this does not occur if there is excess antivenom present, which is usually the case after the administration of therapeutic antivenom.…”

Section: Introductionmentioning

confidence: 99%

Detection of Snake Venom in Post-Antivenom Samples by Dissociation Treatment Followed by Enzyme Immunoassay

Maduwage

O’Leary

Silva

2016

Toxins

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Venom detection is crucial for confirmation of envenomation and snake type in snake-bite patients. Enzyme immunoassay (EIA) is used to detect venom, but antivenom in samples prevents venom detection. We aimed to detect snake venom in post-antivenom samples after dissociating venom-antivenom complexes with glycine-HCl (pH 2.2) and heating for 30 min at 950 °C. Serum samples underwent dissociation treatment and then Russell’s viper venom or Australian elapid venom measured by EIA. In confirmed Russell’s viper bites with venom detected pre-antivenom (positive controls), no venom was detected in untreated post-antivenom samples, but was after dissociation treatment. In 104 non-envenomed patients (negative controls), no venom was detected after dissociation treatment. In suspected Russell’s viper bites, ten patients with no pre-antivenom samples had venom detected in post-antivenom samples after dissociation treatment. In 20 patients with no venom detected pre-antivenom, 13 had venom detected post-antivenom after dissociation treatment. In another 85 suspected Russell’s viper bites with no venom detected pre-antivenom, 50 had venom detected after dissociation treatment. Dissociation treatment was also successful for Australian snake envenomation including taipan, mulga, tiger snake and brown snake. Snake venom can be detected by EIA in post-antivenom samples after dissociation treatment allowing confirmation of diagnosis of envenomation post-antivenom.

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“…A study describing 11 years (2005–2015) of snakebite data concluded that one vial of antivenom was sufficient to effectively treat envenoming by all taxa of Australian elapids. These antivenom dosage recommendations were based on enzyme‐linked immunosorbent assay (ELISA) of serially tested clinical samples (eg, blood from envenomed patients) or samples from rodents injected with venom, presumably in order to quantify circulating venom and venom bound with antibody . It is arguable that this method inaccurately determines a true neutralising dose in humans, because:…”

Section: Determining a Reasonable Dosementioning

confidence: 99%

“…The assessment of the first case by clinical toxinologists found that two vials as an initial dose was definitely justified . It is arguable whether additional antivenom would have had therapeutic benefit for this patient, but providing it earlier is highly desirable because this could conceivably neutralise sequestered venom as it is absorbed from the bite site and may therefore bind circulating venom toxins as they enter the vascular system . However, a single vial of antivenom would clearly be insufficient for patients with envenoming similar to these examples.…”

Section: Recent Coronial Findingsmentioning

confidence: 99%