Reply to comment on: Failure of a new antivenom to treat Echis ocellatus snake bite in rural Ghana: the importance of quality surveillance

Visser, L.E.; Kyei-Faried, S.; Belcher, Donald W.; Geelhoed, Diederike; Leeuwen, Jules Schagen van; Roosmalen, Jos van

doi:10.1016/j.trstmh.2009.06.001

Cited by 2 publications

(1 citation statement)

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“…AV-C is produced using venom from the Indian saw-scaled viper ( Echis carinatus ) and marketed as an African antivenom despite a demonstrated lack of efficacy against African Echis species in both clinical and preclinical studies. 18,19 In 2008 a rural hospital in Ghana reported a 6-fold increase in mortality after switching from high-quality FAV-Afrique (FAV-A; Aventis Pasteur, Lyon, France) to the less expensive AV-C. 20 Any difference in cost was negated by the large amount of AV-C required during the study to compensate for its lower efficacy. More than half (56%) of all patients treated with AV-C required additional doses of antivenom compared to less than one quarter (22%) of those treated with FAV-A.…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Two Patients with Intracranial Hemorrhage due to Carpet Viper (Echis ocellatus) Envenomation in a Limited-Resource Environment

Benjamin

Chippaux

Tamou-Sambo

et al. 2019

Wilderness & Environmental Medicine

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The West African carpet viper (Echis ocellatus) causes more deaths than any other snake in sub-Saharan Africa. Carpet viper envenomations are characterized by a venom-induced consumption coagulopathy and systemic bleeding syndrome, in addition to local symptoms of painful progressive swelling and tissue destruction. The highest mortality rate is seen in the final stages of the syndrome, which typically ends with fatal internal bleeding or hemorrhagic shock. We present 2 cases of E ocellatus envenomation with intracranial hemorrhage seen at a rural hospital in Bemb er ek e, Benin, and describe the successful management of these patients in a limited-resource setting. In one case the patient was treated with an ineffective Indian-made antivenom before evaluation by the authors and continued to deteriorate until she was treated with effective antivenom 10 d after the bite. In both cases lumbar puncture was performed for diagnostic or therapeutic purposes with good effect, and both patients made full recoveries without sequelae. These cases demonstrate the remarkable ability of high-quality antivenoms to reverse life-threatening envenomations even in the final stages of the hemorrhagic syndrome and illustrate the dangers posed by low-quality antivenoms that have flooded the market in the developing world.

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Section: Discussionmentioning

confidence: 99%