Snakebite Envenoming Diagnosis and Diagnostics

Abstract

Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually. The diagnosis of snakebite envenoming is commonly based on a combination of patient history and a syndromic approach. However, the availability of auxiliary diagnostic tests at the disposal of the clinicians vary from country to country, and the level of experience within snakebite diagnosis and intervention may be quite different for clinicians from different hospitals. As such, achieving timely diagnosis, and thus treatment, is a challenge faced by treating personnel around the globe. For years, much effort has gone into developing novel diagnostics to support diagnosis of snakebite victims, especially in rural areas of the tropics. Gaining access to affordable and rapid diagnostics could potentially facilitate more favorable patient outcomes due to early and appropriate treatment. This review aims to highlight regional differences in epidemiology and clinical snakebite management on a global scale, including an overview of the past and ongoing research efforts within snakebite diagnostics. Finally, the review is rounded off with a discussion on design considerations and potential benefits of novel snakebite diagnostics.

Access to antivenoms in the developing world: A multidisciplinary analysis

“…A wider range of innovations to traditional antivenoms are now being developed, including new adjuvants, improved immunizing mixtures, quality control tools and assays, and the use of toxicovenomic technology-aided antivenom design, alongside new generation SBE treatments based on small molecules or cocktails of neutralizing antibody cocktails ( Gutiérrez et al, 2017 ). Likewise, the availability of new rapid tests to identify the offending snake species may have an impact on antivenom designs in the future ( Knudsen et al, 2021 ). The novel antivenoms that arise from these innovations will likely have very different characteristics in terms of geographic coverage, administration routes and costs, compared to conventional antivenoms.…”

A Strategy for Efficient Preparation of Genus-Specific Diagnostic Antibodies for Snakebites

“…To date, most diagnostic antibodies exhibit poor specificity (12)(13)(14)(15), thus hindering the correct selection and dosage of antiserum. We showed here that the principles of venom similarities and the underlying cross-reactivities of the same genus could be applied to develop universal genus-specific diagnosis tools for snakebite (11). A strategy was developed to effectively choose and prepare genus-specific snake venom antibodies that meet the requirement of a rapid and efficient clinical diagnosis of snakebite.…”

Clinical management of snakebite envenoming: Future perspectives

“…Early treatment of SBE has been linked to improved patient outcome, faster recovery, and decreased resource consumption at treatment facilities ( Johnston et al, 2017 ; Anderson et al, 2018 ; Alfred et al, 2019 ; Pinho et al, 2005 ; Mise et al, 2018 ). Therefore, researchers have long been developing supportive tools for the diagnosis of SBE, especially for differentiation of snake venoms ( Knudsen et al, 2021 ). Supportive diagnostic tools could potentially bring about multiple benefits, perhaps the foremost of which is facilitation of early and correct treatment, including selection of the most appropriate antivenom.…”

“…Similar conclusions were obtained in Sri Lanka, although this country has polyvalent antivenoms available ( Ariaratnam et al, 2009 ). Syndromic diagnostic algorithms have also been used in Australia ( Isbister et al, 2013 ; Knudsen et al, 2021 ) and in sub-Saharan Africa by Médecins Sans Frontières (MSF). A large number of studies have been published on the development of diagnostic methods for the detection of venom components in different biological samples, notably using enzymatic immunoassays ( Knudsen et al, 2021 ).…”

“…Syndromic diagnostic algorithms have also been used in Australia ( Isbister et al, 2013 ; Knudsen et al, 2021 ) and in sub-Saharan Africa by Médecins Sans Frontières (MSF). A large number of studies have been published on the development of diagnostic methods for the detection of venom components in different biological samples, notably using enzymatic immunoassays ( Knudsen et al, 2021 ). Yet these are rarely used in both research and clinical practice, with the sole exception of Australia ( Isbister et al, 2013 ).…”