The clinical significance of venom detection in patients of cobra snakebite

Hung, Dong-Zong; Liau, Ming-Yi; Lin‐Shiau, Shoei‐Yn

doi:10.1016/s0041-0101(02)00336-7

Cited by 70 publications

(69 citation statements)

References 14 publications

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“…Based on this retrospective review, patients bitten by snakes of the family Elapidae (neurotoxic venom) required higher antivenom doses and had greater chances for complications, even after antivenom therapy. We found similar epidemiological patterns in previous studies including male predominance (86%), bites on distal extremities of the body (98%) and a large incidence of attacks occurring near the individual residence (57%) (3,4,(7)(8)(9). Correct antivenom administration remains the mainstay of therapy, with a suggested elapsed time from the moment of the bite to the antivenom administration of six to eight hours (10).…”

Section: Discussionsupporting

confidence: 89%

Appropriate antivenom doses for six types of envenomations caused by snakes in taiwan

Chieh-Fan¹,

Tzeng-Jih²,

Wen-Chi³

et al. 2009

J. Venom. Anim. Toxins incl. Trop. Dis

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ABSTRACT:Six of the 15 species of venomous snakes found in Taiwan are responsible for most of the clinically significant envenomations in the country. These species are: Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Naja atra, Bungarus multicinctus, Deinagkistrodon acutus and Daboia russelii siamensis, which together can be subdivided into three groups based on their venom effects. Primary treatment consists of rapid administration of appropriate antivenoms. The present study aimed to identify a proper dose of antivenom for each snake group as well as to describe hemorrhagic, neurotoxic, and mixed effects of their venoms. A retrospective chart review identified 72 snakebite cases referred to an emergency department. Data on epidemiology, examination findings, snake identification, treatment, antivenom dose and complications were collected. After excluding 14 patients, data from 58 victims were analyzed. Most studied cases were male (86%). Significantly higher doses of antivenom were administered against neurotoxic envenomations (mean dose: three vials) compared with the other two (p < 0.05). Moreover, patients affected by neurotoxic bites were more likely to develop blurred vision and other complications (p < 0.05). Multivariate logistic regression analysis indicated that neurotoxic envenomation was a risk factor for complications (OR: 8.84,. Neurotoxic envenomations and complication occurrence were positively correlated with antivenom dosage. In conclusion, patients affected by neurotoxic envenomations received higher doses of antivenom than others whereas incidence of complications was associated with higher antivenom doses.

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Section: Discussionsupporting

confidence: 89%

Appropriate antivenom doses for six types of envenomations caused by snakes in taiwan

Chieh-Fan¹,

Tzeng-Jih²,

Wen-Chi³

et al. 2009

J. Venom. Anim. Toxins incl. Trop. Dis

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“…14 A study using an enzyme-linked immunosorbent assay to detect the amount of N atra venom revealed that two to eight vials of antivenin are sufficient to eliminate systemic circulating venom if presentation is early. 6 The efficacy of systemically administrated antivenin to diminish local tissue destruction is still controversial, however, and needs further study. 3 In an animal study, the cytotoxic venom of N atra was shown to bind with high affinity to tissues leading to high levels of local tissue destruction.…”

Section: Discussionmentioning

confidence: 99%

“…5 In contrast, N atra envenomation is associated with more cytotoxic effects. 3,6,7 Although an equine-derived bivalent F(ab)2 antivenin has been produced by the Centers for Disease Control, ROC (Taiwan) to neutralise the venom of N atra, the surgical intervention rate remains high. 1,8 The main objective of this study was to investigate the clinical presentations and predictors for surgery in patients with N atra envenomation.…”

Section: Introductionmentioning

confidence: 99%

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Wang

et al. 2016

Hong Kong Med J

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Objectives:To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation.Methods: This case series was conducted in the only tertiary care centre in eastern Taiwan. Patients who presented to the emergency department with Naja atra bite between January 2008 and September 2014 were included. Clinical information was collected and compared between surgical and non-surgical patients.Results: A total of 28 patients with Naja atra envenomation presented to the emergency department during the study period. Of these, 60.7% (n=17) required surgery. Necrotising fasciitis (76.5%) was the main finding in surgery. Comparisons between surgical and non-surgical patients showed skin ecchymosis (odds ratio=34.36; 95% confidence interval, 2.20-536.08; P=0.012) and a high total dose of antivenin (≥6 vials; odds ratio=14.59; 95% confidence interval, 1.10-192.72; P=0.042) to be the most significant predictors of surgery. The rate of bacterial isolation from the surgical wound was 88.2%. Morganella morganii (76.5%), Enterococcus faecalis (58.8%), and Bacteroides fragilis (29.4%) were the most common pathogens involved. Bacterial susceptibility testing indicated that combined broadspectrum antibiotics were needed to cover mixed aerobic and anaerobic bacterial infection.

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“…A definite diagnosis was made by the identification of the culprit snake, which included the examination of the snake, identification of the snake by the patient through a picture, or laboratory testing of the venom by the treating physician. [12][13][14] Patients with typical manifestations, as determined through physical examination, serial wound inspection, a relevant history, and clinical improvement after receiving specific antivenom for N. atra were included in the "clinical case" group (Table 1). 2,3,15 After a careful review of the medical records, patients with snakebites other than those of N. atra (e.g., patients with snakebites of the other five medically important snakes [T. stejnegeri, P. mucrosquamatus, D. acutus, D. siamensis, and B. multicinctus] and less toxic or nonvenomous snakes) and patients with equivocal manifestations and a negative identification of culprit snake were excluded.…”

Section: Methodsmentioning

confidence: 99%

Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy

Mao¹,

Liu²,

Hung³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. A total of 112 cases of Naja atra envenomation were examined at two referring hospitals: Taichung Veterans General Hospital in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan. Overall, 77% (86/112) of cases developed clinically suspected wound infections and 54% (61/112) required surgery secondary to tissue necrosis, finger or toe gangrene, and/or necrotizing fasciitis. Morganella morganii was the most abundant gramnegative bacterial strain isolated from bite wounds, followed by Proteus spp., Aeromonas hydrophila, Pseudomonas aeruginosa, and Providencia spp. in descending order; Enterococcus spp. were the most common gram-positive bacteria and Bacteroides spp. were the only anaerobic bacteria. A few episodes of bacteremia were caused by Bacteroides and Shewanella spp. There were no significant variations in the distribution of bacterial species between these two hospitals except for a higher incidence of M. morganii, Enterococcus spp., and polymicrobial infection observed at VGH-TP, which may have been related to variations in the fecal flora of prey and oral flora of individual snakes in different geographic areas in Taiwan. According to the susceptibility test involving various pathogens, first-line drug options for the management of N. atra snakebite wound infections may include monotherapy with ureidopenicillin or combination therapy with aminopenicillin and a third-generation cephalosporin or fluoroquinolone. A prospective evaluation of empiric antibiotic therapy for the management of N. atra snakebite should be considered.

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The clinical significance of venom detection in patients of cobra snakebite

Cited by 70 publications

References 14 publications

Appropriate antivenom doses for six types of envenomations caused by snakes in taiwan

Appropriate antivenom doses for six types of envenomations caused by snakes in taiwan

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy

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