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PubMedDate not supplied

[Inefficacy of bothropic antivenin in the neutralization of the coagulation activity of Lachesis muta muta venom. Report of a case and experimental confirmation].

In the State of Amazonas and in areas nearby Manaus, the snakes responsible for the majority of accidents are Bothrops atrox and Lachesis muta muta, with a percentage of confirmed species of 76% and 17%, respectively. Frequently, in the absence of the laquetic and bothropic-laquetic antivenoms, the Instituto de Medicina Tropical de Manaus (IMTM) has been using bothropic antivenom in the treatment of laquetic accident. In this paper is related a case of accident caused by L. muta muta; the patient was treated with bothropic antivenom, and after received twenty ampoules of this antivenom, maintained blood incoagulability until the 13th day after the accident. Experiments to obtain the potency of the bothropic antivenom for the coagulant and hemorrhagic activities has been done, using Bothrops atrox venom as control. The results showed that the potency of the antivenom for the hemorrhagic activity was similar, and the potency for the coagulant activity for the L. m. muta venom was 9.2 times minor than that for B. atrox. The antibodies titles from three different lots of bothropic antivenom varied for the L. m. muta venom, and were constant for the B. atrox venom. Due to the inefficiency of the bothropic antivenom on the neutralization of the coagulant activity for the L. m. muta venom, the use of bothropic antivenom is not recommended in the treatment of Lachesis muta muta accidents.

Adult↗
PubMedDate not supplied

[Effect of reduction in the Bothrops antivenin dose administrated in patients bitten by the Bothrops snake].

Seven hundred and thirty accidents by Bothrops snake bite attended at Hospital Vital Brazil-Instituto Butantan (HVB-IB) were studied: 411 of in 1983/84 (group A) and 319 in 1986 (group B). All the patients were seen in the Hospital 6 hours after the bite. As an average, all the 411 patients of the group A and the 319 patients of the group B received antivenom capable of neutralizing 215 mg and 117 mg of Bothrops jararaca, respectively. Both groups were similar concerning to: sex and age of the patients; anatomic region bitten; frequency of incision and tourniquet use at the site bite; time in between of the accident and the admission at HVB-IB; classification of B. jararaca either young or adult; frequency of the coagulation impairment. There was no difference in the evolution of the local envenoming manifestations and there were no cases of death.

Adolescent↗
PubMedDate not supplied

[Evaluation in mice of the efficacy of antivenins administered at the site of the intramuscular inoculation of the Crotalus durissus terrificus venom].

The efficacy of the Crotalus durissus terrificus antivenom administration by intramuscular (im) injection at the same place of the im inoculation, of the C. d. terrificus venom was evaluated in mice. In three experiments two DL50 of the venom were inoculated and the antivenom was administered in three different ways: half of the ED50 by intraperitoneal (ip) administration and half by injection, at the same place, immediately after the venom inoculation and thirty minutes after the im venom inoculation; four fifth of ED50 by ip administration and one fifth by injection, at the same place and thirty minutes after the venom inoculation. The antivenom that was administered by intraperitoneal route provided a higher protection to mice (a lower death rate in a 48 hours period) than when it was administered in parts, by intramuscular injection, at the same place of the venom inoculation (p < 0.05). Therefore, it is concluded that this should not be used in human beings bitten by snakes.

Animals↗
PubMed1997

[Genetic origin of venom variability: impact on the preparation of antivenin serums].

One of the main possible origin of the biochemical variations of venoms could be genetic. We studied the venom of members of litters born in a snake farm (12 Crotalus atrox and 21 Naja haje). We first used the electrophoresis in cellulose acetate (AE). Then, variations were confirmed by immunoelectrophoresis (AIE) using an antivenom (IPSER Africa, Pasteur Mérieux Sérums & Vaccines) and immunsera prepared on rabbit from i) venom presenting the maximum of bands in electrophoresis (complete venom) and ii) pure toxins (neurotoxin-alpha and cardiotoxin-gamma). At last, the toxicity of some samples was measured and the ability of SAV to neutralise the corresponding sample was measured. The AE of C. atrox venoms showed a good homogeneity, probably due to a good genetic stability of the investigated group. On the other hand, N. haje venoms have revealed a great heterogeneity. The 13 samples were allocated to five groups according to the absence of some fractions compared to the complete venom. The AIE showed that the neurotoxin-alpha is present in every sample, but variable in quantity, even when it did not appear on AE. We suggest that these pattern variations are due either to relative variations of protein fractions in samples or to modifications of the chemical composition of the neurotoxin-alpha. However, the variation of toxicity between the different samples questioned the neutralisation ability of antivenoms. We propose that venom sample choice for SAV production should be based on biochemical criteria and toxicity of samples rather than random pooling.

Animals↗
PubMed1997

[Drug or plant substances which antagonize venoms or potentiate antivenins].

Dendroaspis jamesoni (Elapidae) and Echis oceliatus (Viperidae) are responsible for most of severe evenomation in Cameroon. Toxicity of venoms of these two species has been measured using mice according to the method of Spearman & Kàrber. The effect on experimental envenomation of various drugs (atropine, promethazine, neostigmine, hydrocortisone, pentosane sulfuric polyester, heparin, tranexamic acid and aminocaproic acid) and plant extracts (Schumanniophyton magnificum, Bidens pilosa, Securidaca longepedunculata and Garcinia lucida) has been observed associated or not with the antivenom lpser Afrique (SAV). The venom of D. jamesoni contains neurotoxins agonizing and antagonising acetylcholine. The toxicity of the venom did not depend on the route of injection. Atropine, promethazine, neostigmine and hydrocortisone protected animals against a venom dose up to 2 LD50. Moreover, atropine and promethazine potentiated the SAV. Similar results have been obtained with extracts from S. magnificum and B. pilosa. The venom of E. ocellatus induces haemorrhage and necrosis. The toxicity increased by 3-fold when the venom was injected through intravenous or intraperitoneal route, compared to intramuscular route. Pentosane sulfuric polyester and tranexamic acid protected mice against doses up to 3 LD50. Pentosane sulfuric polyester, hydrocortisone, heparin and aminocaproic acid increased the SAV protective titre by 50%. However, tried plant extracts weakly antagonised the venom and did not potentiate the SAV.

Aminocaproates↗
PubMed1998

Preliminary evaluation of Vipera palaestinae snake bite treatment in accordance to the severity of the clinical syndrome.

The intravenous administration of a 60 ml dose of Vipera palaestinae antivenin was the suggested standard treatment of every bitten patient. In this study 85 Vipera palaestinae bitten patients where selectively treated with antivenin depending on the severity of the clinical picture. Patients who developed systemic or severe local signs received 20 ml of antivenin over 30 min. If symptoms were still present, an additional 10 ml of antivenin was given until systemic signs subsided. Repeated doses of 10 ml of antivenin was administered in each case of systemic symptom relapse. 49% of patients did not exhibit any systemic symptoms and did not receive antivenin treatment. In 63% of antivenin treated cases symptoms were aborted by a single dose of 20 ml of antivenin. 23% of the antivenin treated patients needed 30-40 ml, 19 needed 50-60 ml and only 1 patient (2%) received 80 ml of drug. Serum sickness complications were found in 44% of antivenin treated patients. The results of this study show that antivenin treatment based on systemic symptoms is effective, required less antivenin than the treatment with fixed dose for each patient and reduces the incidence of serum sickness.

Adolescent↗
PubMed1992

Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases.

STUDY OBJECTIVE: To review cases of black widow spider envenomation to describe the clinical presentation and evaluate the efficacy of treatment. DESIGN: Retrospective chart review. SETTING: An urban toxicology referral center. TYPE OF PARTICIPANTS: All patients attended by the toxicology service and discharged from our hospital between January 1982 and December 1990 with a diagnosis of black widow spider envenomation. INTERVENTIONS: Inclusion criteria were either a positive black widow spider identification or a visible envenomation site ("target lesion"). Depending on the clinical presentation, patients were categorized as grade 1, 2, or 3 in severity. The efficacy and side effects of treatment alternative were evaluated. MEASUREMENTS AND MAIN RESULTS: One hundred sixty-three patients met the inclusion criteria. The most common sites of envenomation were the upper and lower extremities. The most common presenting complaint was generalized abdominal, back, and leg pain. One hundred eighteen patients initially presented to our institution, and 45 were transfers. Pain relief of grade 2 and 3 envenomations was achieved most effectively with either black widow spider-specific antivenin alone or a combination of IV opioids and muscle relaxants. Fifty-eight patients received antivenin with complete resolution of symptoms in a mean time of 31 +/- 26.7 minutes. Of the 118 patients initially seen at our institution, the mean total duration of symptoms was 9 +/- 22.7 hours in patients receiving antivenin and 22 +/- 24.9 hours in patients not receiving antivenin. Fifty-two percent of patients not receiving antivenin required hospitalization, whereas only 12% of those receiving antivenin were admitted. One patient died of severe bronchospasm after receiving antivenin. Calcium gluconate was not effective in providing symptomatic relief in this series, with 96% of the grade 2 and 3 envenomations treated initially with calcium gluconate requiring the addition of IV opioids or other analgesics for symptomatic relief. Fifty-five percent of patients initially receiving IV morphine and 70% of those initially receiving both IV morphine and benzodiazepines obtained symptomatic relief without additional medication. CONCLUSION: One hundred sixty-three envenomations by black widow spiders were reviewed and graded according to severity with treatment modalities evaluated. Although calcium gluconate usually has been considered the first-line treatment of severe envenomations by black widow spiders, we found it ineffective for pain relief compared with a combination of IV opioids and benzodiazepines. The use of antivenin significantly shortened the duration of symptoms in severe envenomations.

Adolescent↗
PubMed1999

Efficacy of serotherapy in scorpion sting: a matched-pair study.

BACKGROUND/OBJECTIVE: Although evidence of scorpion antivenin effectiveness in the clinical setting is lacking, scorpion antivenin is generally considered the only specific treatment for scorpion sting irrespective of its clinical severity. We conducted a matched-pair study to assess the efficacy of systematic administration of scorpion antivenin. METHODS: Among 600 stung patients who participated in a study on the efficacy of high-dose hydrocortisone after scorpion sting, 135 (cases) had been treated with 10 to 20 mL intravenous scorpion antivenin (neutralizing 10 LD50 venom/mL). Controls were matched on disease severity on arrival to the emergency department. The severity of envenomation was graded I or II according to the absence (grade I) or the presence (grade II) of systemic manifestations of scorpion envenomation. Assessment of scorpion antivenin efficacy was based on the rate of changing severity grade in both groups (clinical improvement or worsening during an observation period of at least 4 hours). RESULTS: Both groups were similar with respect to clinical severity (36 patients were graded II in each group), age, sex, time-lapse between scorpion sting and ED arrival, and the administration of adjunctive therapy such as hydrocortisone. By the 4-hour evaluation, 50% and 64% of patients initially graded II exhibited a substantial clinical improvement in cases and controls, respectively, suggesting similar effects in cases and controls. There was no difference in preventive effects: 13% and 10% of cases and controls developed systemic manifestations of scorpion envenomation during the 4-hour observation period; 23% of cases and 17% controls were hospitalized by this time. There was no difference in the duration of hospitalization. Three cases developed anaphylactic shock as a consequence of scorpion antivenin administration, while 1 scorpion antivenin-untreated patient died from refractory shock. CONCLUSION: Systematic administration of scorpion antivenin irrespective of clinical severity did not alter the clinical course of scorpion sting. A prospective study is needed concerning the response of the more severe scorpion envenomations.

Adolescent↗
PubMed1985

[Poisoning by domestic vipers (Vipera berus and Vipera aspis). A retrospective study of 113 patients].

In a retrospective study, 113 bites which occurred in Switzerland within a 16-year period by either of the two indigenous adders (Vipera berus and Vipera aspis) were analyzed. 13 patients showed no signs of envenomation. Out of the other 100, 62 patients had merely minor (local edema only) and 24 moderate envenomation (vomiting, diarrhea, cramps, hypotension), while 24 had severe envenomation (shock and angioneurotic edema of the tongue and lips). No fatalities were recorded. In residents of the endemic area the bites occurred accidentally in 86% of the cases, while tourists were bitten after manipulating the snake in 42%. Specific antivenin was given to 49 of 95 hospitalized patients. In cases of severe envenomation (n = 14) a reduction of the median duration of hospitalization from 10 days in patients without antivenin therapy (n = 4) to 5 days in patients with antivenin therapy (n = 10) was obtained. In cases of moderate (n = 21) or minor envenomation (n = 49), antivenin therapy did not influence the hospital stay of 4 and 2 days respectively. In the 11 patients with bites not followed by envenomation the antivenin treatment increased the duration of hospitalization from 1 day (in 6 patients without antivenin) to 2 days (in 5 patients with antivenin). Side effects of the antivenin treatment, such as urticaria, angioneurotic edema, respiratory distress, fever and lymphadenopathy were noted in 4 out of 49 patients.

Adolescent↗
PubMed1997

Widow spider envenomation (latrodectism): a worldwide problem.

The objective of this study was to review widow spider envenomation on a worldwide basis, with an emphasis on regional variability in management, particularly between the United States and Australia. Data sources were the Medline database (1966-1997) for English language references using as key words widow spider, latrodectism, and red back spider, and Mesh headings. Textbooks of toxinology were also used. Studies involving clinical reports and series were selected. The data indicated that envenomation by widow spiders (latrodectism) is common worldwide. Local pain and sweating predominate, in about 25% of cases becoming generalized or developing in remote sites. The mortality in published series varies from 5% to 10%, although these may be overestimates. Australia may have the highest rate of latrodectism in the world. The literature reveals regional disparities in the treatment and outcome of latrodectism. In Australia, intramuscular antivenin has been used liberally for more than 40 years with a very low rate (0.5% to 0.8%) of allergic reactions and no deaths recorded since its introduction. Antivenin is routinely successful in relieving the effects of latrodectism. In the United States, the antivenin is given intravenously, is usually reserved for very severe cases, and the rate of allergic reaction is high (from 9% up to 80% in those skin testing positive). Deaths have been recorded after antivenin. The literature suggests that antivenin to one species of Latrodectus is likely to be effective against other species. The conclusion drawn was that latrodectism is a common envenomation worldwide. There is a strong case for a comparative trial of Australian vs US antivenin in treating latrodectism due to the black widow spider in the United States.

Animals↗
PubMed1993

Crotalidae envenomation in children.

Poisonous snakebites cause a severe envenomation syndrome in children, yet treatment remains controversial. Sixty-seven patients were treated for poisonous snakebites at our institution between 1975 and 1990; 18 were children < or = 12 years old. There were 13 rattlesnake bites, 4 copperhead bites, and 1 unidentified bite. Initial management included intravenous fluids and antibiotic administration, laboratory studies, tetanus prophylaxis, affected limb elevation, and a limited excision of the bite site in the emergency room. Antivenin was administered only if signs of systemic involvement such as shock, coagulopathy, gastrointestinal cramping, or neurological involvement were present. Children developed systemic involvement 72% of the time, 9 children (50%) developed coagulopathy. Consequently, 11 (61%) children received antivenin. The dose of antivenin they received was 3.2 ml/kg and the children tolerated it well with only 36% of them demonstrating adverse reactions to the antivenin. Clinically, the pediatric patients demonstrated signs and symptoms of a fulminant envenomation syndrome (8 days, average hospital stay), yet, they had a good eventual outcome. Only 11% of children reported long-term morbidity. No deaths occurred and 100% of patients were able to return to full preinjury activities. We conclude that Crotalidae envenomation in children is a serious disease and warrants hospitalization, early surgical involvement, and frequent use of antivenin.

Animals↗
PubMed1991

Treatment of snakebite poisoning.

The epidemiology, mechanics, prevention, pharmacology, clinical manifestations, and treatment of snakebites are reviewed. Poisonous snakes bite approximately 8000 persons annually in the United States, causing approximately 12-15 deaths per year. Pit vipers (rattlesnakes, copperheads, cottonmouths, and massasaugas) are responsible for 99% of all snakebite poisonings; coral snakes and other foreign exotic species are responsible for the additional 1%. Envenomation is characterized by pain, edema, and ecchymoses at or near the site of venom injection, followed by cardiac, hematologic, neurologic, renal, and pulmonary toxicity. The major clinical finding in most snakebite poisonings is local tissue necrosis. Immediate treatment for snakebite includes limiting movement and placing a constriction band proximal to the site of venom injection. If medical care is more than 30 minutes away, the wound may be incised and suctioned. Antivenin therapy is the mainstay of medical treatment of snakebite, along with administration of plasma expanders, pain medication, diazepam, tetanus toxoid, antiseptics, and antibiotics. Patients who have pain, swelling, ecchymoses, systemic symptoms, or abnormal laboratory findings within 30 minutes to one hour of a bite are probable candidates to receive antivenin therapy. Before receiving antivenin therapy, the patient must be tested for hypersensitivity to the antivenin. Antivenin therapy is most effective when given within four hours of the snakebite. Pharmacists--especially those serving rural areas--should be familiar with current snakebite treatments, both local and systemic, and should be prepared to provide important information and dispel any myths about snakebite poisoning.

Animals↗