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PubMedDate not supplied

Exotic snakebite: envenomation by an African puff adder (Bitis arietans).

We report an envenomation by the African puff adder (Bitis arietans), an exotic snake in the United States. The patient developed swelling and ecchymoses in the affected extremity, and cutaneous necrosis of the envenomated fingertip. There was no significant coagulopathy. He received 20 vials of specific antivenin (Schlangengift-Immunserum Behring Zentralafrika, Behringwerke, Marburg, Germany) and debridement of devitalized finger tissue. The only permanent sequelae were cutaneous scarring and permanent loss of the fingernail on the envenomated finger. Exotic snakebite is a rare presenting problem in emergency departments. The initial approach to a patient envenomated by an exotic venomous snake is discussed. Use of antivenin and supportive care are emphasized.

Adult↗
PubMed2002

Proteins from Mucuna pruriens and enzymes from Echis carinatus venom: characterization and cross-reactions.

Mucuna pruriens seeds have been widely used against snakebite in traditional medicine. The antivenin property of a water extract of seeds was assessed in vivo in mice. The serum of mice treated with extract was tested for its immunological properties. Two proteins of Echis carinatus venom with apparent molecular masses of 25 and 16 kDa were detected by Western blot analysis carried out using IgG of mice immunized with extract or its partially purified protein fractions. By enzymatic in-gel digestion and electrospray ionization-mass spectrometry/mass spectrometry analysis of immunoreactive venom proteins, phospholipase A(2,) the most toxic enzyme of snake venom, was identified. These results demonstrate that the observed antivenin activity has an immune mechanism. Antibodies of mice treated with non-lethal doses of venom reacted against some proteins of M. pruriens extract. Proteins of E. carinatus venom and M. pruriens extract have at least one epitope in common as confirmed by immunodiffusion assay.

Animals↗
PubMed2003

Copperhead envenomations in the Carolinas.

INTRODUCTION: Although the copperhead (Akistrodon contortrix) is responsible for most Crotaline envenomations in the Carolinas, manifestations and treatment are poorly characterized. OBJECTIVE: We sought to describe the clinical course after copperhead bites. METHOD: Structured review of copperhead exposures reported to a regional poison center from 1997-2000. Hospital records were reviewed when available. Phone followup was attempted. RESULTS: A total of 178 cases were identified. Of these 75% were males. The median age was 31 yr (range 2-93). The bite site included hand (52%), foot (36%), leg (7%), and arm (5%). Classification included dry (7%), mild (48%), moderate (39%), and severe (6%). The most common symptom was pain (93%). Local findings included swelling (94%), fang marks (93%), ecchymosis (53%), erythema (37%), bullae (13%), and tissue necrosis (8%). Eleven of 37 patients developed abnormal PT and/or PTT. Two patients bled. Patients were treated at a healthcare facility in 160 cases, with 79 patients admitted. Opioid analgesics were the most common therapy (81%). Equine-derived antivenin was given in 14 cases (range 2-30 vials). Antivenin reactions developed in three. Two patients received blood products. Surgical treatment included debridement (6), grafting (2), digit amputation (1), digit dermotomy (1), and fasciotomy (1). No patients died. In followup, 18 patients reported limb dysfunction ranging from 5-365 days. CONCLUSION: Copperhead bites typically result in mild to moderate envenomation due to local tissue effects. Significant systemic manifestations are rare. Limb dysfunction can be prolonged.

Adolescent↗
PubMed1981

Prolonged defibrination syndrome after green pit viper bite with persisting venom activity in patient's blood.

Venom activity in citrated plasma from a patient with a green pit viper bite was demonstrated by measuring its ability to decrease fibrinogen levels in normal plasma for six days after the bite. By in-vitro study, the minimal amount of crude venom to induce hypofibrinogenemia was 0.5 microgram/ml of normal plasma. The findings explained the continuing defibrination with bleeding and especially the failure of fresh-frozen plasma transfusion to correct hypofibrinogenemia in this patient. The most beneficial therapy should therefore be the neutralization of venom by antivenin, for as long as abnormal coagulation profiles are present, to discontinue the defibrinating process. The preparation of potent antivenin must be encouraged.

Adult↗
PubMed1987

Elapid snake bite.

Four patients were admitted with respiratory muscle paralysis following an elapid snake bite. Two were treated with antivenine, repeated doses of neostigmine and artificial ventilation; the other two with artificial ventilation only. There was no clinically significant difference in recovery. It is suggested that one should avoid the use of antivenine and neostigmine in the management of elapid snake bite once muscle paralysis has become established.

Adolescent↗
PubMed1977

A study of the treatment of pit viper envenomization in 45 patients.

Forty-five patients with snake bite were studied: 33 were classified nontoxic and 12 toxic. There were no deaths and four complications in the nontoxic group; two deaths and three complications in the toxic group. The data suggest that rapid recovery is generally to be expected in nontoxic patients regardless of the form of local therapy. The risk of antivenin complications outweighs the minimal therapeutic benefits when administered to most nontoxic patients. If nausea and vomiting are the only manifestations of systemic toxicity antivenin may not be necessary for rapid and complete recovery. The combination of hypotension and bleeding diathesis represents a particularly severe form of toxicity that may result in death if adequate systemic and supportive therapy is not rapidly instituted.

Antivenins↗
PubMed1980

Venom yield of the North American coral snake and its clinical significance.

The dry venom yields of 14 North American coral snakes were measured and correlated to the length of the individual snake. There exists a positive linear correlation between the length of the snake and the amount of dried venom elaborated. The results of this experiment show that the North American coral snake is capable of injecting far more venom than has been previously reported in the literature. A large coral snake can produce 20 mg of dried venom, which is equal to approximately four or five lethal doses for human adults. At least ten 10 ml vials of specific North American coral snake antivenin (Wyeth) would be required to neutralize this quantity of venom. The largest yield of 28 mg of dried venom was obtained from an 89.5 cm specimen, representing approximately seven lethal doses and requiring at least fourteen 10 ml vials of antivenin for neutralization. Observations on the envenomation characteristics of this snake are described.

Adolescent↗
PubMed1986

Crotalidae envenomation.

We treated 18 patients who had Crotalidae envenomation between January 1980 and September 1984. Primary antivenin therapy minimized morbidity and obviated mortality. More specificially, judicious though quantitatively sufficient antivenin therapy made surgical intervention unnecessary. We review the literature on Crotalidae anatomy, venom toxicology, and the envenomation syndrome.

Adolescent↗
PubMed1999

Neurotoxicity associated with suspected southern Pacific rattlesnake (Crotalus viridis helleri) envenomation.

An 18-year-old man was bitten on the hand by a snake he believed to be a Southern Pacific rattlesnake (Crotalus viridis helleri). Within minutes he developed generalized weakness, difficulty breathing, diplopia, dysphagia, and dysphonia. Neurological examination revealed ptosis and decreased motor strength. These symptoms partially improved after administration of Antivenin (Crotalidae) Polyvalent, but the patient continued to have difficulty walking for several days due to weakness. In addition to neurological symptoms, the patient also experienced pain immediately after the bite occurred and rapid swelling of the entire extremity, which extended beyond the shoulder. He complained of a metallic taste in his mouth and developed intense muscle fasciculations of the face, tongue, and upper extremities, which lasted for 2 days and did not improve with antivenin treatment. He exhibited laboratory evidence of coagulopathy and rhabdomyolysis. Although neurotoxins are known to occur in the venom of certain populations of rattlesnakes, only a few clinical reports describing severe neurological symptoms appear in the literature. To our knowledge, this is the first reported case of neurotoxicity associated with a suspected Southern Pacific rattlesnake envenomation.

Adolescent↗
PubMed2000

Venomous snakebites in an urban area: what are the possibilities?

OBJECTIVE: To estimate the number of different species of venomous snakes privately kept in a large urban area. METHODS: An anonymous survey of potential snake owners in the Philadelphia urban and suburban area. The survey was mailed to members of the Philadelphia Herpetological Society. In addition, the survey was published in 2 herpetological newsletters and online in the Herpetology Network. RESULTS: One hundred sixty responses were obtained during a 6-month period. Ownership of 74 different varieties of venomous snakes was reported. Antivenin was not locally available for 13 of these species. CONCLUSION: A wide variety of venomous captive snakes can be found in the private sector. The potential for having to treat an envenomation requires the emergency physician to maintain an education of snakebite management options, including the various antivenin options available in their geographical location.

Animals↗
PubMed1984

Neutralization of croatalidae venom induced platelet aggregation by affinity chromatography isolated IgG to Crotalus viridis helleri venom.

IgG was isolated from commercial antivenin by affinity chromatography using Crotalus viridis helleri venom as an affinant. This purified IgG was demonstrated to be more effective than the commercial antivenin in preventing platelet aggregation induced by four separate crotalid venoms in vitro. Affinity chromatography appears to be an effective means for specific, polyvalent IgG isolation and purification.

Animals↗
PubMed1977

Identification and neutralization of biological activities associated with venom from the brown recluse spider, Loxosceles reclusa.

Venom from the brown recluse spider, Loxosceles reclusa, reacted with human erythrocytes to form venom-sensitized erythrocytes. These cells were agglutinated specifically by high dilutions of adsorbed rabbit antivenin or were lysed by normal blood group compatible human sera. The specific rabbit antivenin prevented venom from attaching to erythrocytes, from interacting with serum complement, and from producing dermonecrotic lesions in rabbits. Results of experiments involving heat inactivation and adsorption to erythrocytes provide circumstantial evidence to suggest that the three biological activities of venom could be associated with a single component or few components with similar properties. The component interacting with serum complement is immunologically distinct from a factor in cobra venom which possesses similar biological activities.

Animals↗
PubMed1984

Russell's viper bite in Sri Lanka. A study of 22 cases.

Twenty-two patients who had been bitten by a Russell's viper were studied. Neurological manifestations and generalized myalgia were observed, respectively, in 86.4% and 72.7%. Renal failure did not occur in three patients who received antivenin within 5 hours of the bite, and it is suggested that administration of antivenin within the first few hours following the bite could prevent renal failure. Of 19 patients who were in acute renal failure, seven responded to conservative management while 12 needed peritoneal dialysis. Nine patients developed pulmonary edema and four had grand mal seizures. Five patients died. Autopsy revealed massive pulmonary edema, thought to be the immediate cause of death, in four of them and extensive cortical and tubular necrosis in three.

Acute Kidney Injury↗
PubMed1998

Venomous snakes of Israel: ecology and snakebite.

Ten species of venomous snakes belonging to three families occur in Israel and in Jordan, some of which may pose a serious threat to humans. Specific, local antivenins are available against only two of the species, while against others regional or European preparations are used. It is suggested that in addition to the monospecific anti-Vipera palaestinae, a polyspecific antivenin be prepared against the clinically most important venomous snakes of the region, namely, Echis coloratus, Pseudocerastes fieldi, Cerastes cerastes, Walterinnesia aegyptia, and Atractaspis engaddensis.

Amino Acid Sequence↗
PubMed2002

Venomous snakebites in the United States: management review and update.

Venomous snakebites, although uncommon, are a potentially deadly emergency in the United States. Rattlesnakes cause most snakebites and related fatalities. Venomous snakes in the United States can be classified as having hemotoxic or neurotoxic venom. Patients with venomous snakebites present with signs and symptoms ranging from fang marks, with or without local pain and swelling, to life-threatening coagulopathy, renal failure, and shock. First-aid techniques such as arterial tourniquets, application of ice, and wound incisions are ineffective and can be harmful; however, suction with a venom extractor within the first five minutes after the bite may be useful. Conservative measures, such as immobilization and lymphatic constriction bands, are now advocated until emergency care can be administered. Patients with snakebites should undergo a comprehensive work-up to look for possible hematologic, neurologic, renal, and cardiovascular abnormalities. Equine-derived antivenin is considered the standard of care; however, a promising new treatment is sheep-derived antigen binding fragment ovine (CroFab), which is much less allergenic. Although there is no universal grading system for snakebites, a I through IV grading scale is clinically useful as a guide to antivenin administration. Surgical intervention with fasciotomy is now reserved for rare cases. Snakebite prevention should be taught to patients.

Animals↗
PubMed2003

Presentation and treatment of venomous snakebites at a northern academic medical center.

Poisonous snakebites are relatively rare in the United States. The incidence of venomous snakebites is comparatively high in the southern states compared with the northern states and reports of these accidents from northern states is particularly uncommon. We report the experience with treatment of venomous snakebites at the University of Michigan over a 25-year period from 1976 to 2001. Six cases were identified and are described in detail. All patients were male and all were bitten in the upper extremity by pit vipers. One patient suffered a moderate envenomation and was treated with antivenin. Four other cases of mild envenomation occurred and two of these cases required antivenin therapy. One case was considered to represent a "dry" bite and required only 24-hour observation. There were no severe envenomations and no mortalities. On short-term follow-up all patients recovered without sequelae. This report demonstrates that venomous snakebites can be treated effectively at low-volume centers.

Academic Medical Centers↗
PubMed2004

Report of two cases: Rattlesnake venom-induced thrombocytopenia.

We report 2 patients who presented with vasomotor symptoms and severe thrombocytopenia following rattlesnake bites. These symptoms persisted in spite of treatment with antivenin and transfusion of multiple doses of platelets. Thrombocytopenia is a common occurrence in moderate to severe crotaline envenomation. Algorithms suggested for the treatment of rattlesnake envenomation with crotaline-specific antivenin may not reverse the associated thrombocytopenia. The precise mechanism of venom-induced thrombocytopenia (VIT), even in the absence of significant coagulopathy, is unknown. Our experience suggests that, unless spontaneous bleeding occurs, repeated transfusion of fresh frozen plasma and/or platelets may not be indicated.

Adult↗
PubMed1991

Snake venom or antivenom induced urticaria.

An amateur herpetologist developed chills, diaphoresis and generalized urticaria 5 h after receiving Antivenin (Crotalidae) Polyvalent (Wyeth) for treatment of rattlesnake (Crotalus atrox) envenomation. The patient had been bitten 8 mo earlier by a copperhead (Agkistrodon contortrix mokeson) resulting in minimal envenomation. He also had been skin testing himself for 6 mo with both diluted Crotalus atrox venom and Antivenin (Crotalidae) Polyvalent (Wyeth) to determine how sensitive he was to antivenom and how resistant he was to the effects of venom. Unusual reactions to antivenom during the treatment of snake-bite victims, such as amateur herpetologists or snake fanciers, with access to both venom and antivenom should raise questions about unusual means of sensitization.

Adult↗