蛇伤凉血合剂治疗青竹蛇咬伤的观察护理

目的 观察蛇伤凉血合剂对青竹蛇咬伤的临床疗效.方法 将680例青竹蛇咬伤病人按随机法分为对照组和治疗组各340例,均给予清创、局部封闭、注射抗蝮蛇蛇毒血清及抗生素、速尿等常规治疗;治疗组加服蛇伤凉血合剂.观察比较两组疗效及肿胀消退时间、疼痛缓解时间、局部坏死发生率、肢体功能受限发生率、住院时间等指标.结果 两组病人临床疗效、肿胀消退时间、疼痛缓解时间、局部坏死发生率、肢体功能受限发生率、住院时间均有差异(P＜0.05).结论 蛇伤凉血合剂对青竹蛇咬伤疗效显著.     

Observation of Bothrops atrox Snake Envenoming Blister Formation from Five Patients: Pathophysiological Insights

In the Brazilian Amazon, Bothrops atrox snakebites are frequent, and patients develop tissue damage with blisters sometimes observed in the proximity of the wound. Antivenoms do not seem to impact blister formation, raising questions regarding the mechanisms underlying blister formation. Here, we launched a clinical and laboratory-based study including five patients who followed and were treated by the standard clinical protocols. Blister fluids were collected for proteomic analyses and molecular assessment of the presence of venom and antivenom. Although this was a small patient sample, there appeared to be a correlation between the time of blister appearance (shorter) and the amount of venom present in the serum (higher). Of particular interest was the biochemical identification of both venom and antivenom in all blister fluids. From the proteomic analysis of the blister fluids, all were observed to be a rich source of damage-associated molecular patterns (DAMPs), immunomodulators, and matrix metalloproteinase-9 (MMP-9), suggesting that the mechanisms by which blisters are formed includes the toxins very early in envenomation and continue even after antivenom treatment, due to the pro-inflammatory molecules generated by the toxins in the first moments after envenomings, indicating the need for local treatments with anti-inflammatory drugs plus toxin inhibitors to prevent the severity of the wounds.     

Neuromuscular toxicology of the venom of Collett's snake (Pseudechis colletti): a histopathological study

Introduction: A bite by Collett's snake, (Pseudechis colletti) can cause rhabdomyolysis in human victims but no signs of neurotoxicity. The pathology of muscle and peripheral nerve has not been described previously. In this study we investigated neuromuscular toxicity in rats. Methods: The venom was inoculated subcutaneously into the anterolateral aspect of one hindlimb of adult rats at a dose replicating that inoculated into an adult human male during an envenoming bite. Results: The venom caused edema, an increase in muscle wet weight, and the degeneration of 20–35% of the underlying soleus muscle. Muscle fiber regeneration began at 4 days and was complete by 8 weeks. There was little evidence of either post‐ or presynaptic toxicity. Conclusions: The dominant effect of this venom in mammals is myotoxicity. Muscle Nerve, 2011     

A ten-year retrospective review of 1 107 snakebite patients in Sanya, China

Sanya is the one of most southern cities and tropical cities in China,situated on Hainan Island.It located between 18°09′ and 18°37′ latitude almost the same geographic position as Hawaii.Because of Sanya＇s location,it is a suitable habitat for snake to reproduce as other tropical areas.     

Thrombotic microangiopathy following Bothrops jararaca snakebite: case report

Context: Thrombotic microangiopathy (TMA) is an uncommon and severe complication of snakebites, and is similar, in general, to hemolytic-uremic syndrome (HUS). We describe a case of TMA following envenomation by Bothrops jararaca.

Case details: A 56-y-old-woman with controlled hypertension was transferred from a primary hospital to our ER ～7?h after being bitten by B. jararaca in the distal left leg. She developed edema extending from the bite site to the proximal thigh, associated with intense radiating local pain, local paresthesia and ecchymosis at the bite site. Laboratory features upon admission revealed coagulopathy (20?min whole blood clotting time - WBCT20?>?20?min), thrombocytopenia (76,000 platelets/mm³) and slight increase in serum creatinine (1.58?mg/dL; RV Discussion: TMA following snakebite has been reported mainly in India, Sri Lanka and Australia, with several patients needing renal replacement therapy. Although controversial, plasmapheresis has also been used in some cases. Our patient developed microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury, a triad of features compatible with TMA similar to HUS. Despite the severity, the outcome following conservative treatment was good, with complete recovery.     

Anticoagulant Activity of Naja nigricollis Venom Is Mediated by Phospholipase A2 Toxins and Inhibited by Varespladib

Bites from elapid snakes typically result in neurotoxic symptoms in snakebite victims. Neurotoxins are, therefore, often the focus of research relating to understanding the pathogenesis of elapid bites. However, recent evidence suggests that some elapid snake venoms contain anticoagulant toxins which may help neurotoxic components spread more rapidly. This study examines the effects of venom from the West African black-necked spitting cobra (Naja nigricollis) on blood coagulation and identifies potential coagulopathic toxins. An integrated RPLC-MS methodology, coupled with nanofractionation, was first used to separate venom components, followed by MS, proteomics and coagulopathic bioassays. Coagulation assays were performed on both crude and nanofractionated N. nigricollis venom toxins as well as PLA₂s and 3FTx purified from the venom. Assays were then repeated with the addition of either the phospholipase A₂ inhibitor varespladib or the snake venom metalloproteinase inhibitor marimastat to assess whether either toxin inhibitor is capable of neutralizing coagulopathic venom activity. Subsequent proteomic analysis was performed on nanofractionated bioactive venom toxins using tryptic digestion followed by nanoLC-MS/MS measurements, which were then identified using Swiss-Prot and species-specific database searches. Varespladib, but not marimastat, was found to significantly reduce the anticoagulant activity of N. nigricollis venom and MS and proteomics analyses confirmed that the anticoagulant venom components mostly consisted of PLA₂ proteins. We, therefore, conclude that PLA₂s are the most likely candidates responsible for anticoagulant effects stimulated by N. nigricollis venom.     

蝰蛇蛇伤致肾损害临床分析

目的 研究圆斑蝰泰国亚种蛇伤伴发肾损伤的临床特点.方法 回顾性分析2006年6月～2013年12月住院的蝰蛇蛇伤患者的临床资料.根据病情予抗蛇毒血清、利尿、透析、中西医结合等多种治疗.观察患者蛇伤以及肾损害转归情况.结果 蝰蛇蛇伤76例,发现尿蛋白阳性75例（98.7％）,血清肌酐增高46例（60.5％）,最高为1192 μmol/L,急性肾功能衰竭10例（13.2％）.蛇伤临床治愈61例（80.3％）,显效13例（17.1％）,死亡2例（2.6％）,死亡原因为合并多脏器功能衰竭,直接死亡原因是呼吸循环衰竭,总有效率为97.4％.肾损害经治疗61例（80.3％）2周内恢复,13例（17.1％）半年内恢复.结论 蝰蛇蛇伤肾损伤多见,临床上应常规进行尿检、血肌酐等检查以利于早期诊断.及时采取中西医结合方法治疗蛇伤所致的肾损害疗效确切.     

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.     

Acute kidney injury induced by thrombotic microangiopathy in two cases of Bothrops envenomation

Context: Bothrops snakes are the most frequent agents of snakebites in South and Central America. Acute kidney injury (AKI) is one of its complications and has multifactorial origin. Thrombotic microangiopathy (TMA)-induced AKI in snakebites is uncommon and is not described in Bothrops envenomation.

Case details: We report two cases of patients bitten by young Bothrops jararaca who developed AKI induced by TMA. Both patients evolved with mild envenomation and received the specific antivenom within 4?h after the snakebite. None of them had hypotension or shock, bleeding or secondary infection. Patient 1 (P1) was diabetic and using oral hypoglycemic drugs, and patient 2 (P2) was hypertensive without regular use of medication. On admission, both patients had levels of fibrinogen lower than 35?mg/dL, D-dimer higher than 10,000?ng/mL. They evolved with AKI, thrombocytopenia, normal coagulation assays, anemia, lactate dehydrogenase (LDH) elevation, low haptoglobin levels, negative direct antiglobulin test, and presence of schizocytes in peripheral blood. Only P1 required renal replacement therapy, and plasmapheresis was not required. Both patients were discharged and did not require outpatient dialysis, and subsequently had normal creatinine levels.

Discussion: TMA may occur in Bothrops jararaca envenomation, even in mild cases that received early specific antivenom.     

Differential action of Indian BIG FOUR snake venom toxins on blood coagulation

Abstract

Snake venom toxins affect hemostasis by modulating blood coagulation factors resulting in pro/anti-coagulant status of blood. Most of the reported effects are in vitro which do not reflect in-vivo coagulation status. The specific interference of venom toxins on coagulation factor(s) in vivo can be used as a marker to identify the snake species responsible for envenomation and administration of species-specific anti-venom thereafter. The current review attempts to highlight specific alterations induced by BIG FOUR venomous snakes of India towards blood coagulation factors. Future insights in this regard will be valuable in identifying the snake species responsible for bite which in most cases is unknown.