Clinical profile of severe scorpion envenomation in children at rural setting.
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he present study is an attempt to evaluate the clinical manifestations of severe scorpion sting in children and their management at a rural setting. Twelve patients with severe scorpion sting referred from primary health center are presented in this report. Eight children had pulmonary edema and hypotension; two had pulmonary edema and hypertension while one each presented with hypertension and tachycardia in isolation. Oral prazosin, dobutamine infusion and sodium nitroprusside drip (SNP) were used as therapeutic options based on the symptomatology. Two children died of massive pulmonary edema despite use of SNP and dopamine drip. Anti scorpion venom did not prevent the cardiovascular manifestations of severe scorpion sting. Early administration of prazosin alleviated the severity of scorpion envenomation (+info)
Characteristics of venomous snakebites in Herzegovina.
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AIM: To investigate the degree to which primary and secondary care physicians in the Herzegovina region follow the protocols recommended in the literature for treatment of patients bitten by a venomous snake. METHOD: We retrospectively examined hospital records of all patients treated at the Department of Infectious Diseases, Mostar University Hospital, for intoxication following a venomous snakebite in the 1997-2002 period. The data on demographic characteristics, clinical presentation, therapy protocols, and final outcome were collected for each patient. RESULTS: From 1997 to 2002, 43 men (60.5%) and 28 women (33.4%) were treated at our Department for a venomous snakebite. The greatest number of snakebites occurred in persons older than 60 (chi-square=12.44, df=3, p=0.006) and during the summer months (chi-square=8.12, df=1, p=0.004). More than half of the patients (38, or 53.5%) were bitten on the hand. The commonest symptoms and signs of the local envenomation were pain (97.1%) and swelling (87.3%), whereas general symptoms were tachycardia (39.4%), nausea (33.8%), and vomiting (28.1%). Also, 56 patients (78.8%) experienced anxiety and fear. The primary care protocol recommended in the literature (antibiotics, tetanus antitoxin, snakebite antiserum, and immobilization) was given to only 2 patients (2%). However, there were no lethal outcomes. CONCLUSION: Development of a precise evidence-based protocol for prehospital management of venomous snakebite is needed in the Herzegovina region, followed by educational efforts targeted at primary care physicians. (+info)
Spider bite--the redback spider and its relatives.
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BACKGROUND: Redback spider bite is thought to be the commonest serious spider bite in Australia. The treatment for the envenomation syndrome it causes, termed 'latrodectism', is the most frequently used antivenom in Australia. Several cases of a 'latrodectism-like' illness after cupboard spider bites ('steatodism') have also appeared to respond to redback antivenom. OBJECTIVE: This article describes the key presenting features of redback spider envenomation and discusses treatment for bites by this spider and that of its close relatives, the cupboard spider. It is intended that this information will assist general practitioners in the diagnosis and management of spider bite in Australia. DISCUSSION: Redback spider antivenom is safe and appears to be broadly cross reactive with the venom of other spiders of the Theridiidae family. Guidelines for the use of this product are also provided. (+info)
Neutralization of the edema-forming, defibrinating and coagulant effects of Bothrops asper venom by extracts of plants used by healers in Colombia.
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We determined the neutralizing activity of 12 ethanolic extracts of plants against the edema-forming, defibrinating and coagulant effects of Bothrops asper venom in Swiss Webster mice. The material used consisted of the leaves and branches of Bixa orellana (Bixaceae), Ficus nymphaeifolia (Moraceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plant of Pleopeltis percussa (Polypodiaceae) and Trichomanes elegans (Hymenophyllaceae); rhizomes of Renealmia alpinia (Zingiberaceae), Heliconia curtispatha (Heliconiaceae) and Dracontium croatii (Araceae), and the ripe fruit of Citrus limon (Rutaceae). After preincubation of varying amounts of each extract with either 1.0 microg venom for the edema-forming effect or 2.0 microg venom for the defibrinating effect, the mixture was injected subcutaneously (sc) into the right foot pad or intravenously into the tail, respectively, to groups of four mice (18-20 g). All extracts (6.2-200 microg/mouse) partially neutralized the edema-forming activity of venom in a dose-dependent manner (58-76% inhibition), with B. orellana, S. orbicularis, G. panamensis, B. rosademonte, and D. croatii showing the highest effect. Ten extracts (3.9-2000 microg/mouse) also showed 100% neutralizing ability against the defibrinating effect of venom, and nine prolonged the coagulation time induced by the venom. When the extracts were administered either before or after venom injection, the neutralization of the edema-forming effect was lower than 40% for all extracts, and none of them neutralized the defibrinating effect of venom. When they were administered in situ (sc at the same site 5 min after venom injection), the neutralization of edema increased for six extracts, reaching levels up to 64% for C. limon. (+info)
Impact of snake bites and determinants of fatal outcomes in southeastern Nepal.
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Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained field workers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 am were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims' rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night. (+info)
Life-threatening envenoming by the Saharan horned viper (Cerastes cerastes) causing micro-angiopathic haemolysis, coagulopathy and acute renal failure: clinical cases and review.
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BACKGROUND: The desert horned vipers (Cerastes cerastes and C. gasperettii) are the most familiar snakes of the great deserts of North Africa and the Middle East, including the plains of Iraq. They are responsible for many human snake bites. In Western countries, they are popular among exotic-snake keepers. AIM: To investigate mechanisms of life-threatening envenoming and treatment. DESIGN: Clinical investigation. METHODS: Clinical and laboratory studies with measurement of serum venom antigen concentrations by enzyme immunoassay. RESULTS: Two men bitten while handling captive Saharan horned vipers (Cerastes cerastes) in Europe developed extensive local swelling and life-threatening systemic envenoming, characterized by coagulopathy, increased fibrinolysis, thrombocytopenia, micro-angiopathic haemolytic anaemia and acute renal failure. The clinical picture is explicable by the presence in C. cerastes venom of several thrombin-like, Factor-X-activating, platelet-aggregating, haemorrhagic and nephrotoxic components. In one case, prophylactic use of subcutaneous epinephrine may have contributed to intracranial haemorrhage. The roles in treatment of heparin (rejected) and specific antivenom (recommended) are discussed. DISCUSSION: Cerastes cerastes is capable of life-threatening envenoming in humans. Optimal treatment of envenoming is by early administration of specific antivenom, and avoidance of ineffective and potentially-dangerous ancillary methods. (+info)
Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms.
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OBJECTIVE: To compare the efficacy and safety of three polyspecific antivenoms for bites by pit vipers. DESIGN: Randomised double blind comparative trial of three antivenoms. SETTING: Shell, Pastaza, southeastern Ecuador. PARTICIPANTS: 210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001. INTERVENTION: One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms. MAIN OUTCOME MEASURES: Permanent restoration of blood coagulability after 6 and 24 hours. RESULTS: The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal. CONCLUSIONS: All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern. (+info)
Best evidence topic report. Scorpion envenomation: does antivenom reduce serum venom concentrations?
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A short cut review was carried out to determine if anitvenom reduces serum venom concentrations. Using the reported search, 69 papers were found, of which four presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. (+info)