Abstract
Russell’s vipers (RVs) envenoming is an important public health issue in South-East Asia. Disseminated intravascular coagulopathy, systemic bleeding, hemolysis, and acute renal injury are obvious problems that develop in most cases, and neuromuscular junction blocks are an additional problem caused by western RV snakebite. The complex presentations usually are an obstacle to early diagnosis and antivenom administration. Here, we tried to produce highly specific antibodies in goose yolks for use in a paper-based microfluidic diagnostic kit, immunochromatographic test of viper (ICT-Viper), to distinguish RVs from other vipers and even cobra snakebite in Asia. We used indirect ELISA to monitor specific goose IgY production and western blotting to illustrate the interaction of avian or mammal antibody with venom proteins. The ICT-Viper was tested not only in prepared samples but also in stored patient serum to demonstrate its preliminary efficacy. The results revealed that specific anti-Daboia russelii IgY could be raised in goose eggs effectively without inducing adverse effects. When it was collocated with horse anti-Daboia siamensis antibody, which broadly reacted with most of the venom proteins of both types of Russell’s viper, the false cross-reactivity was reduced, and the test showed good performance. The limit of detection was reduced to 10 ng/ml in vitro, and the test showed good detection ability in clinical snake envenoming case samples. The ICT-Viper performed well and could be combined with a cobra venom detection kit (ICT-Cobra) to create a multiple detection strip (ICT-VC), which broadens its applications while maintaining its detection ability for snake envenomation identification. Nonetheless, the use of the ICT-Viper in the South-East Asia region is pending additional laboratory and field investigations and regional collaboration. We believe that the development of this practical diagnostic tool marks the beginning of positive efforts to face the global snakebite issue.
Highlights
The snakebite of Russell’s vipers (RVs), Daboia (D.) russelii and D. siamensis, is an important public health issue in South-East Asia due to its wide but discrete distribution and notable organs injuries, such as neurological paralysis, bleeding diathesis and acute kidney injury in cases of significant envenomation
To use precious antivenom more effectively, a snake species discrimination tool might be helpful for treatment by ensuring accurate antivenom usage and dosage
We revealed that avian IgY might be an economical alternative for collocation with the equine F(ab’)2 fragment in the development of a diagnostic device with improved performance
Summary
The snakebite of Russell’s vipers (RVs), Daboia (D.) russelii (western RV, RVW) and D. siamensis (eastern RV, RVE), is an important public health issue in South-East Asia due to its wide but discrete distribution and notable organs injuries, such as neurological paralysis, bleeding diathesis and acute kidney injury in cases of significant envenomation. Patients present with local swelling, consumptive coagulopathy with severe bleeding, hypopituitarism, and acute renal failure when bitten by the RVE, while those bitten by the RVW present with neurological paralysis [3, 4]. The same as Taiwan, RVE envenomation presented with local swelling, systemic coagulopathy and neurotoxicity, and should be differentiated from envenomation of Naja atra (NA), Protobothrops mucrosquamatus (PM) and Trimeresurus stejnegeri (TS) [6,7,8]. A simple, sensitive and high efficacy diagnostic method might be needed to reduce the harm caused by misdiagnosis, especially in regions with poor health systems or limited medical resources
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