Daboia (Vipera) palaestinae Envenomation in 123 Horses: Treatment and Efficacy of Antivenom Administration.

Sharon Tirosh-Levy,Judith Comte,Emanuel Gazit,Amir Steinman,Israel Nissan,Annie Gabay,Reut Solomovich-Manor,Gila A Sutton

doi:10.3390/toxins11030168

Sharon Tirosh-Levy, Judith Comte + Show 6 more

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Journal: Toxins	Publication Date: Mar 19, 2019
Citations: 6	License type: CC BY 4.0

Affiliation: Hebrew University of Jerusalem, Israel Ministry of Health

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Envenomation by venomous snakes is life threatening for horses. However, the efficacy of available treatments for this occurrence, in horses, has not yet been adequately determined. The aim of this study was to describe the treatments provided in cases of Daboia palaestinae envenomation in horses and to evaluate the safety and efficacy of antivenom administration. Data regarding 123 equine snakebite cases were collected over four years from 25 veterinarians. The majority of horses were treated with procaine-penicillin (92.7%), non-steroidal anti-inflammatory drugs (82.3%), dexamethasone (81.4%), tetanus toxoid (91.1%) and antivenom (65.3%). The time interval between treatment and either cessation or 50% reduction of local swelling was linearly associated with case fatality (p < 0.001). The overall mortality rate was 20.3%. Treatment with procaine-penicillin was significantly associated with reduced mortality (OR = 0.11). Three horse-derived antivenom products were available during the study period, of which the horses were administered different brands of varying dosages. Administration of the recommended dosage of any of the aforementioned products led to a significant decrease in mortality (p = 0.014), even in severe cases (scoring 2 or greater on the equine snakebite severity scale). No adverse reactions were reported. The results of this study show that species-specific D. palaestinae antivenom administered at the manufacturer-recommended dosage is effective in significantly reducing mortality in cases of envenomation in horses.

Highlights

Envenomation by venomous snakes is a major cause of morbidity and mortality in both humans and animals worldwide [1]
Treatment of D. palaestinae envenomation differs depending on the affected species and includes supportive measures, pain management, antibiotics, antihistamines and steroids, some of which are controversial within the scientific community [5,6,8,11,12,13]
All incidences of envenomation occurred between April snakebite cases were included in the study

Summary

Introduction

Envenomation by venomous snakes is a major cause of morbidity and mortality in both humans and animals worldwide [1]. Incidences of envenomation by D. palaestinae were reported in humans, dogs [5,6,7], cats [8], horses [9] and a ram [10]. Treatment of D. palaestinae envenomation differs depending on the affected species and includes supportive measures, pain management, antibiotics, antihistamines and steroids, some of which are controversial within the scientific community [5,6,8,11,12,13]. The mainstay of treatment in human patients is prompt administration of antivenom, which is considered to be the only specific and effective treatment, reducing mortality from 6–10% to 0.5–2% [2,14,15,16]. Most antivenoms are produced from animal sera, most commonly horses’, which undergo a process of fractionation and purification to produce either whole IgG, F(ab’) or Fab fragments [17,18]

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