Anti-snake Venom Therapy Research Articles

Vasculotoxic Snake Bite: Infusion Antisnake Venom Therapy versus Bolus Antisnake Venom Therapy at Tertiary Care Centre

The problem of snake bites is widespread throughout the world and particularly in tropical regions. In India, snake bites are found to be one of the leading causes of mortalities and morbidities. According to statistics, approximately 35 000 to 50 000 fatal bites occur every year in India. However, snake bites are usually prevalent in rainy season. Burden of snake-bite has been documented by many investigators recently, with the consequences of snake bite being explored. Identifying chronic impairments and associated socioeconomic costs is an important part of assessing snakebite burden, however, providing significant data on these respect is difficult. Aim: To study infusion antisnake venom therapy versus bolus antisnake venom therapy in vasculotoxic snake bite at tertiary healthcare care. Material and methods: The current study was an observational study. During the study, four different anti-snake venom regimens were used to treat patients with vasculotoxic snake bites by comparing clinical manifestations, laboratory investigations, the amount of anti-snake venom required, the incidence of complications, and the outcomes. Results: In the present study, demographic data showed significant preponderance of snakebite amongst farmers (n=44). However, the drill was followed by housewives (n=29), students (n=17), teachers (n=4) and shopkeepers (n=3) amongst the reported cases respectively. Conclusion: study concludes that not only proper regimens but also the modality of treatment for the patients of viperine vasculotoxic snake bite is equally important. In order to decrease the morbidity and mortality of snake bite patients, it is imperative to make ASV available universally in areas with high snake bite incidences and to adequately train health care providers about snake bite treatment.

SNAKEBITE PRESENTING AS ACUTE CORONARY SYNDROME: AN INTERESTING DIAGNOSIS AND MANAGEMENT

Snakebite is a common presentation in India, especially in the Sub-Himalayan region. The most common presentation of snakebiteis neurotoxic and hematologic complications. Acute coronary syndrome after a snakebite is rare. This case report explicitly explainsa patient presenting as acute coronary syndrome after a snakebite with dynamic electrocardiogram changes. Later on, the anti-snakevenom therapy was given to the patient and her condition improved. It should be kept in mind that, since the pathology of snakebiteinducedmyocardial infarction is different, its management will also be different.

Anti-snake venom potential of Clerodendrum serratum extracts on Bungarus caeruleus and Daboia russelii venom

Anti-snake venom therapy is the only treatment for snake bite but leads to acute and chronic conditions which may be severe. The medicinal plants have gained importance over years to find an effective alternative to anti-snake venom. The present study focused on evaluating the potential of Clerodendrum serratum for the anti-snake venom activity. Phytochemicals were extracted from the C. serratum with different solvents. The ethyl acetate and methanolic extracts were found to neutralize the major enzyme toxins (phospholipase A2, protease and hyaluronidase) of Bungarus caeruleus and Daboia russelii venom at a concentration of 100 µg/mL. The fibrinogenolytic activity of both the venoms were neutralized. The study proves that the plant C. serratum possesses certain compounds which inhibit the toxins present in the venom of B. caeruleus and D. russelii.
 Video Clip of Methodology:
 Hyaluronidase assay: 3 min 30 sec Click to watch

A rare case of common krait envenomation presented with locked-in syndrome masquerading as brain death

Krait (elapid snake) bite may be painless, without evidence of flange marks, and the patient is many times unaware of the bite. This may present as unexplained neuroparalysis and deep coma with absent brainstem reflexes, and it may look like brain death. We present a case of such unexplained neuroparalysis who was diagnosed on clinical ground, and the patient was completely recovered with anti-snake venom (ASV) and supportive treatment. A high index of suspicious, background history of the patient and timely empirical ASV therapy can save the patient from a coma with unexplained neuroparalysis from definite death.

Low dose versus high dose anti-snake venom therapy in the treatment of haematotoxic snake bite in South India.

Most of the studies on the appropriate dose of anti-snake venom (ASV) are from tertiary hospitals and the guidelines are unclear. Our observational study compared the outcomes of two prevalent treatment regimes for haematotoxic snake bite in a secondary care hospital in South India. The time to normalisation of whole blood clotting time, mortality and complications were not different between the groups. The average dose of ASV required in the low and high dose groups were 106 mL and 246 mL, respectively. Consequently, patients who received low dose ASV incurred approximately 50% less expense. Urticarial rashes were also significantly fewer in the low dose group.

Delayed neurological manifestation in viper bite despite anti-snake venom therapy

Envenomation due to snake bite is an acute life threatening medical emergency. Among the different families of snakes, viper bites are known to cause local manifestations like cellulitis, blebs, compartment syndrome; as well as systemic manifestations which include neurological, hematological and renal failure. This is a case of a middle aged man who presented with viper bite. He was given anti-snake venom (ASV) and became asymptomatic. After about 72 hours of ASV therapy, he started developing generalised paralysis. He was given another course of ASV, following which he recovered completely. To the best of knowledge, this form of delayed neurological manifestations following viper bite, despite receiving ASV has not been reported yet.

The potential of Tamarindus indica seed extract as anti-snake venom against Ophiophagus hannah, Naja kaouthia and Daboia russelli in mice

Introduction: Globally, snakebite cases are estimated to be around 5 million annually affecting mainly the poorer countries like Africa and Asia, and in 2009 WHO has categorized it as a ‘neglected tropical disease’. Currently the standard treatment for snake envenomation is the anti-snake venom therapy, which is expensive, poor supply and species specific. This study was conducted to evaluate the potential of using Tamarindus indica seed extract (TSE) to inhibit the in-vitro and in-vivo effects of snake venom of three snakes; namely Ophiophagus hannah, Naja kaouthia and Daboia russelli. Methods: Methanolic extract of TSE was used. In-vitro enzymatic inhibition study i.e phospholipase A2, proteolytic and phosphomonoesterase were studied. In-vivo acute subcutaneous (SC) toxicity of TSE in ICR mice was conducted. Study on the SC TSE inhibition of lethality was also conducted. Results: Findings from enzymatic inhibition studies showed that, TSE was able to significantly reduce (p<0.05) all three enzymatic activities. SDS-PAGE experiment showed disruption of protein bands when venom reacted with TSE. No signs of toxicity were observed over 4 weeks when mice were exposed to SC TSE 60mg/20g except for superficial skin ulcers. Histological examination of the liver, both kidneys and skin showed no changes when compared to the control group. TSE was able to increase the mice survival rate. Conclusions: The study shows that SC TSE was safe to be injected up to 60mg/20g and has the potential to delay the effects of venoms from O. hannah, N. kaouthia and D. russelli.

An in vitro evaluation of the Native American ethnomedicinal plant Eryngium yuccifolium as a treatment for snakebite envenomation.

Aim:At least seven North American tribes specifically mention the use of Eryngium (typically roots) as an anti-snake venom therapy. As snake envenomation is an endemic, life-threatening medical risk, is there a scientific basis for the Native American ethnomedicine? Could this be demonstrated in an assay amenable to mechanistic evaluation and high throughput screening for later isolation and possible evaluation as a source for a lead drug?Materials and Methods:Proteases, mainly metalloproteases, are thought to be the main pathological agents in most American snake venoms. Water extracts of four plant parts of Eryngium yuccifolium were tested for enzyme inhibition in three highly sensitive in vitro protease assays, with multiple venoms.Results:Interestingly, activity was found in all plant parts, not just the roots, in the general protease assay, also in the most specific assay for collagenases, but less so for elastases where enzymatic activity was low, and against five species of American snake venoms. Inhibition spared the activity of a mammalian elastase, suggesting it has some specificity. In dose response assays, inhibitory activity in extracts of Eryngium was noticeably more effective than randomly chosen plants and comparable to some others.Conclusions:All data shown here are consistent with pharmacological inhibition of proteases in at least selected venoms of common venomous snakes by Eryngium extracts. Moreover, as the genus is widely distributed in America, the ethnological practice of using this plant as an anti-snake venom treatment is supportable, may have been common, and suggests further bioactivity and phytochemical studies are warranted.

A Survey of Snakebite Management Knowledge Amongst Select Physicians in Hong Kong and the Implications for Snakebite Training

The objective of the study was to assess the level of knowledge regarding snakebite management in doctors likely to treat such bites in the Special Administrative Region of Hong Kong in the People's Republic of China. Key concerns were doctor confidence, consistency of approach, use of anti-snake venom (ASV), and ancillary treatments. Hong Kong hospitals are equipped according to developed country standards, and knowledge therefore becomes the key factor in successful management. A predesigned questionnaire consisting of 29 multiple-choice questions was submitted to physicians likely to treat snakebite victims at all Hong Kong hospitals receiving such patients. The key finding identified that only 29% of responding doctors were confident about treating snakebites. In the case of ASV selection between the 2 products available that deal with different species, 66% of doctors either were unsure of which to use or believed the 2 ASVs to be the same. The use of inappropriate clinical endpoints for ASV therapy suggests it is being used unnecessarily. There is clear room for improvement in the knowledge base and confidence level of physicians treating snakebites in Hong Kong. Key components of management, such as ASV choice, indications, dosing, and clinical endpoints for administration, were sources of confusion to the participants in this study. The results demonstrate the need for a locally developed and widely distributed snakebite management protocol.

Snake bite mimicking brain death.

A 6 year old girl woke up with pain and increasing swelling over the left hand and difficulty in breathing. On examination, she had swelling of the left forearm and hand, flaccid quadriparesis and was in respiratory failure requiring mechanical ventilation. Two clean puncture wounds were identified on the left thumb. A provisional diagnosis of snake bite with severe envenomation was made and she was given anti snake venom therapy. Over a period of about 4 hours her weakness progressed. She became areflexic, developed internal and external ophthalmoplegia and loss of other brain stem reflexes mimicking brain death. Mechanical ventilation was continued despite features suggestive of brain stem dysfunction. About 36 hours after ventilation she showed a flicker of movement of her fingers and gradually the power improved. She was weaned off the ventilator and extubated after 5 days. External ophthalmoplegia is an established association with cobra envenomation, but, this combination of internal and external ophthalmoplegia can mimic brain death and pose a dilemma to the caregivers regarding continuation of therapy.

A Locally Developed Snakebite Management Protocol Significantly Reduces Overall Anti Snake Venom Utilization in West Bengal, India

The purpose of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom (ASV) used in treating snakebites in a developing country and its effect on mortality. In addition, basic epidemiology data were collected and analyzed. Experts in Indian snakebites developed a protocol specifically designed for snakebite treatment in India. A training program was implemented in Midnapore Medical College in West Bengal, India, under the direction of the Health Minister to train care providers in the new protocol. After training, data were collected for 839 snakebite victims over a 12-month period and included epidemiological data, ASV volumes administered, and mortality. The results were collated and compared with results calculated from 780 snakebite victims treated during the 12-month period before implementation of the protocol. Treatment prior to protocol implementation was based on knowledge gained by the care providers from western and forensic medicine textbooks. Protocol-guided treatment resulted in a 66% decline in the amount of ASV administered to victims. Fewer victims received ASV based on rational guidelines for assessing envenomation, dosage and repeat dosage, and clear endpoints to ASV therapy. In addition, there was a trend towards reduced mortality and an absolute reduction of 24%. Use of the protocol reduced ASV utilization and the number of deaths. Locally developed protocols should be encouraged by such organizations as the World Health Organization and national and state governments and should be established with significant input from local experts.

Uveitis following anti-snake venom therapy

Snakebite is a common medical emergency in the tropics, causing multisystemic involvement. Ophthalmic manifestations after snakebite have included ptosis and ophthalmoplegia. Uveitis as an immunological complication following therapy with anti-snake venom (ASV) serum has been rarely reported in literature. We reported two patients who developed uveitis and acute renal failure following snakebite treatment with ASV serum. Both patients recovered uneventfully with appropriate therapy.