Neurotoxic Snake Bite Research Articles

Unravelling the enigma: Autopsy challenges in alleged snakebite deaths

Snakebites account for a substantial public health burden in India, contributing to 80 % of global snakebite fatalities. This case series explores the intricacies of two alleged neurotoxic snakebite deaths, delving into the complexities of diagnosing neurotoxic snakebite deaths in India through meticulous medico-legal autopsies. Despite initial suspicions and circumstantial evidence suggesting snakebite involvement, the autopsies revealed surprising causes of death. The article discusses challenges in accurately attributing deaths to snakebites, and the potential for false claims, and underscores the crucial role of Forensic pathologists in dispelling enigmas. Forensic pathologists are urged to maintain an unbiased approach, allowing postmortem findings to guide conclusions amidst deliberate attempts to mislead. The cases described highlight that ruling out snake bites in cases with positive history is as challenging as opining a case of neurotoxic snake bite as they are mainly the diagnosis of exclusion in autopsy.

Neurotoxic snakebite envenomation treated with Philippine cobra antivenom in the eastern Visayas: a descriptive study between 2016 and 2020.

There is a significant shortage of observational studies on neurotoxic snakebite envenomation in the Philippines. This lack of data, especially concerning treatment using Purified Cobra Antivenom (PCAV), has prompted the initiation of this foundational study. The target population included snakebite patients admitted to the Eastern Visayas Medical Center and treated with PCAV between 2016 and 2020. A retrospective chart review was conducted for data collection. The investigation analyzed the hospital stay and patient features of individuals who were administered either lower or higher doses of PCAV. Eighty-two patients were identified during the study. Of these, 27 (33%) were under 20years of age and 50 (61%) were male. Most patients, totalling 75 (92%) were hailed from rural areas. Of the 82 patients, 59 (72%) received one or two ampoules of PCAV during the course. However, patients who received more than two ampoules had a longer median hospital stay than those who received less than three ampoules [96h (interquartile range, IQR 66-122) vs. 125h (IQR 96-218), P=0.038]. The study reported five in-hospital mortalities (6.1%). The individuals who needed a high dosage of PCAV tended to have more extended hospital stays, yet over 70% of the patient population required a lower dosage. To gain a clearer understanding of the burden of neurotoxic snakebites and determine the optimal PCAV dosage based on disease severity in the area, a more comprehensive, prospective study is recommended.

Delayed Neurotoxic Paralysis with Confounding Hypokalaemia

Snakebite is a major health issue in India and developing nations across the globe. Common krait bites are associated with delayed paralysis and locked-in syndrome. Locked-in syndrome has been documented among patients of snakebite. Our case is unique due to the confounding effect of hypokalaemia which may confuse the physician as hypokalaemic periodic paralysis (HPP), a rare genetic condition which can also be precipitated by a stressful event such as snakebite. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. As krait bite are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. We urge our fellow researchers to look out for similar findings in their patients. Key messages: Locked-in syndrome in snakebites can be due to the effect of the venom in blood onto the ventral pons. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. We presume this hypokalaemia to be nutritional in origin. As krait bites are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. Keywords: Case report, Hypokalaemia, Neurotoxic, Snake envenomation

Compendium of medically important snakes, venom activity and clinical presentations in Ghana.

Snake bite envenoming (SBE) is one neglected tropical disease that has not received the needed attention. The sequelae of burdensome disability and mortality impact the socioeconomic life of communities adversely with little documentation of SBE in health facility records in Ghana. This study details SBE and snake distribution, habits/habitats, type of venom expressed and clinical manifestations. We conducted a structured thematic desk review of peer reviewed papers, books and reports from repositories including PubMed, World Health Organization (WHO) and Women's & Children's Hospital (WCH) Clinical Toxinology Resources using bibliographic software EndNote and search engine Google Scholar with the following key words; snakes, medical importance, snake bites, venom and venom type, envenomation, symptoms and signs, vaccines, venom expenditure, strike behaviour and venom-metering + Ghana, West Africa, Africa, World. We also reviewed data from the District Health Information Management System (DHIMS) of the Ghana Health Service (GHS). Outcome variables were organized as follows: common name (s), species, habitat/habit, species-specific toxin, clinical manifestation, antivenom availability, WHO category. Snake bites and SBE were grouped by the activity of the expressed venom into neurotoxic, cardiotoxic, haemorrhagic, cytotoxic, myotoxic, nephrotoxic and procoagulants. Neurotoxic snake bites were largely due to elapids. Expressed venoms with cardiotoxic, haemorrhagic, nephrotoxic and procoagulant activities principally belonged to the family Viperidae. Snakes with venoms showing myotoxic activity were largely alien to Ghana and the West African sub-region. Venoms showing cytotoxic activity are expressed by a wide range of snakes though more prevalent among the Viperidae family. Snakes with neurotoxic and haemorrhagic venom activities are prevalent across all the agro-ecological zones in Ghana. Understanding the characteristics of snakes and their venoms is useful in the management of SBE. The distribution of snakes by their expressed venoms across the agro-ecological zones is also instructive to species identification and diagnosis of SBE.

Alleged Snake Bite with Fatal Antemortem Aspiration: A diagnostic Conundrum

The determination of the cause of death in the alleged snake bite deaths presents a great challenge for autopsy surgeons at autopsy. Unwitnessed bites, improper history, unavailable clinical records, and absent bite marks on the external examination often impact the assessment of snakebite deaths by autopsy surgeons. This is even more complicated when the snake bite involves an unusual or obscure site, for example, the scalp. It is often encountered in neurotoxic snake bites which are associated with minimal or no local findings at the bite site. We describe a case of an alleged snake bite on the head, wherein the relatives of the deceased old lady claimed that the cobra bit her on the vertex region of the scalp before being brought dead to the hospital. However, significant life-threatening conditions such as fatal myocardial infarction and antemortem aspiration of food up to the terminal bronchiole were found at the autopsy rather than evidence of snakebite. The role of autopsy surgeons in such cases is described in this report.

Reversible Brain Death

Snakebite is a serious public health problem and one of the priorities in WHO's list of neglected tropical diseases. It significantly increases morbidity and mortality associated with envenomation in India. A neurotoxic snakebite can present in the form of symptoms ranging from asymptomatic presentation, ptosis, and complete external and internal ophthalmoplegia to complete respiratory failure. This is a case report of a 22-year-old male, who presented with bilateral ptosis and impending respiratory failure. He soon became deeply comatose, with absent brain stem reflexes (mute plantar, fixed pupils, and the absence of the doll's eye reflex) which were suggestive of brain death. He was treated with polyvalent anti-snake venom, anticholinesterases, and supportive therapy and recovered completely with an excellent outcome.

Neuroparalytic Snake Bite Masquerading as Acute Abdominal Pain in Children

Background: Neurotoxic snakebite (usually by the krait) presents with abdominal colic and chest pain as a common premonitory sign of envenomation. Being a nocturnal snake, the time of unprovoked painless biting is usually at night and the victims are individuals sleeping on the ground. Thus, history is usually not forthcoming. Snakebite causes morbidity (neuroparalytic, myopathic, vasculopathic, venom-induced consumption coagulopathy, cardiotoxic, nephrotoxic, etc.), and mortality if not given timely treatment with anti-snake venom (ASV), the only specific treatment. Clinical Description: We present four children from a rural background who were admitted successively over a month during the last rainy season. They initially became symptomatic with acute abdominal pain from midnight to early morning time and developed neuroparalytic manifestations within a few hours. On exclusion of other causes by clinical evaluation, we suspected snakebite envenomation though there was no witnessing of the event or evidence of fang bites. Investigations to rule out commonly associated organ dysfunction were ordered. Management: All children were given supportive therapy. Three cases required mechanical ventilation. The first two received ASV relatively late as the suspicion of snakebite was not considered initially. In the third case, the administration of ASV was early and the hospital stay was shorter. The fourth case received ASV at a peripheral health center and was referred in case he required ventilator support. However, his neuroparalysis did not progress to respiratory failure and he was discharged the earliest. Conclusions: Clinicians should consider snakebite in children belonging to rural areas who present with acute abdominal pain during the rainy season, and monitor for signs of neurotoxicity and other clinical manifestations of snake envenomation. A high index of suspicion should be kept, as definitive treatment with ASV results in early recovery without any sequelae, and reduces mortality.

Role of Anti Snake Venom in Snake Bite in Third Trimester of Pregnancy

A case of pregnancy associated with neurotoxic snake bite presenting with Neuropathic symptoms and systemic envenomation complicated by disseminated intravascular bleeding is uncommon. We present a case of 22-year-old Primigravida at 32 weeks gestation with snake bite on left-hand, with left-hand swelling, nasal bleeding and neuropathic signs. At presentation, there was pallor, tachycardia, hypotension, a gravid uterus with a single live fetus, & regular fetal heart rate. Primi Gravida with venomous snake bite with Neuropathy with disseminated intravascular Coagulation was diagnosed. Conservative management with Anti Snake Venom instituted led to survival of both mother and continuation of pregnancy.

SNAKE BITE IN CHILDREN – A HOSPITAL-BASED CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Background– Snake bite is a neglected issue in our country. It is a potentially life-threatening condition with its incidence being underestimated. Many poisonous snakes are found in this part of the country, most of them being neurotoxic in nature. Despite a large number of morbidities and mortalities every year, very little attention is paid by clinicians in this area. Objectives – a) To study the prevalence, epidemiological, demographic and clinical prole of non-poisonous and poisonous snake bites. b) To study the various complications of snake bite and their response to standard treatment in these patients. It is an institutional-basedMethodology- cross-sectional descriptive study carried out in the Department of Pediatrics, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India. All children under 12 years of age admitted in our pediatric ward with a alleged history of snake bite between June 2021 to May 2022 were included in the study after taking informed consent from the guardians of these children. Total 94 patients were included in our study. Results- Most of the patients were more than 5 years of age with the mean age being 7.74 years. The incidence of snake bite was more in males (61.70%) as compared to females(38.29%). Cases were more reported from rural areas (84.04%) as compared to urban areas(15.96%) .Bites were more common in the lower extremities (74.47%) as compared to upper extremities (25.53%) and between the months of June to August (38.3%). Most patients reported to the hospital within 6 hours of bite (71.3%). Most of them hadn't used any rst aid, while rest of them had used a tourniquet or application of herbs or had cut the affected part proximal to the bite before reaching the hospital. 42.55% were non-poisonous bites and 57.45% were poisonous snake bites. Out of the poisonous bites majority (34.05%) were neurotoxic snake bites and 23.40% were vasculotoxic in nature. Among neurotoxic snake bites, ptosis was the predominant symptom and among vasculotoxic snakebites, cellulitis and oliguria were the predominant symptoms. ASV was administered in 57.45% patients. Around 18.08% patients required invasive ventilation and 23.4% required non-invasive ventilatory support. Eventually 94.68% patients were discharged successfully and the remaining patients were discharged with complications or were referred to a higher centre. There was no mortality due to snake bite during the study period. Conclusion- Snake bite victims who were brought to our hospital early had an excellent prognosis in our study. Awareness about the necessity of early medical attention needed in cases of snake bites can reduce the complications and mortality arising out of them.

Autopsy Study of Renal Lesions in Snake Bite Cases

Background: Snake bite is the significant health problem in India, particularly in many rural regions. In general, the bites of snakes are due to the lower epidemiological profile and they are caused by non-poisonous snake bites, dry bites and envenomation. Venom is the saliva of snake ejected during the act of biting from the modified parotid glands. It can be neurotoxic, vasculotoxic in action. Methods: A descriptive study was carried out in 107 patients conducted at Madurai Medical College & Hospital, Madurai from the period of April 2017 to march 2018. Out of 107 patients proportionate samples was selected based on the inclusion and exclusion criteria. Findings: Out of the 107 patients, 49 (45%) were males and 58 (54.3%) were females. Similarly, deaths were reported to the hospital, who failed to receive ASV and with those patients who reported late to the hospital with a mortality rate, 81%. Other findings like local findings like pain and swelling 76 (43%), cellulitis, 76 (43%), gross findings and histopathological findings were recorded. Conclusion: The rationalisation of anti- snake venom therapy can be done to prevent ASV related to kidney injury. Incidence of renal lesions in neurotoxic snake bites suggests a strict monitoring of renal parameters and timely intervention of treatment measures such as dialysis even in neurotoxic snake bite

English

Snake bite is a major health concern in India. Common krait is one of the most dangerous and poisonous neurotoxic snakes. Snake bite is a medical emergency. India has the highest snake bite death rate in the world.1 Elapidae, viperidae, pit viper and hydrophiidae are the main poisonous snake families in India. Elapidae family includes common cobra, king cobra and common krait.2 Common Indian krait is about 10 times more poisonous than cobra. Snake toxins are neurotoxic or haematotoxic. Krait is neurotoxic, which interrupts neuromuscular transmission of impulse and causes paralysis of muscles. Neostigmine which is an anticholinesterase can reverse the neurological manifestations of the venom.3 Treatment of neurotoxic snake bite includes administration of anti-snake venom, neostigmine with atropine and invasive ventilation if there is respiratory muscle weakness or paralysis. Maximum dose of neostigmine to reverse neuromuscular blockade is 10 mg over 24 hours. 4 Here we report a case of a 60-years-old male who presented with a snake bite followed by respiratory distress and bilateral ptosis. The patient was treated as per standard protocol. However, his ptosis did not improve as per expectations. Hence, neostigmine was given for prolonged period to revert ptosis in neurotoxic snake bite. In this case study we are discussing about maximum dose of neostigmine given to revert ptosis in a neurotoxic snake bite, as their no case report regarding it.

Clinical and Demographic Profile of Neurotoxic Snake Bite Patients in a Tertiary Care Hospital in Bangladesh

Background:Neurotoxic Snake bite is an important health hazard that may lead to fatality in Bangladesh, particularly in rural areas. Epidemiological data point to 700000 incidences of snake bite resulting in 6000 deaths in a year. Despite the criticality of this issue, limited studies are available in the pertinent literature. Consequently, to bridge the gap and offer fresh insights into this domain, the present study was an effort to observe the clinical and demographic profile of neurotoxic snake bite in tertiary care hospital of Bangladesh. Methods:This research was a hospital based observational study which was conducted at the inpatient department of Medicine in Dhaka Medical College Hospital (DMCH). Thirty five patients admitted in DMCH for neurotoxic snake bite were examined according to the inclusion and exclusion criteria. Ethical issues were ensured properly throughout the study. After obtaining a written informed consent, patents’ history was taken and physical examination was done and data were recorded in structured case record form. In the end, the collected data was analysed by computer via SPSS 22. Results: Neurotoxic snake bite was most frequent (34.3%) in age group 21-30 years. The mean age of the subjects was 32.31 ±14.33 SD. Total 11 Neurotoxic snake was identified and 7 were Cobras and 4 were Kraits. Difficulty in swallowing, difficulty in speech, double vision, and difficulty in breathing were found in 11.4%, 28.6%, 5.7%, and 37.1% of the cases, respectively. Moreover, all the subjects had Ptosis (100%), 14.3% had external ophthalmoplegia, 57.1% had broken neck sign. Furthermore 60% of the cases recovered completely, 17.1% recovered with complications, but unfortunately 22.9% of the patients died. Conclusion: Ptosis and broken neck signs are the most frequent neurotoxic signs. However, a larger study is needed to validate and approve this finding.

Ambispective study of clinical picture, management practices and outcome of snake bite patients at tertiary care centre in Northern India.

Background:Snakebite is a common but neglected public health problem of tropical & subtropical regions worldwide. This study was conducted to look into profile, first aid measures, management strategy and outcomes of snake bite patients.Methods:This was an ambispective study conducted in the Department of Medicine & Emergency Medicine at AIIMS, New Delhi from June 2011 to May 2017 and enrolled 54 patients. In retrospective part 33 case records of snake bite patients were retrieved and in prospective part 21 patients were recruited. All relevant information including demographic parameters, first aid measures, clinical and laboratory profile and outcomes were recorded in pre made proformas. All data were analysed using IBM Stata version 13 and Microsoft Excel 2011.Results:Majority of patients were male, and the mean age was 27.6 years. Maximum numbers of bites 34 (63%) happened in the rainy season and Krait was the most common culprit species. Neurological manifestations were most common (70.4%) followed by haematological. Most common complication was ventilatory failure (78.6%), and median dose of ASV was 20 vials. Forty-nine (90.7%) patients were discharged successfully. There was significant association of sepsis and shock with non survivors of snake bite with respective P values of 0.02 and 0.007.Conclusion:Neurotoxic snake bite (70.4%) was the most common type of envenomation. Most common complication was ventilatory failure and majority of patient (90.7%) successfully discharged. Sepsis and shock were significantly associated with non survivors of snake bite.

Expanding donor pool by utilizing deceased donors with snake envenoming.

In India, the deceased kidney transplant program is still in its preliminary stage, and accepting deceased donors with snakebite is just a forward step to expand the donor pool. We report here the outcome of 8 successful renal transplantations from brain-dead donors who died from a neurotoxic snakebite. We accepted them as donors as they had no evidence of hemotoxic snakebite. 7 recipients did well. 1 died due to sepsis with a functioning graft. 1 required renal biopsy that showed acute tubular necrosis. 1 required re-exploration due to graft collection due to a surgical issue. Patient and graft survival in follow-up were similar to other matched deceased donors in our center. According to our experience, utilizing brain-dead donors who died from a neurotoxic snakebite is safe and may dramatically expand the donor pool especially in countries where death due to snakebite is high in numbers.

Two Decades of Deceased Donor Kidney Transplantation at Ahmedabad, India.

Gujarat, Tamil Nadu, Telangana, Maharashtra, Kerala, Chandigarh, and Karnataka are states in India with active programs for deceased donor kidney transplant. We report our experience of 2 decades of deceased donor kidney transplant at the Institute of Kidney Diseases and Research Center, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India. This single-center retrospective study comprised data from 831 deceased donor kidney transplant recipients between January 1, 1997 and December 31, 2018. Mean recipient age was 38 ± 14 years; 564 were male, and 267 were female. Mean donor age was 45.3 ± 17.13 years; 565 were men, and 266 were women. Between January 1, 1997 and March 15, 2020, 5838 kidney transplants were completed, including 4895 living donor kidney transplants, 943 deceased donor kidney transplants, and 440 kidney paired donation transplants. Over the mean follow-up time of 8 ± 5.4 years, patient survival rate was 70% (n = 581) and death-censored graft survival rate was 84% (n = 698). Delayed graft function was shown in 210 patients (25%) and biopsy-proven acute rejection rate in 180 patients (21%). Our experience of favorable outcomes with deceased donor kidney transplants has expanded the donor pool in many ways, including transplant from expanded criteria donors to younger recipients; transplant from older donors to older recipients; donation after cardiac death; successful intercity organ procurement; dual-kidney transplant; en bloc transplant from a pediatric deceased donor; and transplant from brain death deceased donors who died from neurotoxic snakebite, recurrent primary brain tumor, bacterial meningitis, or head injury, or with disseminated intravascular coagulation and deranged renal functions. The pathway to increase organ donation was investigated. Deceased donor kidney transplant can achieve acceptable graft function with patient/graft survival, which may encourage the use of this approach to increase the number of available organs.

Neurotoxic snakebites at a primary healthcare center in Nepal: an experience of a PAHS graduate

Nepal has one of the highest snakebite fatalities in South Asia. Most bites occur in rural areas where there is a lack of both adequate facilities for treatment and transport. Despite several limitations, prompt access and focus on supportive care are the major strengths of peripheral healthcare centers. Here we present the management of two cases of neurotoxic snakebites. Timely intervention can save lives in case of snakebites; hence establishment of snakebite treatment centers in the periphery can mitigate the problem of delay in care. Patan Academy of Health Sciences can contribute by training medical graduates in snakebite management.

Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’
 Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite.
 Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite.
 Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients were in the age group of 20-39 years ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications observed were acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%) patients recovered and 13 (7.65%) patients died and out of 130 neurotoxic snake bites, 124 (95.39%) patients recovered and 6 (4.61%) patients died, overall mortality was 6.3%. In our study, bite to needle time was less than 1 hour in 47 patients (15.66%), less than 6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%).
 Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.

Varespladib (LY315920) inhibits neuromuscular blockade induced by Oxyuranus scutellatus venom in a nerve-muscle preparation

The phospholipase A2 (PLA2) inhibitors varespladib (LY315920) and its orally available derivative methyl-varespladib (LY333013) have been proposed as potential therapies for the treatment of snakebite envenomings in which toxicity depends on the action of PLA2s. In this study, the ability of LY315920 to abrogate the effect of the potent neurotoxic venom of Oxyuranus scutellatus (taipan) was assessed using the mouse phrenic nerve-diaphragm preparation. LY315920 inhibited the venom when (a) incubated with venom before addition to the medium; (b) added to the medium before addition of venom, and; (c) added to the medium within 30 min after addition of venom, and even after the onset of decline in twitch response. This contrasts with previous results with antivenom using the same experimental model, in which the window of time when antibodies are effective is shorter than 10 min. It is proposed that such differences may depend either on the higher affinity of the inhibitor for PLA2s or on the possibility that LY315920 reaches the cytosol of the nerve terminals, inhibiting neurotoxins that have been internalized. Our findings bear implications on the therapeutic potential of varespladib in neurotoxic snakebite envenomings mediated by presynaptically-acting PLA2s.

A pan-specific antiserum produced by a novel immunization strategy shows a high spectrum of neutralization against neurotoxic snake venoms

Snakebite envenomation is a neglected tropical disease of high mortality and morbidity largely due to insufficient supply of effective and affordable antivenoms. Snake antivenoms are mostly effective against the venoms used in their production. It is thus crucial that effective and affordable antivenom(s) with wide para-specificity, capable of neutralizing the venoms of a large number of snakes, be produced. Here we studied the pan-specific antiserum prepared previously by a novel immunization strategy involving the exposure of horses to a ‘diverse toxin repertoire’ consisting of 12 neurotoxic Asian snake toxin fractions/ venoms from six species. This antiserum was previously shown to exhibit wide para-specificity by neutralizing 11 homologous and 16 heterologous venoms from Asia and Africa. We now show that the antiserum can neutralize 9 out of 10 additional neurotoxic venoms. Altogether, 36 snake venoms belonging to 10 genera from 4 continents were neutralized by the antiserum. Toxin profiles previously generated using proteomic techniques of these 36 venoms identified α-neurotoxins, β-neurotoxins, and cytotoxins as predominant toxins presumably neutralized by the antiserum. The bases for the wide para-specificity of the antiserum are discussed. These findings indicate that it is feasible to generate antivenoms of wide para-specificity against elapid neurotoxic venoms from different regions in the world and raises the possibility of a universal neurotoxic antivenom. This should reduce the mortality resulting from neurotoxic snakebite envenomation.

A breath of fresh air: Capnography, innovation, ASF approach to treatment and training for neurotoxic snakebites in austere environments

A breath of fresh air: Capnography, innovation, ASF approach to treatment and training for neurotoxic snakebites in austere environments