Snake Antivenom Research Articles

Stress-induced Late Onset Adult Section Idiopathic Epilepsy after Snakebite: A Rare Case Report

Viper snake bites are associated with haemorrhagic qualities and bleeding disorders, including intracerebral haemorrhage. However, idiopathic epilepsy resulting from viper venom is considered a rare condition. Here is a case of a 30-year-old female who developed idiopathic epilepsy following a snake bite within two hours of the incident. Based on her clinical symptoms and laboratory investigations, the patient was immediately treated with Anti-Snake Venom (ASV) and supportive care. She then experienced an idiopathic seizure upon admission, and her Electroencephalography (EEG) showed generalised epileptiform activity. Subsequently, she was treated with anticonvulsant agents. After being discharged, the patient was readmitted one month later for the same condition, experiencing multiple seizure episodes, each lasting about 40 to 50 seconds. Her MRI of the brain was normal. She was then treated with two anticonvulsant agents and discharged with regular follow-up. This case highlights the importance of maintaining a high suspicion for seizures in patients presenting after envenomation. Early diagnosis and aggressive management may help prevent further neuromuscular damage to the patient.

Ingestion of Unknown Snake Venom: A Case Report

Venom from a snake is extremely uncommonly consumed by humans. It can be administered in a variety of ways, including a direct bite on the tongue or other parts of the body, or it can be taken as a venom pill at rave parties. The belief is that upon consumption, it provides virility, a sense of elation, and excitement, among other effects. However, it is more often dangerous to the human body and can even be fatal. Only a very small number of cases have been described in publications. In the present case report, a 36-year-old male patient who was an alcoholic and had a history of psychiatric disease initially arrived with anxiety as a result of having consumed snake venom the day before. As for the patient’s vital signs, they were acceptable. For observation, the patient was admitted to the intensive care unit reserved for medicine. However, antisnake venom was not administered. After 24 hours, he was released from the hospital. This is an unusual case where the patient was relatively unharmed after the consumption and didn’t show any obvious lasting effects on the neurological or haematological systems. If the venom is not effectively broken down in the intestines and is absorbed as such, drinking snake venom can have deadly repercussions. The treatment is determined by the features that the patient presents. In the present case, antivenom was not administered, as the need was not justified. However, there may arise situations in other cases where it should be administered sparingly.

Herbal Antivenins as an Eye Opener Towards Snake Envenomation

Snakebites are the most neglected health problem in India. Antivenoms are used in treatment, but since they are mostly unavailable, the mortality rate is even higher in rural areas. The currently available antivenoms are monovalent and polyvalent and are effective against four common snakes in India. In this article, we have reviewed the herbal antivenoms against specific snake species along with their in vitro and in vivo studies and the phytochemicals responsible for antivenom activity. These phytochemicals have been scientifically proven to neutralize the effects of deadly snake venoms and can be used as an adjunct to anti snake venom therapy or can be effectively used to provide proper first aid in snake bite cases to decrease the mortality rates. Studies have been conducted on plant extracts to explore their antivenom activity along with anti myotoxic, anti haemorraghic as well as anti inflammatory activity. These herbs are used ethnopharmacologically by traditional healers for snake envenomations. The review here is a comprehensive approach to the phytochemicals having anti venom activity, however, further studies are needed to gain in-depth knowledge.

Clinico-epidemiological profile and outcome of snakebite patients presented to a teaching institute - A descriptive retrospective review.

Snakebites are a significant cause of morbidity and mortality in India despite availability of anti-snake venom and the absence of a large number of highly venomous snakes. This may be attributed to treatment seeking behaviour of the population. The study aims to find out common clinical features, outcome, and delay in arrival time to the hospital in snakebite cases. This is a cross-sectional retrospective record-based study among the patients presented with a history of snakebites to the Basaveshwara Medical College Hospital and Research Centre, Chitradurga, conducted from 1 January 2019 to 31 January 2021. Out of the 96 patients, the majority of snakebite victims were male and of an age group of 21-30 years. The most common site for snakebite was the lower limb, and about 57.2% of patients had visible fang marks. Among snake species identified, the most common was krait bites, followed by cobra bites. Neurotoxic envenomation manifestation and severe presentation were found in almost half (53.1%) of the cases. Almost half of the patients took 1-4 hours to arrive at the health facility. Surprisingly, only 35% cases arrived to the health care facility within an hour of snakebite. Most of the patients (82%) recovered with the treatment with very minimal fatality/mortality. Although half of the patients presented with severe forms, only 35% of the patients arrived within an hour to the health care facility. This indicates the need for an information dissemination system to avoid severe disease as well as to prevent mortality.

A case of acquired thrombotic microangiopathy secondary to Russell’s viper bite

Russell’s viper is one of the ‘big four’ most dangerous poisonous snakes in India. The farmer and snakes, especially the Russell's viper, coexist in tenuous relationship in the ecosystem. The clinical manifestations of viper bite are localized pain and swelling, coagulopathy, and renal impairment. The venom induced consumption coagulopathy (VICC) following Russell’s viper bite can result in a syndrome consistent with thrombotic microangiopathy (TMA), manifesting with thrombocytopenia, microangiopathic hemolytic anemia (MAHA) and acute kidney injury (AKI). TMA is rarely reported as a complication of Russell’s viper envenoming. Our patient, a farmer, was bitten by Russell’s viper and was brought to a nearby hospital within an hour. He was administered anti-snake venom (ASV) and supportive therapy. As his renal function declined, he was transferred to our hospital. He developed thrombocytopenia, and MAHA as evidenced by progressive anemia, schistocytes on peripheral smear, increased levels of lactate dehydrogenase (LDH), and AKI unresponsive to fluid management and diuretic administration. He was managed with sustained low-efficiency dialysis (SLED) and therapeutic plasma exchange (TPE). After three cycles of TPE and seven cycles of SLED over the next three weeks, the patient recovered completely and has been asymptomatic for more than six-months during follow up. The case is reported for rarity of TMA in the Russell’s viper envenomation, and the role of TPE in such cases.

BILATERAL PTOSIS AND SEVERE RESPIRATORY DISTRESS AS NEUROTOXIC SYMPTOM AFTER KRAIT ENVENOMATION IN CENTRAL INDIA: CASE REPORT AND REVIEW OF LITERATURE

Snake bite is a very well-known medical emergency presented in an Emergency Department, leading to life threatening condition if not treated adequately. Snake bite is very common in rural areas of central India where medical facilities are not well developed, so mortality rates are higher from respiratory arrest is evident compared to developed cities of state. Among the several snake families, krait bites are known to result in neurological symptoms, including ptosis, external ophthalmoplegia, paralysis of pharyngeal muscles, followed by respiratory and generalised muscle paralysis. We report a case of 45-year-old female from rural area presented to us with Snake bite followed by a bilateral ptosis and respiratory muscle paralysis with abdominal pain after getting primary treatment, she was managed in our hospital with mechanical ventilation, anti-snake venom and other supportive measures.

Phytochemical characterization and phospholipase A2 inhibitory effect of Vitex negundo L. root extracts

Ethnopharmacological relevanceSnake bites are a critical health issue in many parts of the world particularly in Asian countries lacking efficient health facilities in rural areas. Cobra is the most common snake type in Asia and is responsible for a large number of mortalities particularly in rural areas. Plants are usually considered the most effective and easy-to-approach treatment for snake bites in rural areas of various countries. Vitex negundo L. is an important medicinal plant traditionally used to treat snake bite envenomation in many countries of Asia. Aim of the studyFrom literature survey of plants traditionally used in the treatment of snake bites in Asian countries including India, Pakistan and Sri Lanka, roots of V. negundo were selected for the present study. Anti-snake venom potential of its roots was assessed through various in vitro assays targeting the phospholipase A2 enzyme. Materials and methodsV. negundo roots were sequentially extracted in different organic solvents to get fractions and in methanol to get total extract. The extracts were evaluated for phospholipase A2 (PLA2) inhibitory potential through inhibition of venom-induced hemolysis, ADP-induced platelet aggregation, PLA2-induced fatty acid hydrolysis and anticoagulant effect of cobra venom. Antioxidant power was determined using DPPH and superoxide radical scavenging assays. GC-MS and HPLC analysis was performed for the total methanol extract. ResultsStrong PLA2 inhibitory effect was observed for all the extracts. The ethyl acetate, acetone and methanol fractions significantly inhibited toxic effects of cobra venom under in vitro conditions. Radical scavenging potential of these fractions was also significantly high as compared to non-polar fractions in both DPPH and superoxide scavenging assays. Phytochemical analysis indicated high phenolic and flavonoid contents in these fractions. GC-MS and HPLC analysis of total methanol extract confirmed the presence of bis(2-ethylhexyl) phthalate, phenol, o-Guaiacol, palmitic acid-methyl ester, methyl stearate, quercetin and kaempferol in the plant. ConclusionThe study concluded that the roots of V. negundo, particularly their polar extracts, have strong PLA2 inhibitory effect against cobra venom confirming their traditional use to manage snake bites. The roots of this plant can be further studied for isolation of plant-based antisera.

Recombinant human scFv antibody fragments against phospholipase A2 from Naja naja and Echis carinatus snake venoms: In vivo neutralization and mechanistic insights

Snake envenomation results in a range of clinical sequelae, and widely used animal-based conventional antivenoms exhibit several limitations including the adverse immunological effects in human snake bite victims. Therefore, human monoclonal anti-snake venom antibodies or fragments can be an alternate therapy for overcoming the existing limitations. We developed venom-neutralizing humanized scFv antibodies and analyzed biochemical mechanisms associated with the inhibition of toxicity. Tomlinson I and J human scFv antibody libraries were screened against Naja naja and Echis carinatus venoms, and seven unique scFv antibodies were obtained. Further, specific toxins of snake venom interacting with each of these scFvs were identified, and phospholipase A2 (PLA2) was found to be prominently captured by the phage-anchored scFv antibodies. Our study indicated PLA2 to be one of the abundant toxins in Naja naja and Echis carinatus venom samples. The scFvs binding to PLA2 were used to perform in vivo survival assay using the mouse model and in vitro toxin inhibition assays. scFv N194, which binds to acidic PLA2, protected 50% of mice treated with Naja naja venom. Significant prolongation of survival time and 16% survival were observed in Echis carinatus venom-challenged mice treated with scFv E113 and scFv E10, respectively. However, a combination comprised of an equal amount of two scFvs, E113 and E10, both interacting with basic PLA2, exhibited synergistically enhanced survival of 33% in Echis carinatus venom-challenged mice. No such synergistically enhanced survival was observed in the case of combinatorial treatment with anti-Naja naja scFvs, N194, and N248. These scFvs demonstrated partial inhibition of venom-induced myotoxicity, and E113 also inhibited hemolysis by 50%, which corroborates the enhanced survival during combinatorial treatment in Echis carinatus venom-challenged mice.

Scaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis

Snakebite envenoming (SBE) affects nearly three million people yearly, causing up to 180,000 deaths and 400,000 cases of permanent disability. Brazil's state of Amazonas is a global hotspot for SBE, with one of the highest annual incidence rates per 100,000 people, worldwide. Despite this burden, snake antivenom remains inaccessible to a large proportion of SBE victims in Amazonas. This study estimates the costs, and health and economic benefits of scaling up antivenom to community health centers (CHCs) and hospitals in the state. We built a decision tree model to simulate three different antivenom scale-up scenarios: (1) scale up to 95% of hospitals, (2) scale up to 95% of CHCs, and (3) scale up to 95% of hospitals and 95% of CHCs. We consider each scenario with and without a 10% increase in demand for antivenom among SBE victims. For each scenario, we model the treatment costs averted, deaths averted, and disability-adjusted life years (DALYs) averted from a societal, health system, and patient perspective relative to the status quo and over a time horizon of one year. For each scenario and perspective, we also calculate the incremental cost per DALY averted and per death averted. We use a willingness to pay threshold equal to the 2022 gross domestic product (GDP) per capita of Brazil. Scaling up antivenom to 95% of hospitals averts up to 2022 DALYs, costs up to USD $460 per DALY averted from a health system perspective, but results in net economic benefits up to USD $4.42 million from a societal perspective. Scaling up antivenom to 95% of CHCs averts up to 3179 DALYs, costs up to USD $308 per DALY averted from a health system perspective, but results in net economic benefits up to USD $7.35 million from a societal perspective. Scaling up antivenom to 95% of hospitals and CHCs averts up to 3922 DALYs, costs up to USD $328 per DALY averted from a health system perspective, but results in net economic benefits up to USD $8.98 million from a societal perspective. All three antivenom scale up scenarios - scale up to 95% of hospitals, scale up to 95% of CHCs, and scale up to 95% of hospitals and 95% of CHCs - avert a substantial proportion of the SBE burden in Amazonas and are cost-saving from a societal perspective and cost-effective from a health system perspective. W.M. and J.S. were funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq productivity scholarships). W.M. was funded by Fundação de Amparo à Pesquisa do Estado do Amazonas (PRÓ-ESTADO, call n. 011/2021-PCGP/FAPEAM, call n. 010/2021-CT&I ÁREAS PRIORITÁRIAS, call n. 003/2022-PRODOC/FAPEAM, POSGRAD/FAPEAM) and by the Ministry of Health, Brazil (Proposal No. 733781/19-035). Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW011944. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The use of antivenom serum, fresh frozen plasma, and platelet concentrate for management strategy of snakebite related coagulopathy: a case series

Snakebite is a medical emergency. It can cause local and systemic effects in humans. Different venomous snakes produce different types of venom, which can cause a variety of symptoms and complications. The scarcity of anti-snake venom serum (SABU) in Indonesia encourages alternative administration strategies to patients, namely suboptimal doses or subdose.
 Three cases of adult patients with a history of snakebite and diagnosed with snakebite grade III were reported. The patient underwent initial antivenom therapy using suboptimal doses of anti-snake venom serum (SABU) due to the scarcity of SABU and fresh frozen plasma (FFP) and thrombocyte concentrate (TC) transfusions as well as initial emergency management and routine blood tests and coagulation function. Evaluation was done daily of clinical improvement and coagulation function.
 This case series proves that administration of suboptimal antivenom therapy, when combined with additional FFP and TC transfusions, coupled with appropriate supportive care and patient monitoring can result in good outcome in patients.
 Key words: Anti-snake Venom Serum; FFP; Snakebite; Thrombocyte Concentrate; Toxin
 Citation: Permana SA, Shalihin MM. The use of antivenom serum, fresh frozen plasma, and platelet concentrate for management strategy of snakebite related coagulopathy: a case series. Anaesth. pain intensive care 2023;27(6):750−756; DOI: 10.35975/apic.v27i6.2250
 Received: July 27, 2023; Revised: October 17, 2023; Accepted: October 17, 2023

A rare complication of acute lower limb ischemia post coronavirus disease 2019 infection in a healthy pediatric patient: case report

BackgroundCoronavirus Disease 2019 (COVID-19) is a novel respiratory disease that first emerged in 2019. Patients infected with this disease present with a myriad of symptoms. Limb ischemia and hypercoagulability are complications identified in adults. COVID-19-related vasculitis is a known but seldom reported complication in pediatric patients, and the treatment approach is still not well established.Case presentationWe report the case of a healthy four-year-old female with a history of COVID-19 who developed acute lower limb ischemia. This was initially treated as a case of acute snake envenomation by administering snake antivenom with no improvement. She eventually developed lower limb acrocyanosis with an inability to ambulate. The patient was started on interleukin-6 receptor inhibitors (tocilizumab), anticoagulants, and pulse steroid therapy. The patient had complete resolution with the loss of only one toe.ConclusionIdentification of thromboembolic complications in pediatric patients with no comorbidities and a history of COVID-19 can be difficult. Early recognition and treatment have a major impact on morbidity and can increase the likelihood of limb salvage.

In-Vivo Antivenom Effect of Annona senegalensis (Pers) Against Biological Activities of Naja nigricollis (Hallowell) Envenomation

Snake bites are a common, serious medical issue often neglected in developing countries. This study aims to investigate the effectiveness of methanolic extract from the root bark of Annona senegalensis in neutralizing the biological activities of Naja nigricollis envenomation in vivo. The methanolic extract was fractionated using a liquid-liquid fractionating method. The inhibition of venom-induced edematogenic and hemorrhagic effects was evaluated in albino rats using a pre-incubation protocol. The aqueous-methanol fraction (AM) of A. senegalensis AM root methanolic extract significantly inhibited the hemorrhagic and edema-inducing activities of the venom. The methanolic extract derived from the root bark of A. senegalensis has exhibited promising potential as an effective anti-snake venom agent.

Clinical Profile and Outcome in Snake Envenomation in the Maval Region of Western Maharashtra: A Rural Tertiary Health-care Hospital Experience.

A prospective observational study was conducted in a rural tertiary health-care hospital in the Maval region to analyze sociodemographic contributors, clinical profile, and outcomes in snake envenomation. Fifty-eight patients with confirmed snakebites admitted to the hospital from November 2019 to August 2021 were studied. Snakebite was found to be the most common in middle-aged adult male agricultural population while working outdoors in the daytime. Bleeding from the bite site and other areas such as the oral cavity, swelling, and bluish discoloration of the affected limb were the clinical features observed. Complications such as cellulitis and acute kidney injury were detected in 81% of patients. Despite this, there was no mortality or permanent disability in any of the patients. The knowledge of risk factors can help the vulnerable agrarian population to protect themselves from snakebites. Good medical facilities such as intensive care units, laboratory support, and availability of antisnake venom and blood products are important determinants in final patient outcome.

Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda

Antivenom is considered the safest and most effective treatment against snake envenomation (SBE); however, global shortages mean that many low-income countries struggle to meet demand. In Rwanda, chronic shortages of essential medicines are an important barrier to robust healthcare delivery and discourage snakebite victims from seeking hospital care. The aim of this retrospective, cross-sectional study was to evaluate the availability and affordability of commodities to treat SBE at hospitals and health centers. In total, our team interviewed pharmacy managers at 111 public and 31 private health facilities (N = 142) to complete a validated quantitative questionnaire, entering data electronically through KoBoCollect. Commodity prices were collected in 2023RWF and for the lowest cost item across any category. A commodity was considered affordable if a treatment regimen cost less than one day's wages, using the international poverty line to approximate a low-income worker's wages. Across all health facilities, mean availability of SBE commodities was relatively good (77.1%). Snake antivenom was only available at public hospitals and was concentrated in urban rather than rural areas. Two snake antivenom types were observed, one of which was not appropriate for treating envenomation by East African snakes. Overall, this meant that only 4.2% of facilities stocked safe and effective antivenom. Black stones, an ineffective traditional treatment, were sold by 5.6% of health providers. Moreover, antivenom did not meet the minimum threshold for affordability, costing on average 10 days of work for a single dose among uninsured individuals. Altogether, this study highlights serious performance gaps among pharmacies responsible for procuring and supplying SBE commodities and helps to explain the widespread belief that SBE treatment is unaffordable at hospitals and health centers. Urgent action is needed to ensure that all hospital and health center pharmacies located in high-risk areas stock appropriate antivenom and that re-stocking time for essential medicines is reduced.

Snake venom detoxification potential of selected Nigerian medicinal plants: a review

Snake envenomation is one of the neglected public health problems with high morbidity and mortality rate across the globe. Snakebite has led to several major health complications such as numbness and flaccid paralysis, damage to local tissue which eventually results in temporary and/or permanent physical impairment. In Nigeria however, lack of access to emergency treatment for snake envenomation has in no small measure contributed to the high rate of snake incidence. Though, a lot of drawbacks and limitations associated with the use of standard antisnake venom (ASV) include storage, side effects, expire in short time coupled with short supply. These factors made snake venom detoxification with ASV unaffordable to victims especially to people living in rural areas who are at high risk of snakebites. Therefore, the use of medicinal plants remains the only alternative for snake venom detoxification (SVD) in Nigeria especially in rural areas. This mini review reported the detoxification potentials of different medicinal plants (parts: leaves, stem bark, root, seed) of creeping foxglove (Asystasia gangetica L.), Resurrection plant (Bryophullum pinnatum Lam), Hammattan lily (Crinum jagus) wild custard apple (Annona sengalensis), plantain (Musa paradiasia) and finger root (Uvaria chamate), used to treat snakebite in Nigeria. Majority of these medicinal plants used by herbalists were validated by recent scientific works conducted on snake venom detoxification potentials. Bioactive antivenin compounds such as aristolochic acid, quercetin, kaempferol, resveratrol isolated from common Nigerian medicinal plants show very promising detoxification potential against snakebites. The authors of this review paper suggest that, more ethnomedicinal survey should be done to explore more plants with SVD potential for the development of effective medications.

How and why snakebite became a global health priority: a policy analysis

BackgroundSnakebite was added to the WHO neglected tropical disease (NTD) list in 2017, followed by a World Health Assembly resolution in 2018, and an explicit global target being set to...

Clinical, laboratory profile and outcomes in children with snakebite from Eastern India.

Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics.

Evaluation of anti-snake venom activity of ethanolic leaf extract of Euphorbia hirta, Ageratum conyzoide and Anogeisus leiocarpus on West African Carpet Viper (Echis ocellatus) in envenomed Sprague Dawley rats.

Evaluation of anti-snake venom activity of ethanolic leaf extract of Euphorbia hirta, Ageratum conyzoide and Anogeisus leiocarpus on West African Carpet Viper (Echis ocellatus) in envenomed Sprague Dawley rats.

Incidence of serum sickness following Indian polyvalent antivenom therapy in a cohort of snake-envenomed patients in rural Sri Lanka

Introduction Serum sickness is a poorly reported delayed adverse reaction following snake antivenom therapy. We aimed to assess the frequency of serum sickness associated with administering Indian polyvalent antivenom in Sri Lanka. Methods We recruited patients from the Anuradhapura snakebite cohort who were admitted to a rural tertiary care hospital in Sri Lanka over one year period. Patients were interviewed over the phone 21 to 28 days post-envenoming to collect data on clinical effects: fever/chills, arthralgia/myalgia, rash, malaise, headache, abdominal pain, and nausea/vomiting. The presence of three or more symptoms between the 5th to 20th days after snake envenoming was defined as serum sickness. Results We were able to contact 98/122 (80%) patients who received antivenom and 423/588 (72%) who did not receive antivenom during the study period. The treated patients received a median dose of 20 vials (interquartile range: 20–30) of Indian polyvalent antivenom and of them, 92 (92%) received premedication. However, 67/98 (68%) developed acute adverse reactions to antivenom, including 19/98 (19%) developing anaphylaxis. Only 4/98 (4%) who received antivenom met the criteria for serum sickness, compared to none who did not receive antivenom therapy. All patients who developed serum sickness were envenomed by Russell’s vipers, were premedicated, and received VINS Bioproducts antivenom. Three of them were treated with hydrocortisone in the acute stage, as premedication or as a treatment for acute adverse reactions of antivenom. Although all four patients sought medical advice for their symptoms, only one was clinically suspected to be serum sickness and treated, while the others were treated for infections. Conclusions We confirmed that Indian polyvalent antivenom use in Sri Lanka is associated with high rates of acute adverse reactions. In contrast to studies of other antivenoms only a small proportion of patients developed serum sickness.

Snake Antivenoms-Toward Better Understanding of the Administration Route.

Envenomations induced by animal bites and stings constitute a significant public health burden. Even though a standardized protocol does not exist, parenterally administered polyclonal antivenoms remain the mainstay in snakebite therapy. There is a prevailing opinion that their application by the i.m. route has poor efficacy and that i.v. administration should preferentially be chosen in order to achieve better accomplishment of the antivenom therapeutic activity. Recently, it has been demonstrated that neutralization not only in the systemic circulation but also in the lymphatic system might be of great importance for the clinical outcome since it represents another relevant body compartment through which the absorption of the venom components occurs. In this review, the present-day and summarized knowledge of the laboratory and clinical findings on the i.v. and i.m. routes of antivenom administration is provided, with a special emphasis on the contribution of the lymphatic system to the process of venom elimination. Until now, antivenom-mediated neutralization has not yet been discussed in the context of the synergistic action of both blood and lymph. A current viewpoint might help to improve the comprehension of the venom/antivenom pharmacokinetics and the optimal approach for drug application. There is a great need for additional dependable, practical, well-designed studies, as well as more practice-related experience reports. As a result, opportunities for resolving long-standing disputes over choosing one therapeutic principle over another might be created, improving the safety and effectiveness of snakebite management.