MyMedR

Fulltext Epidemiology of snake bite in north Malaya

REID HA, THEAN PC, ARTIN WJ

Br Med J, 1963 Apr 13;1(5336):992-7.

PMID: 13973752

Matched MeSH terms: Snake Bites*

A short synopsis of some of the commoner Malayan snakes, with special reference to the venomous snakes. Part I.

Smart AGH

Malayan Medical Journal, 1932;7:118-124.

Matched MeSH terms: Snake Bites

Fulltext Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation

Ahmad Khaldun, I., Mohd Fyzal, B., Soo, C. I., Yeap, B. T., Mohamed Faisal, A. H.

Medicine & Health, 2017;12(2):357-362.

MyJurnal

The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.
Keywords: emergency, envenoming, neurotoxicity, snakebite

Matched MeSH terms: Snake Bites*

The secretory phenotypes of envenomed cells: Insights into venom cytotoxicity

Yong Y, Hiu JJ, Yap MKK

Adv Protein Chem Struct Biol, 2023;133:193-230.

PMID: 36707202 DOI: 10.1016/bs.apcsb.2022.08.001

Snake envenomation is listed as Category A Neglected Tropical Diseases (NTD) by World Health Organization, indicates a severe public health problem. The global figures for envenomation cases are estimated to be more than 1.8 million annually. Even if the affected victims survive the envenomation, they might suffer from permanent morbidity due to local envenomation. One of the most prominent local envenomation is dermonecrosis. Dermonecrosis is a pathophysiological outcome of envenomation that often causes disability in the victims due to surgical amputations, deformities, contracture, and chronic ulceration. The key venom toxins associated with this local symptom are mainly attributed to substantial levels of enzymatic and non-enzymatic toxins as well as their possible synergistic actions. Despite so, the severity of the local tissue damage is based on macroscopic observation of the bite areas. Furthermore, limited knowledge is known about the key biomarkers involved in the pathogenesis of dermonecrosis. The current immunotherapy with antivenom is also ineffective against dermonecrosis. These local effects eventually end up as sequelae. There is also a global shortage of toxins-targeted therapeutics attributed to inadequate knowledge of the actual molecular mechanisms of cytotoxicity. This chapter discusses the characterization of secretory phenotypes of dermonecrosis as an advanced tool to indicate its severity and pathogenesis in envenomation. Altogether, the secretory phenotypes of envenomed cells and tissues represent the precise characteristics of dermonecrosis caused by venom toxins.

Matched MeSH terms: Snake Bites*

Incidence, clinical manifestation and general management of snake bites

Trishnananda M

Southeast Asian J Trop Med Public Health, 1979 Jun;10(2):248-50.

PMID: 524149

There are regional patterns in snake-bites. Bites by cobras have a high incidence in Thailand and in the Philippines with a high case fatality rate. Among the venomous snakes of haemorrhagic nature, bites by Trimeresurus species such as green pit viper, Taiwan habu and Taiwan bamboo viper are important in Thailand and Taiwan for their high incidence of bite, although the case fatality rates are low. Bites by Malayan pit vipers are also important in Thailand and Malaysia because of their high incidence. Bites by sea snakes are more common in Malaysia than in the Philippines and Thailand.

Matched MeSH terms: Snake Bites/diagnosis*; Snake Bites/drug therapy

Potential para-specific and geographical utility of Thai Green Pit Viper (Trimeresurus albolabris) Monovalent Antivenom: Neutralization of procoagulant and hemorrhagic activities of diverse Trimeresurus pit viper venoms

Yong MY, Tan KY, Tan CH

Toxicon, 2021 Nov;203:85-92.

PMID: 34600909 DOI: 10.1016/j.toxicon.2021.09.021

The Trimeresurus complex consists of diverse medically important venomous pit vipers that cause snakebite envenomation. Antivenoms, however, are in limited supply, and are specific to only two out of the many species across Asia. This study thus investigated the immunoreactivities of regional pit viper antivenoms toward selected Trimeresurus pit viper venoms, and examined the neutralization of their hemotoxic activities. Trimeresurus albolabris Monovalent Antivenom (TaMAV, Thailand) exhibited a higher immunoreactivity than Hemato Bivalent Antivenom (HBAV, raised against Trimeresurus stejnegeri and Protobothrops mucrosquamatus, Taiwan) and Gloydius brevicaudus Monovalent Antivenom (GbMAV, China), attributed to its monovalent nature and conserved antigens in the Trimeresurus pit viper venoms. The venoms showed moderate-to-strong in vitro procoagulant and in vivo hemorrhagic effects consistent with hemotoxic envenomation, except for the Sri Lankan Trimeresurus trigonocephalus venom which lacked hemorrhagic activity. TaMAV was able to differentially neutralize both in vitro and in vivo hemotoxic effects of the venoms, with the lowest efficacy shown against the procoagulant effect of T. trigonocephalus venom. The findings suggest that TaMAV is a potentially useful treatment for envenomation caused by hetero-specific Trimeresurus pit vipers, in particular those in Southeast Asia and East Asia. Clinical study is warranted to establish its spectrum of para-specific effectiveness, and dosages need be tailored to the different species in respective regions.

Matched MeSH terms: Snake Bites*

Bleeding manifestations in snake bite

Devaraj T

Southeast Asian J Trop Med Public Health, 1979 Jun;10(2):255-7.

PMID: 524151

Bleeding following bites by the Malayan Pit Viper can either be local or systemic. Bleeding at the site of the bite is due to the local action of the venom as a vasculotoxin. Systemic bleeding occurs with severe poisoning and appears to be mainly dependent on platelet deficiency and the co-existing defibrination syndrome appears to play a minor role in the initiation of bleeding. Thus in the clinical situation non-clotting blood with no overt bleeding can continue up to weeks when specific antivenene is not given. Assessment of the severity of poisoning can easily be made at the bedside. Specific viper antivenene rapidly corrects the spontaneous bleeding and clotting defect of severe systemic poisoning but has no effect on local poisoning.

Matched MeSH terms: Snake Bites/blood*; Snake Bites/diagnosis

Bites and stings by venomous animals with special reference to snake bites in West Malaysia

Lim BL, Abu Bakar bin Ibrahim

Med J Malaya, 1970 Dec;25(2):128-41.

PMID: 4251134

Matched MeSH terms: Snake Bites/epidemiology

A case of fatal envenomation by a captive puff adder (Bitis arietans) in Malaysia

Husain Z, Wicaksono AC, Renault A, Md Zhahir SS, Ismail AK

Toxicon, 2023 Mar 01;224:107023.

PMID: 36640813 DOI: 10.1016/j.toxicon.2023.107023

The Puff Adder (Bitis arietans) is a viper native to Africa and the Middle East. Envenomation by this species often requires the administration of appropriate antivenom in order to achieve a favorable outcome. A patient was bitten in both hands by a captive B. arietans presented to a teaching hospital in Malaysia. The patient developed painful progressive swelling on both limbs that extended to the chest, hypotension, hypokalemia with worsening anemia, thrombocytopenia, coagulopathy, and severe metabolic acidosis. The patient was managed supportively while waiting for the appropriate antivenom, Antivipmyn-Africa, from the Singapore Zoo. The patient developed cardiorespiratory arrest twice and did not recover from the second. The patient was pronounced dead 23 hours post-incident. The local unavailability of the appropriate antivenom may be the most important factor that contributed to the patient's death. There is also a need to amend the Malaysian Wildlife Act in order to prevent such cases from recurring.

Matched MeSH terms: Snake Bites*

Fulltext Sea-snake bite; a survey of fishing villages in northwest Malaya

REID HA, LIM KJ

Br Med J, 1957 Nov 30;2(5056):1266-72.

PMID: 13479694

Matched MeSH terms: Snake Bites*

Fulltext SPECIFIC ANTIVENENE AND PREDNISONE IN VIPER-BITE POISONING: CONTROLLED TRIAL

REID HA, THEAN PC, MARTIN WJ

Br Med J, 1963 Nov 30;2(5369):1378-80.

PMID: 14063030

Matched MeSH terms: Snake Bites*

Fulltext Management of Snakebite

Citation: Management of Snakebite. Putrajaya: Ministry of Health, Malaysia; 2017

Matched MeSH terms: Snake Bites

Epidemiology of sea-snake bites

Reid HA

J Trop Med Hyg, 1975 May;78(5):106-13.

PMID: 1152101

Epidemiological features as reflected by 101 patients with unequivocal sea-snake bite received in north-west Malaya are reviewed. Enhydrina schistosa caused over half the bites, including seven of the eight fatal bites. It is the most dangerous sea-snake to man. Over 90 per cent of the victims were male and 80 of the 101 patients were fishermen bitten at their job. Most victims were bitten on the lower limb through treading on the snake, and this resulted in more cases of serious poisoning than upper limb bites (caused through handling nets, sorting fish and so on). Only 14 cathers were bitten (through treading on the sea-snake; no bathers were bitten while swimming). In patients coming to hospital more than six hours after the bite, there was a four-fold increase in serious poisoning compared with patients coming within six hours of the bite. Thus, as time elapses after the bite, the victim is less likely to seek medical help unless poisoning is severe. Despite the lethal toxicity of sea-snake venom, in patients seen during 1957-61 before sea-snake antivenom became available, the mortality was only 10 per cent. Trivial or no poisoning followed in 80 per cent of the bites. On the other hand, of 11 patients (20 per cent) with serious poisoning, over half (six patients) died despite supportive hospital treatment. These epidemiological features observed in Malaya probably apply to most fishing folk along Asian coastlines where sea-snakes abound. If this is so, sea-snake bite must be a common hazard feared by millions of fishing folk, and a common cause of illness and death. But it is unlikely that the extent of this problem will be revealed to orthodox medicine for many decades because most fishing villages are far from medical centres; and even if hospitals or medical centres are available, fishing folk are usually reluctant to attend them. Only one species of sea-snake, Pelamis platurus, extends to the east coasts of Africa and west coasts of the tropical Americas, but for various reasons this species does not appear to constitute much of a hazard to fishing folk in these areas. Although bathers are occasionally bitten along Asian coasts, when they inadvertently tread on a sea-snake, the risk of sea-snake bite in this area is extremely low. The prevention of sea-snake bite and poisoning is considered. Highly effective antivenom is now available for treating victims with serious poisoning; death should not occur provided adequate medical treatment is given within a few hours of the bite. The main problem is provision of adequate medical care at rural medical centres and overcoming the reluctance fishing folk often have in attending these centres.

Matched MeSH terms: Snake Bites/classification; Snake Bites/drug therapy; Snake Bites/epidemiology*

Fulltext A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia

Chew KS, Khor HW, Ahmad R, Rahman NH

Int J Emerg Med, 2011;4:41.

PMID: 21752254 DOI: 10.1186/1865-1380-4-41

Although the majority of the snakebite cases in Malaysia are due to non-venomous snakes, venomous bites cause significant morbidity and mortality if treatment measures, especially ant-venom therapy, are delayed.

Matched MeSH terms: Snake Bites

The principles of snakebite treatment

Reid HA

Clin. Toxicol., 1970 Sep;3(3):473-82.

PMID: 5520050

Matched MeSH terms: Snake Bites/diagnosis; Snake Bites/immunology; Snake Bites/mortality; Snake Bites/epidemiology; Snake Bites/therapy*

Ventricular bigeminy following a cobra envenomation

Ismail AK, Weinstein SA, Auliya M, Appareo P

Clin Toxicol (Phila), 2012 Jul;50(6):518-21.

PMID: 22702902 DOI: 10.3109/15563650.2012.696119

Envenoming by some species of cobras (Naja species) may include cardiotoxic effects including various dysrhythmias. However, dysrhythmias leading specifically to ventricular bigeminy have not been previously documented. We report a case of cardiotoxicity and the development of ventricular bigeminy following a cobra envenomation.

Matched MeSH terms: Snake Bites/complications*

Bitten by the "flying" tree snake, Chrysopelea paradisi

Tan TL, Ismail AK, Kong KW, Ahmad NK

J Emerg Med, 2012 Apr;42(4):420-3.

PMID: 22154775 DOI: 10.1016/j.jemermed.2011.03.038

The paradise tree snake, Chrysopelea paradisi, is a rear-fanged colubrid. Like other members of the genus Chrysopelea, it is able to glide through the air, and thus, is commonly known as a "flying snake." There are few documented effects of its bite on humans.

Matched MeSH terms: Snake Bites*

Evaluation of the cross-neutralization capacity of Thai green pit viper antivenom against venom of Myanmar green pit viper

Yee KT, Maw LZ, Kyaw AM, Khow O, Oo AW, Oo TKK, et al.

Toxicon, 2020 Apr 15;177:41-45.

PMID: 32056833 DOI: 10.1016/j.toxicon.2020.02.003

Green pit viper (Trimeresurus sp.) bite occurred throughout Myanmar, but there is no specific antivenom produced in the country for related envenomation. Instead, Myanmar Russell's viper antivenom (Anti-MRV) was often misused because of prolonged clotting time was observed from both species. Thai green pit viper antivenom (Anti-TGPV) raised against Trimeresurus albolabris was found to be effective against venoms of more than ten Trimeresurus sp. from Thailand, Malaysia and Indonesia. The present study compared the neutralization capacities of Anti-TGPV and Anti-MRV towards the venom from T. erythrurus from Myanmar. Anti-TGPV was more efficacious than Anti-MRV in cross-neutralizing the lethal and haemorrhagic activities of the venom by a potency of a least 1.4 times higher. Although Anti-TGPV effectively cross-neutralized the coagulation activity of the venom, Anti-MRV failed to do so. Immunodiffusion and immunoblot experiments showed that Anti-TGPV cross-reacted with more protein components of the venom than Anti-MRV. In conclusion, Anti-TGPV is a better choice for patients bitten by Myanmar green pit viper, but further clinical investigation is required. The current findings highlight the development of a specific antivenom against Myanmar green pit viper venom.

Matched MeSH terms: Snake Bites/drug therapy*

Fulltext Cross neutralization of Afro-Asian cobra and Asian krait venoms by a Thai polyvalent snake antivenom (Neuro Polyvalent Snake Antivenom)

Leong PK, Sim SM, Fung SY, Sumana K, Sitprija V, Tan NH

PLoS Negl Trop Dis, 2012;6(6):e1672.

PMID: 22679522 DOI: 10.1371/journal.pntd.0001672

BACKGROUND: Snake envenomation is a serious public health threat in the rural areas of Asian and African countries. To date, the only proven treatment for snake envenomation is antivenom therapy. Cross-neutralization of heterologous venoms by antivenom raised against venoms of closely related species has been reported. The present study examined the cross neutralizing potential of a newly developed polyvalent antivenom, termed Neuro Polyvalent Snake Antivenom (NPAV). NPAV was produced by immunization against 4 Thai elapid venoms.

PRINCIPAL FINDINGS: In vitro neutralization study using mice showed that NPAV was able to neutralize effectively the lethality of venoms of most common Asiatic cobras (Naja spp.), Ophiophagus hannah and kraits (Bungarus spp.) from Southeast Asia, but only moderately to weakly effective against venoms of Naja from India subcontinent and Africa. Studies with several venoms showed that the in vivo neutralization potency of the NPAV was comparable to the in vitro neutralization potency. NPAV could also fully protect against N. sputatrix venom-induced cardio-respiratory depressant and neuromuscular blocking effects in anesthetized rats, demonstrating that the NPAV could neutralize most of the major lethal toxins in the Naja venom.

CONCLUSIONS/SIGNIFICANCE: The newly developed polyvalent antivenom NPAV may find potential application in the treatment of elapid bites in Southeast Asia, especially Malaysia, a neighboring nation of Thailand. Nevertheless, the applicability of NPAV in the treatment of cobra and krait envenomations in Southeast Asian victims needs to be confirmed by clinical trials. The cross-neutralization results may contribute to the design of broad-spectrum polyvalent antivenom.

Matched MeSH terms: Snake Bites/therapy*

The Effect of a Polyvalent Antivenom on the Serum Venom Antigen Levels of Naja sputatrix (Javan Spitting Cobra) Venom in Experimentally Envenomed Rabbits

Yap MK, Tan NH, Sim SM, Fung SY, Tan CH

Basic Clin Pharmacol Toxicol, 2015 Oct;117(4):274-9.

PMID: 25819552 DOI: 10.1111/bcpt.12398

The treatment protocol of antivenom in snake envenomation remains largely empirical, partly due to the insufficient knowledge of the pharmacokinetics of snake venoms and the effects of antivenoms on the blood venom levels in victims. In this study, we investigated the effect of a polyvalent antivenom on the serum venom antigen levels of Naja sputatrix (Javan spitting cobra) venom in experimentally envenomed rabbits. Intravenous infusion of 4 ml of Neuro Polyvalent Snake Antivenom [NPAV, F(ab')2 ] at 1 hr after envenomation caused a sharp decline of the serum venom antigen levels, followed by transient resurgence an hour later. The venom antigen resurgence was unlikely to be due to the mismatch of pharmacokinetics between the F(ab')2 and venom antigens, as the terminal half-life and volume of distribution of the F(ab')2 in serum were comparable to that of venom antigens (p > 0.05). Infusion of an additional 2 ml of NPAV was able to prevent resurgence of the serum venom antigen level, resulting in a substantial decrease (67.1%) of the total amount of circulating venom antigens over time course of envenomation. Our results showed that the neutralization potency of NPAV determined by neutralization assay in mice may not be an adequate indicator of its capability to modulate venom kinetics in relation to its in vivo efficacy to neutralize venom toxicity. The findings also support the recommendation of giving high initial dose of NPAV in cobra envenomation, with repeated doses as clinically indicated in the presence of rebound antigenemia and symptom recurrence.

Matched MeSH terms: Snake Bites/blood; Snake Bites/drug therapy*; Snake Bites/immunology

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