Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases.

PubMed

Pardal, Pedro Pereira de Oliveira; Pardal, Joseana Silva de Oliveira; Gadelha, Maria Apolônia da Costa; Rodrigues, Líliam da Silva; Feitosa, Darlan Tavares; Prudente, Ana Lúcia da Costa; Fan, Hui Wen

2010-01-01

Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.

Ornament induced complications in snake bites: Revisiting the "Do it RIGHT" approach.

PubMed

Mallik, Subhendu; Singh, Sudipta Ranjan; Sahoo, Sangeeta; Mohanty, Manoj Kumar

2016-01-01

Limb adorning ornaments (LAO) can exacerbate the local effects of envenoming in case of venomous snake bite. Cultural presuppositions do inhibit victims from removing symbolically/ritually important jewelry even under circumstances that might increase the dangers of envenoming-induced gangrene formation. The recommendation to remove the LAO is usually skipped in guidelines and if at all included the very real hazard is uncommonly documented. We observed 14 cases of snake bite with LAO on the bitten limb with minimal to severe local complications. The possible reasons were discussed with recommendations of proper and timely methods of removal of these ornaments. We suggest inclusion of this concept of 'Remove' in the recommended first aid methods of the guidelines/protocols.

Ornament induced complications in snake bites: Revisiting the “Do it RIGHT” approach

PubMed Central

Mallik, Subhendu; Singh, Sudipta Ranjan; Sahoo, Sangeeta; Mohanty, Manoj Kumar

2016-01-01

Limb adorning ornaments (LAO) can exacerbate the local effects of envenoming in case of venomous snake bite. Cultural presuppositions do inhibit victims from removing symbolically/ritually important jewelry even under circumstances that might increase the dangers of envenoming-induced gangrene formation. The recommendation to remove the LAO is usually skipped in guidelines and if at all included the very real hazard is uncommonly documented. We observed 14 cases of snake bite with LAO on the bitten limb with minimal to severe local complications. The possible reasons were discussed with recommendations of proper and timely methods of removal of these ornaments. We suggest inclusion of this concept of 'Remove’ in the recommended first aid methods of the guidelines/protocols. PMID:27843867

Annual Incidence of Snake Bite in Rural Bangladesh

PubMed Central

Rahman, Ridwanur; Faiz, M. Abul; Selim, Shahjada; Rahman, Bayzidur; Basher, Ariful; Jones, Alison; d'Este, Catherine; Hossain, Moazzem; Islam, Ziaul; Ahmed, Habib; Milton, Abul Hasnat

2010-01-01

Background Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. Methodology/Principal Findings We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4 / 100,000 person years (95% C I 513.4–789.2 /100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. Conclusions/Significance Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted. PMID:21049056

[Bites of venomous snakes in Switzerland].

PubMed

Plate, Andreas; Kupferschmidt, Hugo; Schneemann, Markus

2016-06-08

Although snake bites are rare in Europe, there are a constant number of snake bites in Switzerland. There are two domestic venomous snakes in Switzerland: the aspic viper (Vipera aspis) and the common European adder (Vipera berus). Bites from venomous snakes are caused either by one of the two domestic venomous snakes or by an exotic venomous snake kept in a terrarium. Snake- bites can cause both a local and/or a systemic envenoming. Potentially fatal systemic complications are related to disturbances of the hemostatic- and cardiovascular system as well as the central or peripheral nervous system. Beside a symptomatic therapy the administration of antivenom is the only causal therapy to neutralize the venomous toxins.

Bites by the white-lipped pit viper (Trimeresurus albolabris) and other species in Hong Kong. A survey of 4 years' experience at the Prince of Wales Hospital.

PubMed

Cockram, C S; Chan, J C; Chow, K Y

1990-04-01

The case records of 242 snake bite victims admitted to the Prince of Wales Hospital in Hong Kong between September 1984 and October 1988 were studied retrospectively. When the snake was identified, the White-lipped pit viper (Trimeresurus albolabris) was by far the commonest species involved. In addition to local oedema and inflammation, evidence of a significant blood clotting disturbance was present in at least 10% of cases, defibrination and thrombocytopenia being the commonest findings. Since such abnormality was not always sought the true figure is likely to be higher. Three fatalities occurred, one of which was secondary to a probable White-lipped pit viper bite, one to a bite by Chinese cobra and one to a bite by Russell's viper.

Development of a polymerase chain reaction to distinguish monocellate cobra (Naja khouthia) bites from other common Thai snake species, using both venom extracts and bite-site swabs.

PubMed

Suntrarachun, S; Pakmanee, N; Tirawatnapong, T; Chanhome, L; Sitprija, V

2001-07-01

A PCR technique was used in this study to identify and distinguish monocellate cobra snake bites using snake venoms and swab specimens from snake bite-sites in mice from bites by other common Thai snakes. The sequences of nucleotide primers were selected for the cobrotoxin-encoding gene from the Chinese cobra (Naja atra) since the sequences of monocellate cobra (Naja kaouthia) venom are still unknown. However, the 113-bp fragment of cDNA of the cobrotoxin-encoding gene was detected in the monocellate cobra venom using RT-PCR. This gene was not found in the venoms of Ophiophagus hannah (king cobra), Bungarus fasciatus (banded krait), Daboia russelii siamensis (Siamese Russell's Viper, and Calloselasma rhodostoma (Malayan pit viper). Moreover, direct PCR could detect a 665-bp fragment of the cobrotoxin-encoding gene in the monocellate cobra venom but not the other snake venoms. Likewise, this gene was only observed in swab specimens from cobra snake bite-sites in mice. This is the first report demonstrating the ability of PCR to detect the cobrotoxin-encoding gene from snake venoms and swab specimens. Further studies are required for identification of this and other snakes from the bite-sites on human skin.

[Case report: Snake bite - an odd case].

PubMed

Evers, Bettina; Muth, Claus-Martin; Georgieff, Michael; Dinse-Lambracht, Alexander

2015-10-01

Emergency medical service is called by a 54-year-old man bitten by his rattlesnake. Upon initial survey we find the patient in a cardiopulmonary stable condition. He has bite marks and pain on his rapidly swelling middle finger of his right hand. Our initial treatment is immobilization of the patient. The snake raiser has already called the poison control center in Munich. By the help of this institution we bring him to a hospital having the right antivenom on hand. © Georg Thieme Verlag Stuttgart · New York.

Ten years of snakebites in Iran.

PubMed

Dehghani, Rouhullah; Fathi, Behrooz; Shahi, Morteza Panjeh; Jazayeri, Mehrdad

2014-11-01

Many species of venomous snakes are found in Iran. The most medically important species which are responsible for the most snakebite incidents in Iran belong to the Viperidae family, including Vipera lebetina, Echis carinatus, Pseudocerastes persicus, Vipera albicornuta and the Elapidae family, especially Naja naja oxiana. At least one kind of venomous snake is found in each of the 31 provinces, and many provinces have more than one venomous species. As a result, snakebite is a considerable health hazard in Iran, especially in the rural area of south and south-west of Iran. A retrospective, descriptive study of snakebite in Iran during 2002-2011 was carried out in order based on data collected from medical records of bite victims admitted to hospitals and health centers. From 2002 to 2011, 53,787 cases of snake bites were reported by medical centers in Iran. The annual incidence of snake bites in 100,000 of population varied from 4.5 to 9.1 during this decade and the number of recorded deaths were about 67 cases. The highest rate of snakebite was found in provinces of south and southwest of Iran. We suggest that people, especially in the rural areas, need to be trained and educated about venomous snakes, their hazards, prevention of bite and the importance of early hospital referral and treatment of victims. Also adequate antivenins as the main life saving medicine should be made available based on the recorded numbers of victims in each area of the country. Copyright © 2014 Elsevier Ltd. All rights reserved.

Snake Bite in South Asia: A Review

PubMed Central

Alirol, Emilie; Sharma, Sanjib Kumar; Bawaskar, Himmatrao Saluba; Kuch, Ulrich; Chappuis, François

2010-01-01

Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders. PMID:20126271

Retrospective analysis of snake victims in Northern India admitted in a tertiary level institute

PubMed Central

Ahmed, Syed Moied; Nadeem, Abu; Islam, Mohd. Sabihul; Agarwal, Shiwani; Singh, Lalit

2012-01-01

Context: Snake bites are the common cause of morbidity and mortality in tropical countries. Aims: To analyze the outcome of snake bite victims Settings and Design: Retrospective analysis of data from Intensive care unit, Department of Anesthesiology. Materials and Methods: All the patients admitted in the intensive care unit for snake bite management during the year May 2004 - April 2009 were retrospectively reviewed. The data included age, sex, month and time of incident, site of bite, dose of anti--snake venom, time of anti--snake venom, administration, duration of mechanical ventilation, complications and death of a victim. Statistical analysis used: Pearson's correlation test, paired samples t-test. Results and Conclusions: 113 patients reported to the Accident and Emergency with history of snake bite. 26 patients were referred to other hospital, 17 patients were brought dead, and 70 patients were admitted to the intensive care unit. In 59 snake-bite victims, maximum data could be recovered. Krait was the most common type of snake bite reported. There was a male preponderance (69.4%) with age ranging between 20 and 40 years (52.5%). The mean lag time (time elapsed between bite and first dose of anti--snake venom) was 5.3 ± 1.4 h and the mean anti-snake venom dose was 12.3 ± 2.4 vials. There was a positive and significant correlation between lag time and total dose of anti--snake venom (correlation coefficient =0.956, P<0.0001). Overall 72.9% patients required mechanical ventilation with a mean duration of 56.2 ± 16.1 h. 10.2% patients sustained cardiac arrest, 8.7% patients developed ventilator associated pneumonia, 6.7% suffered mild anti-snake venom reaction, 6.7% had hypotension and 5.1% patients developed renal failure. The overall mortality was 5.1%. PMID:22345945

Snake bite complicated by acute kidney injury secondary to necrotizing glomerulonephritis.

PubMed

Al Qahtani, Mohammad A; Altheaby, Abdulrahman; Al Anazi, T; Al Saad, Khaled; Binsalih, S; Al Helail, Mohammed

2014-11-01

We present a 38-year-old man who presented to the emergency department with complaints of a snake bite. He developed acute kidney injury (AKI) and the kidney biopsy showed necrotizing glomerulonephritis, which is rarely reported in AKI after snake bite.

Symptoms and circumstances associated with bites by the brown tree snake (Colubridae: Boiga irregularis) on Guam

USGS Publications Warehouse

Fritts, T.H.; McCoid, M.J.; Haddock, R.L.

1994-01-01

A review of 94 cases of snakebite by the brown tree snake, Boiga irregularis, in Guam spanning a two year period shows a high proportion (80%) involve victims bitten while sleeping in their homes at night. Some bites apparently involve attempts to feed on small children. Of all children less than 1 yr old that were bitten in a two year period, infants 1-3 mo old comprised 82%. The symptoms exhibited by children are more severe than those experienced by adults. The snake is a rear-fanged (i.e., has enlarged and grooved teeth on the posterior maxillae) colubrid with a moderately large Duvernoy's gland.

Coyotes Are Afraid of Little Snakes.

ERIC Educational Resources Information Center

Weewish Tree, 1979

1979-01-01

Wichita tale of a contest between Coyote and Small Snake to see whose teeth are strongest. They bite each other, and soon big, strong Coyote is dead from the poisoned bite of the tiny snake. Explains why, from that time onward, coyotes have been afraid of little snakes. (DS)

Epidemiological aspects of snake bites on a Liberian rubber plantation.

PubMed

Stahel, E

1980-12-01

During a one-year period 95 patients with a history of snake bite were admitted to the hospital of a Liberian rubber plantation. The population at risk included the field workers (tappers and slashers) with an incidence of 4.2 symptomatic snake bites per thousand per year. The incidence of symptomatic bites was 1.7 per thousand in the group of non-field employees and 0.4 per thousand per year in the group of non-employees. The temporary disability was between 3 and 5 days, and the loss of workings days due to snake bites was one day per 10,000 working days on the plantation. Among the 95 patients 27 did not show any symptoms of envenoming except occasional fang marks. 64 patients developed cytotoxic symptoms alone. In this group, the night adder (Causus maculatus) was the main responsible snake. 4 patients showed signs of systemic envenoming. Two were haematological and two were neurological in nature and caused by Bitis species and Naja species, respectively. No fatalities were noted. A definite maximum of snake bites was observed during October and November which corresponds to the transition from rainy to dry season.

Molecular evidence that the deadliest sea snake Enhydrina schistosa (Elapidae: Hydrophiinae) consists of two convergent species.

PubMed

Ukuwela, Kanishka D B; de Silva, Anslem; Mumpuni; Fry, Bryan G; Lee, Michael S Y; Sanders, Kate L

2013-01-01

We present a striking case of phenotypic convergence within the speciose and taxonomically unstable Hydrophis group of viviparous sea snakes. Enhydrina schistosa, the 'beaked sea snake', is abundant in coastal and inshore habitats throughout the Asian and Australian regions, where it is responsible for the large majority of recorded deaths and injuries from sea snake bites. Analyses of five independent mitochondrial and nuclear loci for populations spanning Australia, Indonesia and Sri Lanka indicate that this 'species' actually consists of two distinct lineages in Asia and Australia that are not closest relatives. As a result, Australian "E. schistosa" are elevated to species status and provisionally referred to Enhydrinazweifeli. Convergence in the characteristic 'beaked' morphology of these species is probably associated with the wide gape required to accommodate their spiny prey. Our findings have important implications for snake bite management in light of the medical importance of beaked sea snakes and the fact that the only sea snake anti-venom available is raised against Malaysian E. schistosa. Copyright © 2012 Elsevier Inc. All rights reserved.

Syndromic approach to treatment of snake bite in Sri Lanka based on results of a prospective national hospital-based survey of patients envenomed by identified snakes.

PubMed

Ariaratnam, Christeine A; Sheriff, Mohamed H Rezvi; Arambepola, Carukshi; Theakston, R David G; Warrell, David A

2009-10-01

Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had bitten, 762 (89%) were venomous. Russell's vipers (Daboia russelii) and hump-nosed pit vipers (Hypnale hypnale) were the most numerous and H. hypnale was the most widely distributed. Fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients. Distinctive clinical syndromes were identified to aid species diagnosis in most cases of snake bite in Sri Lanka where the biting species is unknown. Diagnostic sensitivities and specificities of these syndromes for envenoming were 78% and 96% by Naja naja, 66% and 100% by Bungarus caeruleus, 14% and 100% by Daboia russelii, and 10% and 97% by Hypnale hypnale, respectively. Although only polyspecific antivenoms are used in Sri Lanka, species diagnosis remains important to anticipate life-threatening complications such as local necrosis, hemorrhage and renal and respiratory failure and to identify likely victims of envenoming by H. hypnale who will not benefit from existing antivenoms. The technique of hospital-based collection, labeling and preservation of dead snakes brought by bitten patients is recommended for rapid assessment of a country's medically-important herpetofauna.

Clinical effects and antivenom use for snake bite victims treated at three US hospitals in Afghanistan.

PubMed

Heiner, Jason D; Bebarta, Vikhyat S; Varney, Shawn M; Bothwell, Jason D; Cronin, Aaron J

2013-12-01

Annually, more than 100,000 US and international military and civilian personnel work in Afghanistan within terrain harboring venomous snakes. Current literature insufficiently supports Afghan antivenom treatment and stocking guidelines. We report the clinical course and treatments for snakebite victims presenting to US military hospitals in Afghanistan. All snakebite victims presenting to 3 US military emergency departments between July 2010 and August 2011 in northern and southern Afghanistan were examined via chart review. Case information included patient demographics, snake description, bite details and complications, laboratory results, antivenom use and adverse effects, procedures performed, and hospital course. Of 17 cases, median patient age was 20 years (interquartile range [IQR], 12-30), 16 were male, and 82% were Afghans. All bites were to an extremity, and median time to care was 2.8 hours (IQR, 2-5.8). On arrival, 8 had tachycardia and none had hypotension or hypoxia. A viper was implicated in 5 cases. Ten cases received at least 1 dose of polyvalent antivenom, most commonly for coagulopathy, without adverse effects. Six received additional antivenom, 6 had an international normalized ratio (INR) > 10, and none developed delayed coagulopathy. Three received blood transfusions. Hospital stay ranged from 1 to 4 days. None required vasopressors, fasciotomy, or other surgery, and none died. All had resolution of marked coagulopathies and improved swelling and pain on discharge. We report the largest series of snake envenomations treated by US physicians in Afghanistan. Antivenom was tolerated well with improvement of coagulopathy and symptoms. All patients survived with minimal advanced interventions other than blood transfusion. Published by Elsevier Inc.

Bites by the colubrid snake Philodryas patagoniensis: a clinical and epidemiological study of 297 cases.

PubMed

de Medeiros, Carlos R; Hess, Priscila L; Nicoleti, Alessandra F; Sueiro, Leticia R; Duarte, Marcelo R; de Almeida-Santos, Selma M; França, Francisco O S

2010-11-01

We retrospectively analyzed 297 proven cases of Philodryas patagoniensis bites admitted to Hospital Vital Brazil (HVB), Butantan Institute, São Paulo, Brazil, between 1959 and 2008. Only cases in which the causative animal was brought and identified were included. Part of the snakes brought by the patients was still preserved in the collection maintained by the Laboratory of Herpetology. Of the 297 cases, in 199 it was possible to describe the gender of the snake, and seventy three (61.3%) of them were female. The length of snakes (snout-vent length) ranged from 160 to 1080 mm. In 117 snakes their state of preservation enabled the dissection and examination of their stomach contents. The stomach was empty in 106 snakes (89.1%). Most bites occurred in the seasons of spring and summer (n = 196, 66.0%) and during warmer periods of the day. The mean age of the victims was 24.1 +/- 15.1 years old and 206 (69.4%) patients were men. Around 92% of the patients sought medical care within 6 h after the bite. Both lower (n = 188, 63.3%) and upper limbs (n = 102, 34.3%) were most frequently bitten, especially the feet and hands (n = 205, 69.0%). The local clinical manifestations were pain (n = 151, 50.8%), transitory bleeding (n = 106, 35.7%), erythema (n = 47, 15.8%) and edema (n = 39, 13.1%). Ecchymosis was not observed. Only 7 (2.4%) patients reported systemic symptoms characterized by mild dizziness and 88 patients (29.6%) showed no evidence of envenoming. The whole blood clotting time was performed in 76 (25.6%) patients on admission and all of them had coagulable blood. Supportive treatment was offered to only 13.4% of patients, namely administration of antihistamines (n = 19, 6.4%) and analgesics (n = 12, 4.1%). Eight patients (2.7%) were mistreated with Bothrops antivenom before their admission to HVB. No sequels or relevant complications were observed in patients, and the prognostic was benign. Therefore, although P. patagoniensis accidents can cause mild local symptomatology, it is very important that health professionals know how to make the correct diagnosis to avoid unnecessary use of antivenom. (c) 2010 Elsevier Ltd. All rights reserved.

Management of pediatric snake bites: are we doing too much?

PubMed

Correa, Jesus A; Fallon, Sara C; Cruz, Andrea T; Grawe, Glenda H; Vu, Phong V; Rubalcava, Daniel M; Kaziny, Brent; Naik-Mathuria, Bindi J; Brandt, Mary L

2014-06-01

The optimal management of children with snake bite injuries is not well defined. The purpose of this study was to review the use of antivenom, diagnostic tests, and antibiotics in children bitten by venomous snakes in a specific geographic region (Southeast Texas). This is a retrospective single-center review of all patients with snake bite injury from 1/2006 to 6/2012. An envenomated bite was defined as causing edema, discoloration of the skin, necrosis, or systemic effects. The severity of injury was scored using a novel 4-point scale based on initial physical examination alone. One hundred fifty-one children (mean age 8.4±4.3years) were treated for a snake bite. There were no mortalities. Lower extremity injuries were most common (60%). Most bites were from copperheads (43%). Envenomation was evident in 82% (average wound score: 2.61±0.81). The median hospital stay for admitted patients (79%) was 2days (range 1-7). Four patients required surgery for complications of the snake bite. Fifty-two children (34%) received CroFab, with one allergic reaction. 22/135 (16%) had evidence of coagulopathy. Seventy-two children (48%) received IV antibiotics. Despite a high rate of envenomated bites in Southeast Texas, significant morbidity is rare. Children with an envenomation score of 1 or 2 are unlikely to be coagulopathic, suggesting that laboratory investigation should be reserved for patients with higher scores. The indications for the administration of CroFab deserve further prospective study. Copyright © 2014 Elsevier Inc. All rights reserved.

Neurotoxic envenoming by South American coral snake (Micrurus lemniscatus helleri): case report from eastern Ecuador and review.

PubMed

Manock, Stephen R; Suarez, German; Graham, David; Avila-Aguero, María L; Warrell, David A

2008-11-01

A man bitten by a large coral snake (Micrurus lemniscatus helleri) in the Amazon basin of Ecuador developed persistent excruciating pain in the bitten arm. On admission to hospital less than 30 min later, he had a polymorphonuclear leucocytosis, thrombocytopenia and mildly prolonged prothrombin time/partial thromboplastin time. Not until 14 h after the bite did he develop the first signs of neurotoxicity. Despite treatment with specific antivenom 50 h after the bite, he required oxygen for respiratory failure 60 h, and 6 h of mechanical ventilation 72 h, after the bite. Over the next 38 h, he required two further intubations and periods of assisted ventilation before being airlifted to a tertiary referral hospital. Complications included bacterial pneumonia, pneumothorax, bronchial obstruction by mucus plugs and mild rhabdomyolysis. He was discharged from hospital 15 days after the bite with persistent limb weakness and urinary incontinence but eventually recovered. The interesting and unusual features of this case (severe local pain, very slow evolution of neurotoxic envenoming, persistent thrombocytopenia and mild coagulopathy) are discussed in the context of what is known of the composition of Micrurus venoms and the small clinical literature on envenoming from their bites.

Factors affecting outcome in children with snake envenomation: a prospective observational study.

PubMed

Sankar, Jhuma; Nabeel, Rehana; Sankar, M Jeeva; Priyambada, Leena; Mahadevan, S

2013-08-01

To evaluate clinical outcome and factors affecting outcome in children with snake envenomation. Prospective observational study. Paediatric intensive care unit of a tertiary care teaching hospital in India. We prospectively enrolled children ≤12 years of age admitted to our hospital with a definitive history of snake bite from August 2007 to June 2010. Demographic characteristics and clinical course of the enrolled children were recorded in a structured proforma and analysed using appropriate statistical methods. Children were treated as per the WHO guidelines (2005) on the management of snake bite in children. Of 110 children studied, 77 (69%) were male. Most (72; 64.2%) had features predominantly of haematotoxic envenomation while 20 (18%) and 18 (16%) children had features of neurotoxic envenomation and local involvement, respectively. 14 children (13%) died and 13 (12%) had major disabilities. On univariable analysis, the following prehospital and admission variables were found to be significantly associated with poor outcome: age, walking for >1 km after the bite, vomiting, haemoglobin ≤10 g/dl at admission and species of snake (cobra). On multivariable analysis, only younger age (adjusted OR 0.85; 95% CI 0.7 to 0.9), walking for >1 km after the bite (adjusted OR 57; 95% CI 4.2 to 782) and haemoglobin ≤10 g/dl at admission (adjusted OR 6; 95% CI 2 to 18.2) remained significant. Younger age at presentation, anaemia (haemoglobin ≤10 g/dl) and distance walked after the bite may be independent predictors of mortality and morbidity in children with snake bite. These features in victims of snake bite warrant early referral to and management in tertiary care centres.

Ethnomedicinal uses of plants for the treatment of snake and scorpion bite in Northern Pakistan.

PubMed

Butt, Maryam Akram; Ahmad, Mushtaq; Fatima, Anam; Sultana, Shazia; Zafar, Muhammad; Yaseen, Ghulam; Ashraf, Muhammad Aqeel; Shinwari, Zabta Khan; Kayani, Sadaf

2015-06-20

Medicinal plants represent one of the most accessible resources available for snake and scorpion bite among the rural communities of Northern Pakistan. This first ethno-botanical study aimed to document the indigenous knowledge and practices of using plants for snake and scorpion bite disorders in Northern Pakistan. Ethno-medicinal data is documented from 187 informants using semi-structured interviews. The data is analyzed using quantitative ethno-botanical indices of frequency citation (FC) and relative Frequency of Citation (RFC). In addition to this, the ethno-medicinal findings of this survey were compared with 10 previous published studies in order to report novel uses of medicinal plants against snake and scorpion bite disorders. In total 62 medicinal plants belonging to 40 families are reported against snake and scorpion bite in this study. Our results showed that Asteraceae is the most used family (10 species), dominant life form is herb (48.38%), leaves were the most used plants part (18 Use-reports) and the paste is most used method of administration (22 reports). The range of RFC was 0.08-0.27 about the use of documented species. Compared to previous published studies, 33.87% similarity index while 66.12% novelty index is reported. About 40 plant species are first time reported with medicinal uses against snake and scorpion bite from Northern Pakistan. This study presents useful traditional knowledge of rural communities for the control of snake and scorpion bite using medicinal plants. The study mainly focused on ethno-medicinal documentation to preserve the valuable traditional knowledge that can be used in future phytochemical and pharmacological studies on medicinal plants of the area. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Severe rhabdomyolysis from red-bellied black snake (Pseudechis porphyriacus) envenoming despite antivenom.

PubMed

Lim, Adeline Y L; Singh, Puneet N; Isbister, Geoffrey K

2016-07-01

Envenoming by the Australian red-bellied black snake (Pseudechis porphyriacus) causes non-specific systemic symptoms, anticoagulant coagulopathy, myotoxicity and local effects. Current management for systemic envenoming includes administration of one vial of tiger snake antivenom within 6 h of the bite to prevent myotoxicity. We present a case of severe rhabdomyolysis in a 16 year old male which developed despite early administration of one vial of tiger snake antivenom. Free venom was detected after the administration of antivenom concurrent with rapidly decreasing antivenom concentrations. The case suggests that insufficient antivenom was administered and the use of larger doses of antivenom need to be explored for red-bellied black snake envenoming. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hugh Alistair Reid OBE MD: investigation and treatment of snake bite.

PubMed

Hawgood, B J

1998-03-01

Alistair Reid was an outstanding clinician, epidemiologist and scientist. At the Penang General Hospital, Malaya, his careful observation of sea snake poisoning revealed that sea snake venoms were myotoxic in man leading to generalized rhabdomyolysis, and were not neurotoxic as observed in animals. In 1961, Reid founded and became the first Honorary Director of the Penang Institute of Snake and Venom Research. Effective treatment of sea snake poisoning required specific antivenom which was produced at the Commonwealth Serum Laboratories in Melbourne from Enhydrina schistosa venom supplied by the Institute. From the low frequency of envenoming following bites, Reid concluded that snakes on the defensive when biting man seldom injected much venom. He provided clinical guidelines to assess the degree of envenoming, and the correct dose of specific antivenom to be used in the treatment of snake bite in Malaya. Reid demonstrated that the non-clotting blood of patients bitten by the pit viper, Calloselasma rhodostoma [Ancistrodon rhodostoma] was due to venom-induced defibrination. From his clinical experience of these patients, Reid suggested that a defibrinating derivative of C. rhodostoma venom might have a useful role in the treatment of deep vein thrombosis. This led to Arvin (ancrod) being used clinically from 1968. After leaving Malaya in 1964, Alistair Reid joined the staff of the Liverpool School of Tropical Medicine, as Senior Lecturer. Enzyme-linked immunosorbent assay (ELISA) for detecting and quantifying snake venom and venom-antibody was developed at the Liverpool Venom Research Unit: this proved useful in the diagnosis of snake bite, in epidemiological studies of envenoming patterns, and in screening of antivenom potency. In 1977, Dr H. Alistair Reid became Head of the WHO Collaborative Centre for the Control of Antivenoms based at Liverpool.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report.

PubMed

Strauch, Marcelo Abrahão; Souza, Guilherme Jones; Pereira, Jordana Nahar; Ramos, Tyelli Dos Santos; Cesar, Marcelo Oliveira; Tomaz, Marcelo Amorim; Monteiro-Machado, Marcos; Patrão-Neto, Fernando Chagas; Melo, Paulo A

2018-01-01

Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus , which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.

Red-bellied black snake (Pseudechis porphyriacus) envenomation in the dog: Diagnosis and treatment of nine cases.

PubMed

Padula, Andrew M; Winkel, Kenneth D

2016-07-01

The clinical signs, biochemical changes and serum and urine venom concentrations for a series of nine cases of Red bellied black snake [RBBS] (Pseudechis porphyriacus) envenomation in eight dogs seen in a regional Australian veterinary hospital are described. Although the resulting envenomation syndrome was, in most cases, relatively mild and responded rapidly to intravenous administration of a novel bivalent caprylic acid purified whole IgG equine antivenom for tiger (Notechis scutatus) and brown snake (Pseudonaja textilis), one fatality prior to antivenom treatment was recorded. The latter case occurred within 1 h of envenomation prior to receiving antivenom treatment. Intravascular haemolysis, pigmenturia, bite site swelling, lethargy, and generally mild coagulopathy were present in most cases. Detectable RBBS venom specific components were found in serum, bite site swab or urine using a standard sandwich ELISA approach. Serum levels fell within the range previously reported for human RBBS envenomation cases (6-79 ng/ml) whilst bite site and urine samples varied more markedly (8.2 to >5000 ng/ml and 2.2-1300 ng/ml respectively). No venom was detected from serum after antivenom treatment. The envenomation syndrome in dogs is similar to what is described for humans, with the exception of the presence of potentially severe venom induced consumption coagulopathy in one case (aPTT > 300 s and fibrinogen < 0.43 g/L) and potential for fatal outcomes. This series represents the largest and most detailed examination of RBBS envenomation in animals yet reported. It reinforces the emerging view that the potential severity of this envenomation has been underappreciated by veterinary practitioners and highlights the possibility of severe venom induced consumption coagulopathy in canine cases. Copyright © 2016 Elsevier Ltd. All rights reserved.

[A case of favourable outcome of severe acute intoxication with an animal poison after a bite by the monocled cobra].

PubMed

Livanov, G A; Batotsyrenkov, B V; Lodiagin, A N; Andrianov, A Iu; Kuznetsov, O A; Loladze, A T; Baranov, D V

2014-01-01

This paper reports a case of severe acute intoxication with an animal poison after a bite by the monocled cobra. Combined treatment including artificial lung ventilation, infusion-detoxication and desensitizing (hormonal) therapy, hemosorption, correction of metabolic disorders with cytoflavin, antibacterial therapy had positive effect on the patient's condition and ensured the favourable outcome ofpotentially lethal poisoning without the use ofa specific anti-snake venom serum.

Texas coral snake (Micrurus tener) bites.

PubMed

Morgan, David L; Borys, Douglas J; Stanford, Rhandi; Kjar, Dean; Tobleman, William

2007-02-01

The clinical features of bites from Texas coral snakes (Micrurus tener) have not been well studied. Our goal was to review the largest number of victims of Texas coral snakebites to determine their characteristics, effects, treatment, and outcome. Retrospective case series of Micrurus tener exposures reported to the Texas Poison Center Network from 2000 to 2004. Eighty-two patients were included in the analysis. Most (57.3%) were 18 to 49-year-old men. Almost 90% had local swelling, pain, erythema, or paresthesias. Only 7.3% had systemic effects, and none of these were severe. Over half received coral snake antivenin, and 15.9% were given opioids for pain. No patient died and no patient required mechanical ventilation due to hypoventilation from the snakebite. There were more local findings and less severe systemic effects than previously reported. Antivenin is not needed for most of these patients, and opioids may be administered safely.

Enhydrina schistosa (Elapidae: Hydrophiinae) the most dangerous sea snake in Sri Lanka: three case studies of severe envenoming.

PubMed

Kularatne, S A M; Hettiarachchi, R; Dalpathadu, J; Mendis, A S V; Appuhamy, P D S A N; Zoysa, H D J; Maduwage, K; Weerasinghe, V S; de Silva, A

2014-01-01

Sea snakes are highly venomous and inhabit tropical waters of the Indian and Pacific Oceans. Enhydrina schistosa is a common species of sea snake that lives in the coastal waters, lagoons, river mouths and estuaries from the Persian Gulf through Sri Lanka and to Southeast Asia. It is considered one of the most aggressive sea snakes in Sri Lanka where fishermen and people wading are at high risk. However, sea snake bites are rarely reported. In this report, we describe three cases where E. schistosa was the offending species. These three patients presented to two hospitals on the west coast of Sri Lanka within the course of 14 months from November 2011 with different degrees of severity of envenoming. The first patient was a 26-year-old fisherman who developed severe myalgia with very high creatine kinase (CK) levels lasting longer than 7 days. The second patient was a 32-year-old fisherman who developed gross myoglobinuria, high CK levels and hyperkalaemia. Both patients recovered and their electromyographic recordings showed myopathic features. The nerve conduction and neuromuscular transmission studies were normal in both patients suggesting primary myotoxic envenoming. The third patient was a 41-year-old man who trod on a sea snake in a river mouth and developed severe myalgia seven hours later. He had severe rhabdomyolysis and died three days later due to cardiovascular collapse. In conclusion, we confirm that E. schistosa is a deadly sea snake and its bite causes severe rhabdomyolysis. Copyright © 2013 Elsevier Ltd. All rights reserved.

Sensationalistic journalism and tales of snakebite: are rattlesnakes rapidly evolving more toxic venom?

PubMed

Hayes, William K; Mackessy, Stephen P

2010-03-01

Recent reports in the lay press have suggested that bites by rattlesnakes in the last several years have been more severe than those in the past. The explanation, often citing physicians, is that rattlesnakes are evolving more toxic venom, perhaps in response to anthropogenic causes. We suggest that other explanations are more parsimonious, including factors dependent on the snake and factors associated with the bite victim's response to envenomation. Although bites could become more severe from an increased proportion of bites from larger or more provoked snakes (ie, more venom injected), the venom itself evolves much too slowly to explain the severe symptoms occasionally seen. Increased snakebite severity could also result from a number of demographic changes in the victim profile, including age and body size, behavior toward the snake (provocation), anatomical site of bite, clothing, and general health including asthma prevalence and sensitivity to foreign antigens. Clinical management of bites also changes perpetually, rendering comparisons of snakebite severity over time tenuous. Clearly, careful study taking into consideration many factors will be essential to document temporal changes in snakebite severity or venom toxicity. Presently, no published evidence for these changes exists. The sensationalistic coverage of these atypical bites and accompanying speculation is highly misleading and can produce many detrimental results, such as inappropriate fear of the outdoors and snakes, and distraction from proven snakebite management needs, including a consistent supply of antivenom, adequate health care, and training. We urge healthcare providers to avoid propagating misinformation about snakes and snakebites. Copyright (c) 2010 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

[Exotic snakes in Europe. A case of Mexican Moccasin (Agkistrodon bilineatus) snakebite].

PubMed

Lonati, Davide; Butera, Raffaella; Cima, Mauro; Cozzio, Susanna; Locatelli, Carlo; Manzo, Luigi

2004-12-18

In the last years exotic snakebite envenomations are increasingly reported. These cases are difficult to manage because of the limited experience of European physicians in the treatment of bites from such venomous snakes; moreover, specific antivenoms are unevenly stocked and they are difficult to find in case of a medical emergency. A 39-year-old herpetologist was bitten in his right hand by a mexican moccasin (Agkistrodon bilineatus) at the workplace, and presented in the Emergency Department 19 hours later. At admission, clinical evaluation showed local necrosis, swelling involving the entire limb up to the trunk, and severe pain. The specific antidote, not stocked in Italy, was sought abroad; its finding and routeing up to spot delivery required 12 hours. The antivenom, given 32 hours after the bite with no adverse reactions, was only partially effective. The clinical course was characterized by extensive edema with rhabdomyolysis. The necrotic wound at the bite site required after several days surgical debridement, and eventually skin graft. At 3 months follow-up, motor impairment of his right hand fingers with functional disability was still present. The envenomation by Agkistrodon bilineatus has some clinical aspects in common with that by European viper species, although crotalid venom usually causes more severe manifestations. The antivenom supply from a foreign country may delay its administration. A specific legislation aimed to simplify antidotes importing procedures for professional snake handlers may improve antivenoms availability and allow their timely use, as soon as clinically indicated.

Bites by the Monocled Cobra, Naja kaouthia, in Chittagong Division, Bangladesh: Epidemiology, Clinical Features of Envenoming and Management of 70 Identified Cases

PubMed Central

Faiz, M. A.; Ahsan, M. F.; Ghose, A.; Rahman, M. R.; Amin, R.; Hossain, M.; Tareq, M. N. U.; Jalil, M. A.; Kuch, U.; Theakston, R. D. G.; Warrell, D. A.; Harris, J. B.

2017-01-01

We describe 70 cases of monocled cobra (Naja kaouthia) bite admitted to Chittagong Medical College Hospital, Bangladesh. The biting snakes were identified by examining the dead snake and/or detecting N. kaouthia venom antigens in patients' serum. Bites were most common in the early morning and evening during the monsoon (May–July). Ligatures were routinely applied to the bitten limb before admission. Thirty-seven patients consulted traditional healers, most of whom made incisions around the bite site. Fifty-eight patients experienced severe neurotoxicity and most suffered swelling and pain of the bitten limb. The use of an Indian polyvalent antivenom in patients exhibiting severe neurotoxicity resulted in clinical improvement but most patients experienced moderate-to-severe adverse reactions. Antivenom did not influence local blistering and necrosis appearing in 19 patients; 12 required debridement. Edrophonium significantly improved the ability of patients to open the eyes, endurance of upward gaze, and peak expiratory flow rate suggesting that a longer-acting anticholinesterase drug (neostigmine) could be recommended for first aid. The study suggested that regionally appropriate antivenom should be raised against the venoms of the major envenoming species of Bangladesh and highlighted the need to improve the training of staff of local medical centers and to invest in the basic health infrastructure in rural communities. PMID:28138054

Snake bite: coral snakes.

PubMed

Peterson, Michael E

2006-11-01

North American coral snakes are distinctively colored beginning with a black snout and an alternating pattern of black, yellow, and red. They have fixed front fangs and a poorly developed system for venom delivery, requiring a chewing action to inject the venom. The severity of a coral snake bite is related to the volume of venom injected and the size of the victim. The length of the snake correlates positively with the snakes venom yield. Coral snake venom is primarily neurotoxic with little local tissue reaction or pain at the bite site. The net effect of the neurotoxins is a curare like syndrome. In canine victims there have been reports of marked hemolysis with severe anemia and hemoglobinuria. The onset of clinical signs may be delayed for as much as 10 to 18 hours. The victim begins to have alterations in mental status and develops generalized weakness and muscle fasciculations. Progression to paralysis of the limbs and respiratory muscles then follows. The best flied response to coral snake envenomation is rapid transport to a veterinary medical facility capable of 24 hour critical care and assisted ventilation. First aid treatment advocated in Australia for Elapid bites is the immediate use of a compression bandage. The victim should be hospitalized for a minimum of 48 hours for continuous monitoring. The only definitive treatment for coral snake envenomation is the administration of antivenin (M. fulvius). Once clinical signs of coral snake envenomation become manifest they progress with alarming rapidity and are difficult to reverse. If antivenin is not available or if its administration is delayed, supportive care includes respiratory support. Assisted mechanical ventilation can be used but may have to be employed for up to 48 to 72 hours.

Envenomation by the red-tailed coral snake (Micrurus mipartitus) in Colombia.

PubMed

Cañas, Carlos A; Castro-Herrera, Fernando; Castaño-Valencia, Santiago

2017-01-01

Although the red-tailed coral snake ( Micrurus mipartitus ) is widely distributed in Colombia and its venom is highly neurotoxic and life threatening, envenomation by this species is rare. Therefore, this report may shed some light on the clinical presentation of M. mipartitus bites. Herein, we describe two cases of patients bitten by red-tailed coral snakes, illustrating the clinical presentation of the victims, the outcomes and treatment provided. Envenomation caused by M. mipartitus provokes predicable neurotoxicity, and its treatment should be based on respiratory support and use of specific antivenom.

Kenyan medicinal plants used as antivenin: a comparison of plant usage

PubMed Central

Owuor, Bethwell O; Kisangau, Daniel P

2006-01-01

The success of snake bite healers is vaguely understood in Kenya, partly due to their unknown materia medica and occult-mystical nature of their practice. A comparison is made of plants used in snake bite treatments by two culturally distinct African groups (the Kamba and Luo). Thirty two plants used for snakebite treatment are documented. The majority of the antidotes are prepared from freshly collected plant material – frequently leaves. Though knowledge of snake bite conditions etiological perceptions of the ethnic groups is similar, field ethnobotanical data suggests that plant species used by the two ethnic groups are independently derived. Antivenin medicinal plants effectively illustrate the cultural context of medicine. Randomness or the use of a variety of species in different families appears to be a feature of traditional snake bite treatments. A high degree of informant consensus for the species was observed. The study indicates rural Kenya inhabitants rely on medicinal plants for healthcare. PMID:16451723

A season of snakebite envenomation: presentation patterns, timing of care, anti-venom use, and case fatality rates from a hospital of southcentral Nepal

PubMed Central

Pandey, Deb P; Vohra, Rais; Stalcup, Philip; Shrestha, Bhola R

2016-01-01

Snakebite envenomation affects thousands of people annually in Nepal. Published hospital-based studies of snakebite treatment in Nepal are scarce. Here we present the results of the first prospective, cross-sectional study of hospitalized envenomed snakebite cases in southcentral Nepal, a region characterized by poor pre-hospital care of snakebites, limited supply and excessive use of antivenom, and a high case/fatality ratio. We seek to identify clinical management problems and suggest potential interventions to improve treatment of snakebites. Out of the 342 patients presented with snakebites to an urban emergency department in the Terai region of Nepal between April and September of 2007, 39 patients were enrolled based on development of ptosis or swelling of bitten body parts. We collected patient demographic information and documented circumstances of snakebite, prehospital care, hospital care, and development of complications. Among 39 envenomated patients admitted to Bharatpur Hospital enrolled in the study 34 (92%) exhibited features of clinically significant neurotoxicity and were treated with antivenom. Antivenom use ranged from 4 to 98 vials of Polyspecific Indian Antivenom per patient. Each of victims (n=34) received antivenom an average of 4.3 (median) ±0.73 (standard error of mean) hours after receiving the snakebite. The overall case fatality rate was 21%. Neurotoxicity developed up to 25.8hr after suspected elapid snakebites. This was not observed for viperid snake bites. No enrolled patients received any of the currently recommended first aid for snake bite. The prevalence of nocturnal elapid snake bites, the practice of inappropriate first aid measures and highly variable administration of antivenom were identified as major challenges to appropriate care in this study. To address these issues we suggest development of a comprehensive checklist for identification of snake species, management of envenomation, and an educational program which teaches proper care at all stages of snakebite treatment. PMID:26998219

TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES.

PubMed

Walker-Meikle, Kathleen

2014-12-01

By end of the thirteenth century, surgeons and university-trained physicians in Western Europe had a plethora of authorities from the Greco-Roman and Arabic tradition from which to consult for the treatment of snake-bites. Venomous animals receive the largest share of attention in the literature on biting animals. Nearly all of the sources focus on the idea of the animal biting or puncturing the skin's surface with their mouths and few poisonous animals where the venom is passed on through the skin or hairs are mentioned. Venomous animals frequently appear in discussions on poisons in general, with poisons of animal, mineral or vegetable origin. The bulk of the discourse dealt with venomous snakes and rabid dogs, the latter considered venomous due to its 'poisonous' saliva, and to a lesser extent, scorpions and spiders. In general the bites of non-venomous animals received scant attention. Unlike modern taxonomical categories, medieval categories for animals were usually connected to the movement or the locale of the animal: flying animals, animals in water, land animals (which mainly covered quadrupeds), and crawling animals. It is in the latter category that snakes were located, along with lizards.

TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES

PubMed Central

WALKER-MEIKLE, KATHLEEN

2015-01-01

By end of the thirteenth century, surgeons and university-trained physicians in Western Europe had a plethora of authorities from the Greco-Roman and Arabic tradition from which to consult for the treatment of snake-bites. Venomous animals receive the largest share of attention in the literature on biting animals. Nearly all of the sources focus on the idea of the animal biting or puncturing the skin’s surface with their mouths and few poisonous animals where the venom is passed on through the skin or hairs are mentioned. Venomous animals frequently appear in discussions on poisons in general, with poisons of animal, mineral or vegetable origin. The bulk of the discourse dealt with venomous snakes and rabid dogs, the latter considered venomous due to its ‘poisonous’ saliva, and to a lesser extent, scorpions and spiders. In general the bites of non-venomous animals received scant attention. Unlike modern taxonomical categories, medieval categories for animals were usually connected to the movement or the locale of the animal: flying animals, animals in water, land animals (which mainly covered quadrupeds), and crawling animals. It is in the latter category that snakes were located, along with lizards. PMID:25729094

Performance of the 20-minute whole blood clotting test in detecting venom induced consumption coagulopathy from Russell's viper (Daboia russelii) bites.

PubMed

Ratnayake, Indira; Shihana, Fathima; Dissanayake, Dhammika M; Buckley, Nicholas A; Maduwage, Kalana; Isbister, Geoffrey K

2017-02-28

The 20-minute whole blood clotting test (WBCT20) is used as a bedside diagnostic test for coagulopathic snake envenoming. We aimed to assess the performance of the WBCT20 in diagnosis of venom induced consumption coagulopathy (VICC) in Russell's viper envenoming. Adult patients admitted with suspected snake bites were recruited from two hospitals. WBCT20 and prothrombin time (PT) test were performed on admission. WBCT20 was done by trained clinical research assistants using 1 ml whole blood in a 5 ml borosilicate glass tube with a 10 mm internal diameter. The PT was measured by a semi-automated coagulation system and international normalised ratio (INR) calculated. VICC was defined as present if the INR was >1.4. The diagnostic utility of WBCT20 was determined by calculating the sensitivity and specificity of the WBCT20 on admission for detecting VICC. There were 987 snake bites where both WBCT20 and PT were done on admission samples. This included 79 patients (8 %) with VICC. The WBCT20 was positive in 65/79 patients with VICC (sensitivity 82 %; 95 % confidence interval [CI]: 72-90 %) and was falsely positive in 13/908 with no coagulopathy. The WBCT20 was negative in 895/908 snake bites with no coagulopathy (specificity: 98 % 95 % CI: 97-99 %) and was falsely negative in 14/79 with VICC. Using trained clinical staff, the WBCT20 test had a relatively good sensitivity for the detection of VICC, but still missed almost one fifth of cases where antivenom was potentially indicated.

"Too good to be true": the controversy over the use of permanganate of potash as an antidote to snake poison and the circulation of Brazilian physiology in the nineteenth century.

PubMed

Vimieiro Gomes, Ana Carolina

2012-01-01

This article examines an international controversy over the most visible scientific event of Brazilian physiology in the nineteenth century. In 1881, Brazilian scientist João Baptista Lacerda stated that he had found an efficient antidote to the poison of Brazilian snakes: permanganate of potash (nowadays, potassium permanganate). His findings were given great publicity in Brazil and traveled rapidly around the world. Scientists, especially in France, contradicted Lacerda's claims. They argued that permanganate of potash could not be a genuine antidote to snake bites since it could not neutralize snake venom when diffused in the body. Lacerda turned down such criticism, claiming that clinical observation provided solid evidence for the drug's local action, on the spot surrounding the bite. The controversy over the use of permanganate of potash as an antidote to snake bite illustrates different regimes of proof that could be mobilized in favor of a physiological discovery.

[The problem of intoxication in the population of the Republic of Guinea due to venomous snake bites].

PubMed

Bal'de, M S; Konstantinov, O K; Kamara, S K

2006-01-01

Intoxication of the population of Guinea due to venomous snake bites (100-150 intoxications per 100,000 with an 18% mortality rate) is a serious public health problem in the Republic of Guinea. Guinea's fauna of venomous snakes is diverse and numbers 20 species that are dangerous to human beings. The representatives of the family Elapidae (cobras and mambas) whose venom is highly toxic (LD50 5-12 mg) are responsible for the bulk (59.6%) of their bites. There has been recently an increase in the number of deaths from venomous snake bites, as high as 60% of the patients consulting a doctor being notified in one of the prefectures. At the same time the situation associated with the availability of antisnake serum is critical in the country due to its minute amount and to the inaccessibility of its high prices. By taking into account the great demand for the serum in Guinea, as everywhere over West Africa (thousands of doses every year), its manufacture may be profitable for potential investors and partners of the Pasteur Institute of Guinea.

Snake bites

MedlinePlus

... larger. Southeast Asia, India, Brazil, and areas of Africa have the most deaths due to snakebite. Considerations ... of the following: Cobra Copperhead Coral snake Cottonmouth (water moccasin) Rattlesnake Various snakes found at zoos Most ...

Snake Envenomation Causing Distant Tracheal Myonecrosis

PubMed Central

Khimani, Amina; Mcnierney, Afton; Surani, Sara; Surani, Salim

2013-01-01

Snakebites are often believed to be poisonous. However, this is not always the case. In fact, each bite differs from snake to snake, depending on if the snake is poisonous and if there is envenomation. Venom in pit viper snakebites is often associated with local necrosis. The abundant literature selections and research articles justify local myonecrosis due to envenomation, but there is not much in the literature regarding myonecrosis at a site distant from the snakebite. We hereby present a case of a 42-year-old man who was transferred to our emergency department after a rattlesnake bit him twice. The patient, besides developing local myonecrosis at the site of the snakebite, developed necrosis of the scrotum as well as tracheal pressure myonecrosis at the site of the endotracheal tube balloon. In this review, we will attempt to discuss the myonecrosis pathophysiology and management related to the rattle snakebite. PMID:24083047

Acute Tetraplegia Caused by Rat Bite Fever in Snake Keeper and Transmission of Streptobacillus moniliformis

PubMed Central

Eisenberg, Tobias; Poignant, Simon; Jouan, Youenn; Fawzy, Ahmad; Nicklas, Werner; Ewers, Christa; Mereghetti, Laurent

2017-01-01

We report acute tetraplegia caused by rat bite fever in a 59-year old man (snake keeper) and transmission of Streptobacillus moniliformis. We found an identical characteristic bacterial pattern in rat and human samples, which validated genotyping-based evidence for infection with the same strain, and identified diagnostic difficulties concerning infection with this microorganism. PMID:28322713

[An overview on envenomings inflicted by the Common adder (Vipera berus) and their treatment in Hungary. Facts and beliefs -- part I].

PubMed

Malina, Tamás; Babocsay, Gergely; Krecsák, László; Schuller, Péter; Zacher, Gábor; Vasas, Gábor

2012-07-15

Consequences of bites by the Common adder (Vipera berus) were reviewed in this study. Patients bitten by snakes from different populations may develop variable symptoms due to geographical venom variation. The correct diagnosis of snake bites and the knowledge of the distribution of venomous snake taxa have a crucial impact on snake bite therapy. The characteristic symptoms of patients bitten by V. berus in Hungary are highlighted. The habitat characteristics, seasonal activity and the Hungarian distribution of the adder are described based on literature data, museum specimens and field observations. However, envenomings are uncommon in Hungary, the annual 3 to 4 incidents have to be taken seriously, regardless of the age and actual health condition of the patients. Contrary to beliefs persisting both among laymen and professionals, the venom of V. berus is powerful. Medical observation of the patients is necessary in the first 5 to 6 hours. Any systemic symptom or progression of the edema requires hospital admission.

Evaluation of the Lethal Potency of Scorpion and Snake Venoms and Comparison between Intraperitoneal and Intravenous Injection Routes

PubMed Central

Oukkache, Naoual; Jaoudi, Rachid El; Ghalim, Noreddine; Chgoury, Fatima; Bouhaouala, Balkiss; Mdaghri, Naima El; Sabatier, Jean-Marc

2014-01-01

Scorpion stings and snake bites are major health hazards that lead to suffering of victims and high mortality. Thousands of injuries associated with such stings and bites of venomous animals occur every year worldwide. In North Africa, more than 100,000 scorpion stings and snake bites are reported annually. An appropriate determination of the 50% lethal doses (LD50) of scorpion and snake venoms appears to be an important step to assess (and compare) venom toxic activity. Such LD50 values are also commonly used to evaluate the neutralizing capacity of specific anti-venom batches. In the present work, we determined experimentally the LD50 values of reference scorpion and snake venoms in Swiss mice, and evaluated the influence of two main venom injection routes (i.e., intraperitoneal (IP) versus intravenous (IV)). The analysis of experimental LD50 values obtained with three collected scorpion venoms indicates that Androctonus mauretanicus (Am) is intrinsically more toxic than Androctonus australis hector (Aah) species, whereas the latter is more toxic than Buthus occitanus (Bo). Similar analysis of three representative snake venoms of the Viperidae family shows that Cerastes cerastes (Cc) is more toxic than either Bitis arietans (Ba) or Macrovipera lebetina (Ml) species. Interestingly, the venom of Elapidae cobra snake Naja haje (Nh) is far more toxic than viper venoms Cc, Ml and Ba, in agreement with the known severity of cobra-related envenomation. Also, our data showed that viper venoms are about three-times less toxic when injected IP as compared to IV, distinct from cobra venom Nh which exhibited a similar toxicity when injected IP or IV. Overall, this study clearly highlights the usefulness of procedure standardization, especially regarding the administration route, for evaluating the relative toxicity of individual animal venoms. It also evidenced a marked difference in lethal activity between venoms of cobra and vipers, which, apart from the nature of toxins, might be attributed to the rich composition of high molecular weight enzymes in the case of viper venoms. PMID:24926799

Evaluation of the lethal potency of scorpion and snake venoms and comparison between intraperitoneal and intravenous injection routes.

PubMed

Oukkache, Naoual; El Jaoudi, Rachid; Ghalim, Noreddine; Chgoury, Fatima; Bouhaouala, Balkiss; Mdaghri, Naima El; Sabatier, Jean-Marc

2014-06-12

Scorpion stings and snake bites are major health hazards that lead to suffering of victims and high mortality. Thousands of injuries associated with such stings and bites of venomous animals occur every year worldwide. In North Africa, more than 100,000 scorpion stings and snake bites are reported annually. An appropriate determination of the 50% lethal doses (LD₅₀) of scorpion and snake venoms appears to be an important step to assess (and compare) venom toxic activity. Such LD₅₀ values are also commonly used to evaluate the neutralizing capacity of specific anti-venom batches. In the present work, we determined experimentally the LD₅₀ values of reference scorpion and snake venoms in Swiss mice, and evaluated the influence of two main venom injection routes (i.e., intraperitoneal (IP) versus intravenous (IV)). The analysis of experimental LD₅₀ values obtained with three collected scorpion venoms indicates that Androctonus mauretanicus (Am) is intrinsically more toxic than Androctonus australis hector (Aah) species, whereas the latter is more toxic than Buthus occitanus (Bo). Similar analysis of three representative snake venoms of the Viperidae family shows that Cerastes cerastes (Cc) is more toxic than either Bitis arietans (Ba) or Macrovipera lebetina (Ml) species. Interestingly, the venom of Elapidae cobra snake Naja haje (Nh) is far more toxic than viper venoms Cc, Ml and Ba, in agreement with the known severity of cobra-related envenomation. Also, our data showed that viper venoms are about three-times less toxic when injected IP as compared to IV, distinct from cobra venom Nh which exhibited a similar toxicity when injected IP or IV. Overall, this study clearly highlights the usefulness of procedure standardization, especially regarding the administration route, for evaluating the relative toxicity of individual animal venoms. It also evidenced a marked difference in lethal activity between venoms of cobra and vipers, which, apart from the nature of toxins, might be attributed to the rich composition of high molecular weight enzymes in the case of viper venoms.

Blindness and scalp haematoma in a child following a snakebite.

PubMed

Katibi, Oludolapo Sherifat; Adepoju, Feyiyemi Grace; Olorunsola, Benedict Oluwasesan; Ernest, Samuel Kolade; Monsudi, Kehinde Fasasi

2015-09-01

Snake envenomation is a major public health problem of the Savannah regions of West Africa. Ocular manifestations of snakebites are rare with few reports documenting blindness as a complication. To highlight an unusual manifestation of snake bites and its attendant problems. A report of scalp haematoma and blindness in a 10 year old child presenting 2 weeks after a snake bite (presumably carpet viper) is a rare manifestation. Local swelling, epistaxis, bilateral proptosis, exposure keratopathy and use of traditional eye medications were associated findings. Anti-venom though administered late saved the child's life but blindness could not be reversed. Ocular ultrasonography revealed layered retrobulbar collection in the left eye, presumably due to hemorrhage. The skull x-ray showed a soft tissue swelling and aspirate from scalp swelling was bloody. Cranial Computed Tomography (CT) scan done late detected no abnormalities. Snakebite is associated with lifelong morbidity. Ocular manifestations must be treated as emergency. This case highlights the effect of ignorance and poverty in a setting of a common medical emergency leading to blindness and reduced quality of life.

North American Snake Envenomation.

PubMed

Corbett, Bryan; Clark, Richard F

2017-05-01

Native US snakes that produce clinically significant envenomation can be divided into 2 groups, crotalids and elapids. The crotalids include rattlesnakes, cottonmouths, and copperheads. Crotalid envenomation can result in significant local tissue damage as well as thrombocytopenia and coagulopathy. Rarely are bites fatal. Native US elapids are all coral snakes that possess neurotoxic venom that can cause weakness, respiratory paralysis, and rarely death. Treatment of both types of envenomation revolves around general supportive care and antivenom administration when indicated. Previously advocated treatments, such as tourniquets, venom extraction, and bite site excision are not recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

Misidentification of copperhead and cottonmouth snakes following snakebites.

PubMed

Cox, Robert D; Parker, Christina S; Cox, Erin C E; Marlin, Michael B; Galli, Robert L

2018-05-24

Copperhead (Agkistrodon contortrix) and cottonmouth or water moccasin (Agkistrodon piscivorus) snakes account for the majority of venomous snakebites in the southern United States. Cottonmouth snakes are generally considered to have more potent venom. Copperheads are considered less venomous and there is some controversy as to whether or not bites from copperhead snakes need to be treated with antivenom. Copperhead and juvenile cottonmouth snakes are both brown in color. The purpose of this study was to evaluate the accuracy of identification by the public and healthcare providers between these two species. Snakebite victims sometimes bring dead snakes to the hospital or have taken pictures of the snake. When this occurred, ED personnel were asked to take a picture of the snake, and forward the picture to the state poison control center. The identification of the snake by witnesses and/or hospital personnel was compared to the identification by the state herpetologist. During the study period, there were 286 cases of snakebites reported to the state poison control center. Pictures were obtained on 49 of the responsible snakes. All copperhead snakes were identified correctly by callers. However, only 21% of cottonmouth snakes were identified correctly, with 74% of cottonmouth snakes being identified as copperheads. Both public and medical personnel performed poorly on identification of cottonmouth snakes. Forty percent of the snakes identified as copperheads were actually cottonmouth snakes. Juvenile cottonmouth snakes were often identified as copperhead snakes.

Incidence and characteristics of snakebite envenomations in the New York state between 2000 and 2010.

PubMed

Joslin, Jeremy D; Marraffa, Jeanna M; Singh, Harinder; Mularella, Joshua

2014-09-01

We sought to evaluate the incidence of reported venomous snakebites in the state of New York between 2000 and 2010. Data were collected retrospectively from the National Poison Data System (NPDS) and then reviewed for species identification and clinical outcome while using proxy measures to determine incidence of envenomation. From 2000 to 2010 there were 473 snakebites reported to the 5 Poison Control Centers in the state of New York. Venomous snakes accounted for 14.2% (67 of 473) of these bites. Only 35 bites (7%) required antivenom. The median age of those bitten by a venomous snake was 33. Most victims were male. Although not rare, venomous snakebites do not occur commonly in New York State, with a mean of just 7 bites per year; fortunately most snakebites reported are from nonvenomous snakes. Yet even nonvenomous bites have the potential to cause moderately severe outcomes. Medical providers in the state should be aware of their management. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

A definite bite by the Ornamental Snake (Denisonia maculata) causing mild envenoming.

PubMed

Isbister, Geoffrey K; Gault, Alan; Tasoulis, Theo; O'Leary, Margaret A

2016-03-01

Many bites from mildly venomous elapids occur but identification or presence of systemic envenoming is rarely confirmed. To confirm systemic envenoming and binding of venom components to a commercial antivenom in a definite bite by the Ornamental Snake (Denisonia maculata) using enzyme immunoassays. A 9-year old boy was bitten by an identified Ornamental Snake. He developed nausea, vomiting, local pain, and swelling. He had a leucocytosis (white cell count, 20.8 × 10(9)/L), an elevated international normalised ratio (INR) of 1.6, but otherwise normal blood tests including D-Dimer and activated partial thromboplastin time. He was treated with Australian Black Snake antivenom because the commercial venom detection kit was positive for Black snake. He was admitted for 36 h with continuing local pain and swelling requiring parenteral analgesia. Blood samples were collected with informed consent for measurement of venom and antivenom concentrations. Venom-specific enzyme immunoassays were developed using the closely related D. devisi venom with Rabbit anti-Notechis (Tiger Snake) and anti-Tropidechis (Rough-scaled Snake) IgG antibodies to detect venom in serum. Standard curves for measured venom versus actual venom concentrations were made to interpolate Denisonia venom concentrations. In vitro procoagulant and anticoagulant activity of venom was assayed. Denisonia venom was detected in the pre-antivenom sample as 9.6 ng/mL D. devisi venom. No antigenic venom components were detected in post-antivenom samples and there were high antivenom concentrations. D. devisi venom had mild in vitro procoagulant activity with a minimum concentration required to clot after 5 min of 2.5-5 μg/mL and even weaker anticoagulant activity. Denisonia bites appear to cause local effects and possibly mild systemic envenoming (with only non-specific systemic symptoms and leucocytosis), confirmed by detection of antigenic venom components in blood. A significant coagulopathy does not appear to occur.

Do Herbal Medicines Have Potential for Managing Snake Bite Envenomation?

PubMed Central

Gupta, Y. K.; Peshin, S. S.

2012-01-01

Snake envenomation is a global public health problem, with highest incidence in Southeast Asia. Inadequate health services, difficult transportation and consequent delay in antisnake venom administration are the main reasons for high mortality. Adverse drug reactions and inadequate storage conditions limit the use of antisnake venom. The medicinal plants, available locally and used widely by traditional healers, therefore need attention. A wide array of plants and their active principles have been evaluated for pharmacological properties. However, numerous unexplored plants claimed to be antidotes in folklore medicine need to be studied. The present article reviews the current status of various medicinal plants for the management of snake bite. PMID:22778503

Clinical toxicology: a tropical Australian perspective.

PubMed

Currie, B J

2000-02-01

Tropical Australia has an amazing diversity of venomous fauna, from "the world's most venomous creature," the multi-tentacled (chirodropid) box jellyfish Chironex fleckeri, to aggressive spiders whose venom remains to be characterized. All genera of highly venomous Australasian elapid snakes are present, except for tiger snakes. Most notable is the taipan (Oxyuranus scutellatus), with the most efficient "snap-release" biting mechanism of any snake and venom components causing the full constellation of clinical envenoming features: coagulopathy from fibrinogen depletion (procoagulant), neurotoxicity (predominantly presynaptic neurotoxin) and rhabdomyolysis (myotoxin). Brown snakes (Pseudonaja textilis and P. nuchalis) now account for most snake bite fatalities in Australia, as a result of severe coagulopathy and a poorly defined early scenario of collapse, postulated to be caused by profound hypotension caused by transient myocardial dysfunction associated with prothrombin activation. Other venomous entities include paralyzing ticks, the blue-ringed octopus, stone fish and other marine animals with venomous spines, paralyzing cone shells, and a wide range of jellyfish including Carukia barnesi and possibly other four-tentacled (carybdeid) box jellyfish causing the Irukandji syndrome.

Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis.

PubMed

Bury, Danielle; Langlois, Neil; Byard, Roger W

2012-03-01

In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids. © 2011 American Academy of Forensic Sciences.

Predictive Factors for Death After Snake Envenomation in Myanmar.

PubMed

Aye, Kyi-Phyu; Thanachartwet, Vipa; Soe, Chit; Desakorn, Varunee; Chamnanchanunt, Supat; Sahassananda, Duangjai; Supaporn, Thanom; Sitprija, Visith

2018-06-01

Factors predictive for death from snake envenomation vary between studies, possibly due to variation in host genetic factors and venom composition. This study aimed to evaluate predictive factors for death from snake envenomation in Myanmar. A prospective study was performed among adult patients with snakebite admitted to tertiary hospitals in Yangon, Myanmar, from May 2015 to August 2016. Data including clinical variables and laboratory parameters, management, and outcomes were evaluated. Multivariate regression analysis was performed to evaluate factors predictive for death at the time of presentation to the hospital. Of the 246 patients with snake envenomation recruited into the study, 225 (92%) survived and 21 (8%) died during hospitalization. The snake species responsible for a bite was identified in 74 (30%) of the patients; the majority of bites were from Russell's vipers (63 patients, 85%). The independent factors predictive for death included 1) duration from bite to arrival at the hospital >1 h (odds ratio [OR]: 9.0, 95% confidence interval [CI]: 1.1-75.2; P=0.04); 2) white blood cell counts >20 ×10 3 cells·μL -1 (OR: 8.9, 95% CI: 2.3-33.7; P=0.001); and 3) the presence of capillary leakage (OR: 3.7, 95% CI: 1.2-11.2; P=0.02). A delay in antivenom administration >4 h increases risk of death (11/21 deaths). Patients who present with these independent predictive factors should be recognized and provided with early appropriate intervention to reduce the mortality rate among adults with snake envenomation in Myanmar. Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

'Offensive' snakes: cultural beliefs and practices related to snakebites in a Brazilian rural settlement

PubMed Central

2010-01-01

This paper records the meaning of the term 'offense' and the folk knowledge related to local beliefs and practices of folk medicine that prevent and treat snake bites, as well as the implications for the conservation of snakes in the county of Pedra Branca, Bahia State, Brazil. The data was recorded from September to November 2006 by means of open-ended interviews performed with 74 individuals of both genders, whose ages ranged from 4 to 89 years old. The results show that the local terms biting, stinging and pricking are synonymous and used as equivalent to offending. All these terms mean to attack. A total of 23 types of 'snakes' were recorded, based on their local names. Four of them are Viperidae, which were considered the most dangerous to humans, besides causing more aversion and fear in the population. In general, local people have strong negative behavior towards snakes, killing them whenever possible. Until the antivenom was present and available, the locals used only charms, prayers and homemade remedies to treat or protect themselves and others from snake bites. Nowadays, people do not pay attention to these things because, basically, the antivenom is now easily obtained at regional hospitals. It is understood that the ethnozoological knowledge, customs and popular practices of the Pedra Branca inhabitants result in a valuable cultural resource which should be considered in every discussion regarding public health, sanitation and practices of traditional medicine, as well as in faunistic studies and conservation strategies for local biological diversity. PMID:20346120

'Offensive' snakes: cultural beliefs and practices related to snakebites in a Brazilian rural settlement.

PubMed

Fita, Dídac S; Costa Neto, Eraldo M; Schiavetti, Alexandre

2010-03-26

This paper records the meaning of the term 'offense' and the folk knowledge related to local beliefs and practices of folk medicine that prevent and treat snake bites, as well as the implications for the conservation of snakes in the county of Pedra Branca, Bahia State, Brazil. The data was recorded from September to November 2006 by means of open-ended interviews performed with 74 individuals of both genders, whose ages ranged from 4 to 89 years old. The results show that the local terms biting, stinging and pricking are synonymous and used as equivalent to offending. All these terms mean to attack. A total of 23 types of 'snakes' were recorded, based on their local names. Four of them are Viperidae, which were considered the most dangerous to humans, besides causing more aversion and fear in the population. In general, local people have strong negative behavior towards snakes, killing them whenever possible. Until the antivenom was present and available, the locals used only charms, prayers and homemade remedies to treat or protect themselves and others from snake bites. Nowadays, people do not pay attention to these things because, basically, the antivenom is now easily obtained at regional hospitals. It is understood that the ethnozoological knowledge, customs and popular practices of the Pedra Branca inhabitants result in a valuable cultural resource which should be considered in every discussion regarding public health, sanitation and practices of traditional medicine, as well as in faunistic studies and conservation strategies for local biological diversity.

An instructive case of presumed brown snake (Pseudonaja spp.) envenoming.

PubMed

Ou, Judy; Haiart, Sebastien; Galluccio, Steven; White, Julian; Weinstein, Scott A

2015-01-01

Several species of medically important Australian elapid snakes are frequently involved in human envenoming. The brown snake group (Pseudonaja spp., 9 species) is most commonly responsible for envenoming including life-threatening or fatal cases. Several Pseudonaja spp. can inflict human envenoming that features minor local effects, but may cause serious systemic venom disease including defibrination coagulopathy, thrombocytopenia, micro-angiopathic hemolytic anemia (MAHA) and, rarely, paralysis. Pseudonaja envenoming is typically diagnosed by history, clinical assessment including occasional active clinical bleeding noted on physical examination (e.g. from venipuncture sites, recent cuts, etc.), and laboratory detection of coagulopathy (prolonged activated partial thromboplastin time [APTT]/INR, elevated D-dimer, afibrinogenemia and thrombocytopenia). Lack of verified identity of the envenoming snake species is a common problem in Australia and elsewhere. Identification and confirmation of the envenoming Australian snake taxon is often attempted with enzyme sandwich immunoassay venom detection kits (SVDKs). However, the SVDK has limited utility due to unreliable specificity and sensitivity when used to detect venoms of some Australian elapids. Antivenom (AV) remains the cornerstone of treatment, although there is debate concerning the recommended dose (1 vs. 2 or more vials) necessary to treat serious Pseudonaja envenoming. Envenomed patients receiving timely treatment uncommonly succumb, but a proportion of seriously envenomed patients may exhibit clinical or laboratory evidence of myocardial insult. An 88-year-old woman presented her dog to a veterinarian after it had sustained a bite by a witnessed snake, reportedly an eastern brown snake (Pseudonaja textilis, Elapidae). The woman became suddenly confused, and lost consciousness at the veterinary office. After transport to hospital, she denied any contact with the snake, but developed large haematomas at intravenous (i.v.) catheter insertion sites; blood tests revealed a severe defibrination coagulopathy, consistent with envenoming by a brown snake. An SVDK-tested urine sample was negative. A non-contrast CT of her head showed a minor subacute infarction of the left corona radiata. A twelve-lead ECG was normal, but her troponins were mildly elevated (39 ng/L). A diagnosis of brown snake envenoming was made and she received 2 vials of brown snake AV i.v., without adverse incident. Thirty min post AV her Glasgow Coma Score (GCS) had improved from 13 to 15 (normal). At 3.5 h post AV all bleeding from i.v. sites ceased, although her troponin T level peaked at 639 ng/L, supporting a diagnosis of non-ST elevated myocardial infarction (NSTEMI). Severe brown snake envenoming may occur in the absence of a perceived bite, and AV is temporally associated with improvement in clinical findings and coagulopathy. However, severe envenoming by this species can be complicated by cardiovascular events that in the circumstance of incomplete or absent history may confuse the primary diagnosis and affect patient outcome.

Microbiology of animal bite wound infections.

PubMed

Abrahamian, Fredrick M; Goldstein, Ellie J C

2011-04-01

The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans.

Microbiology of Animal Bite Wound Infections

PubMed Central

Abrahamian, Fredrick M.; Goldstein, Ellie J. C.

2011-01-01

Summary: The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans. PMID:21482724

Acute renal failure in acute poisoning: prospective study from a tertiary care centre of South India.

PubMed

Sweni, Shah; Meenakshisundaram, Ramachandran; Sakthirajan, R; Rajendiran, Chinnasamy; Thirumalaikolundusubramanian, Ponniah

2012-03-01

Cases of people presenting with poisoning are likely to develop acute renal failure (ARF), which may be due to multiple mechanisms/aetiologies. These cases need careful observation and appropriate treatment. To find the risk of ARF among acute poisoning cases, identify the underlying causes and to analyse the outcome. In this prospective study with nested case control, 1,250 cases admitted to the Poison Control, Training and Research Centre of Government General Hospital, Madras Medical College were monitored and evaluated for development of ARF. Patients with history of diabetes/hypertension, known chronic kidney disease, chronic NSAID therapy, those on drugs that increase serum creatinine by inhibiting creatinine secretion and other co-morbid illnesses were excluded. Data were interpreted after subjecting them to bivariate logistic regression and then step wise multivariate analysis. Thirty-two cases developed ARF. Twenty-four were due to snake bite, the rest due to chemical poisons. Chances of developing ARF were greater (6.15%) among the poisoning due to bites and stings than chemical poisoning (0.9%). Five in the former and seven in the latter expired. Among cases bitten by snakes, only 22 (7%) cases bitten by Russell Viper Daboia russelii developed renal failure. Copper sulphate and rat killer poisonings were the commonest causes of chemical induced ARF, dichromate, indigenous medicines and vasmol 33 (paraphenelyne diamine) were the least causes for ARF. None of the patients with organophosphate developed ARF nor did any of the 150 admitted for overdose of medicines developed ARF. The risk of ARF among the cases of poisoning was 2.5%. The outcome of ARF among bites and stings was better than chemical poisoning, and the difference was highly significant (p= 0.005, OR = 0.04-1.0, 95% CI = 0.004-0.38). Early recognition and appropriate measures reduce the occurrence of ARF. © 2011 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Incidence and mortality due to snakebite in the Americas

PubMed Central

2017-01-01

Background Better knowledge of the epidemiological characteristics of snakebites could help to take measures to improve their management. The incidence and mortality of snakebites in the Americas are most often estimated from medical and scientific literature, which generally lack precision and representativeness. Methodology/Principal findings Authors used the notifications of snakebites treated in health centers collected by the Ministries of Health of the American countries to estimate their incidence and mortality. Data were obtained from official reports available on-line at government sites, including those of the Ministry of Health in each country and was sustained by recent literature obtained from PubMed. The average annual incidence is about 57,500 snake bites (6.2 per 100,000 population) and mortality is close to 370 deaths (0.04 per 100,000 population), that is, between one third and half of the previous estimates. The incidence of snakebites is influenced by the abundance of snakes, which is related to (i) climate and altitude, (ii) specific preferences of the snake for environments suitable for their development, and (iii) human population density. Recent literature allowed to notice that the severity of the bites depends mainly on (i) the snake responsible for the bite (species and size) and (ii) accessibility of health care, including availability of antivenoms. Conclusions/Significances The main limitation of this study could be the reliability and accuracy of the notifications by national health services. However, the data seemed consistent considering the similarity of the incidences on each side of national boundaries while the sources are distinct. However, snakebite incidence could be underestimated due to the use of traditional medicine by the patients who escaped the reporting of cases. However, gathered data corresponded to the actual use of the health facilities, and therefore to the actual demand for antivenoms, which should make it possible to improve their management. PMID:28636631

Deaths From Bites and Stings of Venomous Animals

PubMed Central

Ennik, Franklin

1980-01-01

Data abstracted from 34 death certificates indicate that the three venomous animal groups most often responsible for human deaths in California from 1960 through 1976 were Hymenoptera (bees, wasps, ants and the like) (56 percent), snakes (35 percent) and spiders (6 percent). An average incidence of 2.0 deaths per year occurred during these 17 years, or an average death rate of 0.01 per 100,000 population per year. Nearly three times more males than females died of venomous animal bites and stings. Half of the deaths from venomous snake bites occurred in children younger than 5 years of age. Susceptible persons 40 years or older appeared to be particularly vulnerable to hymenopterous insect stings and often quickly died of anaphylaxis. Fatal encounters with venomous animals occurred more often around the home than at places of employment or during recreational activities. Deaths resulting from spider bites are rare in California but many bites are reported. Medical practitioners are urged to seek professional assistance in identifying offending animals causing human discomfort and to use these animals' scientific names on death certificates and in journal articles. ImagesIGN. PMID:7467305

Snakebites in Africa and Europe: a military perspective and update for contemporary operations.

PubMed

Wilkins, Daniel; Burns, D S; Wilson, D; Warrell, D A; Lamb, L E M

2018-04-05

Snakebite envenoming is rare among military patients, with few cases reported in recent years. Increasingly, however, military operations are taking place in remote parts of Africa, which are inhabited by numerous species of venomous snake, and in Europe, where dangerous species exist but are less common. Bites from a venomous snake may prove fatal, and therefore military medics must be adequately prepared to manage them. This paper reviews the most medically significant species of venomous snake present in Africa and Europe, before suggesting an evidence-based approach to snakebite prevention and management, including possible changes to the UK's Clinical Guidelines for Operations. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Venomous snakebites.

PubMed

Adukauskienė, Dalia; Varanauskienė, Eglė; Adukauskaitė, Agnė

2011-01-01

More than 5 million people are bitten by venomous snakes annually and more than 100,000 of them die. In Europe, one person dies due to envenomation every 3 years. There is only one venomous snake species in Lithuania--the common adder (Vipera berus)--which belongs to the Viperidae family; however, there are some exotic poisonous snakes in the zoos and private collections, such as those belonging to the Elapidae family (cobras, mambas, coral snakes, etc.) and the Crotalidae subfamily of the Viperidae family (pit vipers, such as rattlesnakes). Snake venom can be classified into hemotoxic, neurotoxic, necrotoxic, cardiotoxic, and nephrotoxic according to the different predominant effects depending on the family (i.e., venom of Crotalidae and Viperidae snakes is more hemotoxic and necrotoxic, whereas venom of Elapidae family is mainly neurotoxic). The intoxication degree is estimated according to the appearance of these symptoms: 1) no intoxication ("dry" bite); 2) mild intoxication (local edema and pain); 3) moderate intoxication (pain, edema spreading out of the bite zone, and systemic signs); 4) severe intoxication (shock, severe coagulopathy, and massive edemas). This topic is relevant because people tend to make major mistakes providing first aid (e.g., mouth suction, wound incision, and application of ice or heat). Therefore, this article presents the essential tips on how first aid should be performed properly according to the "Guidelines for the Management of Snake-Bites" by the World Health Organization (2010). Firstly, the victim should be reassured. Rings or other things must be removed preventing constriction of the swelling limb. Airway/breathing must be maintained. The bitten limb should be immobilized and kept below heart level to prevent venom absorption and systemic spread. Usage of pressure bandage is controversial since people usually apply it improperly. Incision, mouth suction, or excision should not be performed; neither a tourniquet nor ice or heat should be applied. A doctor must monitor respiratory rate, blood pressure, heart rate, renal function, fluid balance, and coagulation status. The only specific treatment method is antivenin--serum with antibodies against antigens of snake venom. Antivenins against pit vipers used in the United States are Antivenin Crotalidae Polyvalent (ACP) and a more purified and hence causing less adverse reactions--Crotalidae Polyvalent Immune Fab (CroFab). In Europe, a polyvalent antiserum against Viperidae family snakes (including the common adder) can be used. Antivenins often may cause severe hypersensitivity reactions because of their protein nature. The bite of the common adder (the only poisonous snake in such countries as Lithuania and Great Britain) relatively rarely results in death; thus, considering the risk of dangerous reactions the antivenin causes itself, the usage of it is recommended to be limited only to life-threatening conditions.

Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - Vipera berus

PubMed Central

2010-01-01

Background Every year many dogs in Sweden are bitten by Vipera berus, the only venomous viper in Sweden. This prospective study investigated clinical signs, some biochemical parameters, treatment, and progress of disease after snakebite in 53 dogs. Effects of treatment with and without glucocorticoids were evaluated. Methods All fifty-three dogs bitten by Vipera berus were examined the same day the dog was bitten and the next day. Two more examinations during 23 days post snake bite were included. Creatinine, creatine kinase (CK), alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), alkaline phosphatase (ALP) and bile acid results were followed through 3 to 4 samplings from 34 of the dogs. Results All dogs had variable severity of local swelling in the bite area and 73 per cent had affected mental status. Initial cardiac auscultation examination was normal in all dogs, but six dogs had cardiac abnormalities at their second examination, including cardiac arrhythmias and cardiac murmurs. All dogs received fluid therapy, 36 dogs were given analgesics, 22 dogs were treated with glucocorticoids, and ten dogs were treated with antibiotics. Evidence of transient muscle damage (increased CK) was seen one day after the snake bite in 15 (54%) of 28 sampled dogs. Moderate changes in hepatic test results occurred in 1 dog and several dogs (22 of 34) had transient, minor increases in one or more hepatic test result. No dog died during the observation period as a consequence of the snake bite. Conclusions Snake bite caused local swelling in all dogs and mental depression of short duration in most dogs. Some dogs had transient clinical signs that could be indicative of cardiac injury and some other had transient biochemical signs of liver injury. Treatment with glucocorticoids did not have any clear positive or negative effect on clinical signs and mortality. PMID:20416040

Snakebite enquiries to the UK National Poisons Information Service: 2004-2010.

PubMed

Coulson, James Michael; Cooper, Gillian; Krishna, Channarayapatna; Thompson, John Paul

2013-11-01

To describe trends regarding snakebite enquiries to the UK National Poisons Information Service (NPIS) from 2004 to 2010. The NPIS telephone enquiry database, the UK Poisons Information Database, was interrogated for enquiries to the four NPIS units from 2004 to 2010. Search terms used were 'snake' and 'snakebite'. Information from the national dataset was available from Cardiff and Edinburgh units from 2004 onwards, Birmingham from June 2005 and Newcastle from September 2006. Five hundred and ten cases were identified, of which 69% were male and 31% female. Average age of cases was 32 years (±1 95% CI). The snake was identified as follows: British Adder in 52% of cases, an exotic species in 26%, unknown in 18% and another UK snake in 4%. 82% of cases occurred between the months of April and September. Cases peaked during August (19%). Forty-two per cent of enquiries involved features of envenoming. Eighty-five cases were assessed as requiring antivenom. Eighty-four cases received treatment with antivenom. No adverse reactions to the antivenom were reported and resolution of clinical features was reported in all treated cases. Advice to use an antidote was followed in 98.8% of cases. Snakebites account for one to two NPIS cases per week. Adder bites account for over half of cases. A quarter of cases were due to non-UK snakes kept in captivity within the UK. Envenoming was said to have occurred in just under half of all cases. Advice given by the NPIS appears to closely reflect national practice guidelines.

Sea snake harvest in the gulf of Thailand.

PubMed

Van Cao, Nguyen; Thien Tao, Nguyen; Moore, Amelia; Montoya, Alfred; Redsted Rasmussen, Arne; Broad, Kenneth; Voris, Harold K; Takacs, Zoltan

2014-12-01

Conservation of sea snakes is virtually nonexistent in Asia, and its role in human-snake interactions in terms of catch, trade, and snakebites as an occupational hazard is mostly unexplored. We collected data on sea snake landings from the Gulf of Thailand, a hotspot for sea snake harvest by squid fishers operating out of the ports of Song Doc and Khanh Hoi, Ca Mau Province, Vietnam. The data were collected during documentation of the steps of the trading process and through interviewers with participants in the trade. Squid vessels return to ports once per lunar synodic cycle and fishers sell snakes to merchants who sort, package, and ship the snakes to various destinations in Vietnam and China for human consumption and as a source of traditional remedies. Annually, 82 t, roughly equal to 225,500 individuals, of live sea snakes are brought to ports. To our knowledge, this rate of harvest constitutes one of the largest venomous snake and marine reptile harvest activities in the world today. Lapemis curtus and Hydrophis cyanocinctus constituted about 85% of the snake biomass, and Acalyptophis peronii, Aipysurus eydouxii, Hydrophis atriceps, H. belcheri, H. lamberti, and H. ornatus made up the remainder. Our results establish a quantitative baseline for characteristics of catch, trade, and uses of sea snakes. Other key observations include the timing of the trade to the lunar cycle, a decline of sea snakes harvested over the study period (approximately 30% decline in mass over 4 years), and the treatment of sea snake bites with rhinoceros horn. Emerging markets in Southeast Asia drive the harvest of venomous sea snakes in the Gulf of Thailand and sea snake bites present a potentially lethal occupational hazard. We call for implementation of monitoring programs to further address the conservation implications of this large-scale marine reptile exploitation. © 2014 Society for Conservation Biology.

AAPCC database characterization of native U.S. venomous snake exposures, 2001-2005.

PubMed

Seifert, Steven A; Boyer, Leslie V; Benson, Blaine E; Rogers, Jody J

2009-04-01

Differences in victim demographics, clinical effects, managements, and outcomes among native viperid (rattlesnake, copperhead, and cottonmouth) and elapid (coral snake) species have not been systematically characterized. The database of the American Association of Poison Control Centers from 2001 through 2005 was analyzed. Between 2001 and 2005, there were 23,676 human exposures (average = 4,735/year) to native venomous snakes in the United States reported to U.S. poison centers in all states except Hawaii: 98% were to viperid snakes and 2% to elapids. Overall, 77% of victims were male, 70% were adults >20 years, and 12% were aged less than 10 years. Sixty-five cases involved pregnant women, with rattlesnake bites resulting in moderate or greater effects in over 70%. The overall hospital admission rate was 53%. Outcomes were generally more severe with rattlesnake and copperhead envenomations and in children <6 years of age. The fatality rate of reported cases was 0.06%. Native U.S. venomous snakebite results in considerable morbidity and mortality. Rattlesnake and copperhead envenomations, and those in children <6 years of age, produce the most severe outcomes, but coral snakebites result in similar hospital admission rates.

Ethnomedicinal plants used for snake envenomation by folk traditional practitioners from Kallar forest region of South Western Ghats, Kerala, India

PubMed Central

Sulochana, Anaswara Krishnan; Raveendran, Dileepkumar; Krishnamma, Anoop Pushkaran; Oommen, Oommen V.

2015-01-01

Background: The traditional medicinal systems of Indian folklore abundantly use medicinal plants or its derivatives for the treatment of snakebites. However, this traditional knowledge is on the verge of extinction, and there is an immediate necessity to conserve this oral traditional knowledge primarily by proper documentation and scientific authentication. The present ethno botanical study carried out among the folk medicine practitioners in the rural settle mental areas of Kallar forest region of southern Kerala, aims to document the folk herbal knowledge particularly for snake envenomation. Materials and Methods: The survey was conducted during the period of June 2012-July 2013 in the rural and forest settlement areas of Kallar in the Thiruvananthapuram district of Kerala. Direct observation and oral communications with local folk medicine practitioners in this region were adopted to collect valid information regarding the herbal formulations used to treat snake bite patients. Results: The study enumerates a list of 24 plant species belonging to seventeen families with anti-venomous potential. The scientific, vernacular and family names of these plants, along with the part used and their application modes are also enumerated in this communication. Conclusions: Plants are believed to be potent snake bite antidotes from centuries back, and knowledge about the use of plants is strictly conserved among tribes through generations without recorded data. It is the need of the hour to document these old drug formulations and is the cardinal responsibility of the scientific community to validate it and come up with new potent drug molecule for the benefit of snake bite victims. PMID:26401384

Feeding behavior and venom toxicity of coral snake Micrurus nigrocinctus (Serpentes: Elapidae) on its natural prey in captivity.

PubMed

Urdaneta, Aldo H; Bolaños, Federico; Gutiérrez, José María

2004-08-01

The feeding behavior and venom toxicity of the coral snake Micrurus nigrocinctus (Serpentes: Elapidae) on its natural prey in captivity were investigated. Coral snakes searched for their prey (the colubrid snake Geophis godmani) in the cages. Once their preys were located, coral snakes stroke them with a rapid forward movement, biting predominantly in the anterior region of the body. In order to assess the role of venom in prey restraint and ingestion, a group of coral snakes was 'milked' in order to drastically reduce the venom content in their glands. Significant differences were observed between snakes with venom, i.e., 'nonmilked' snakes, and 'milked' snakes regarding their behavior after the bite. The former remained hold to the prey until paralysis was achieved, whereas the latter, in the absence of paralysis, moved their head towards the head of the prey and bit the skull to achieve prey immobilization by mechanical means. There were no significant differences in the time of ingestion between these two groups of coral snakes. Susceptibility to the lethal effect of coral snake venom greatly differed in four colubrid species; G. godmani showed the highest susceptibility, followed by Geophis brachycephalus, whereas Ninia psephota and Ninia maculata were highly resistant to this venom. In addition, the blood serum of N. maculata, but not that of G. brachycephalus, prolonged the time of death of mice injected with 2 LD(50)s of M. nigrocinctus venom, when venom and blood serum were incubated before testing. Subcutaneous injection of coral snake venom in G. godmani induced neurotoxicity and myotoxicity, without causing hemorrhage and without affecting heart and lungs. It is concluded that (a) M. nigrocinctus venom plays a role in prey immobilization, (b) venom induces neurotoxic and myotoxic effects in colubrid snakes which comprise part of their natural prey, and (c) some colubrid snakes of the genus Ninia present a conspicuous resistance to the toxic action of M. nigrocinctus venom.

Differential action of medically important Indian BIG FOUR snake venoms on rodent blood coagulation.

PubMed

Hiremath, Vilas; Nanjaraj Urs, A N; Joshi, Vikram; Suvilesh, K N; Savitha, M N; Urs Amog, Prathap; Rudresha, G V; Yariswamy, M; Vishwanath, B S

2016-02-01

Snakebite is a global health problem affecting millions of people. According to WHO, India has the highest mortality and/or morbidity due to snakebite. In spite of commendable research on Indian BIG FOUR venomous species; Naja naja and Bungarus caeruleus (elapid); Daboia russelii and Echis carinatus (viperid), no significant progress has been achieved in terms of diagnosis and management of biting species with appropriate anti-snake venom. Major hurdle is identification of offending species. Present study aims at differentiation of Indian BIG FOUR snake venoms based on their distinguish action on rodent blood coagulation. Assessment of coagulation alterations by elapid venoms showed negligible effect on re-calcification time, prothrombin time, activated partial thromboplastin time and factors assay (I, II, V, VIII and X) both in vitro and in vivo. However, viperid venoms demonstrated significant anticoagulant status due to their remarkable fibrinogen degradation potentials as supported by fibrinogenolytic activity, fibrinogen zymography and rotational thromboelastometry. Though results provide hint on probable alterations of Indian BIG FOUR snake venoms on blood coagulation, the study however needs validation from human victim's samples to ascertain its reliability for identification of biting snake species. Copyright © 2015 Elsevier Ltd. All rights reserved.

Snake venom poisoning in the Plovdiv region from 2004 to 2012.

PubMed

Iliev, Yanko T; Tufkova, Stoilka G; Zagorov, Marin Y; Nikolova, Stanka M

2014-01-01

Envenomation by poisons of biological origin is very common globally in the tropical and subtropical areas mainly, where the biological diversity of the species clearly leads to evolution of highly toxic species. The weather warming trend in Bulgaria, whether cyclic or permanent, allows for a change in the biological response of reptiles and insects inhabiting the temperate zone by a possible migration of biological species from the subtropical zone towards the temperate zone because of the new environmental conditions. There are very few studies on snake bite envenoming in Bulgaria. The AIM of the study was to find the incidence of the acute accidental intoxication (AAI) caused by snake venom in adult individuals in a large region of Bulgaria between 2004 and 2012 and characterises it by number, type, main clinical features, course and socio-demographic parameters of the victims so that preventive measures can be taken, wherever necessary. We studied retrospectively all 68 cases of AAI caused by snake venom in adult individuals (> 18 years old) hospitalized in the Clinic of Toxicology in St. George University Hospital, Plovdiv over the period from 2004 to 2012 by 23 quantitative and qualitative parameters. We found that the average annual incidence of snake venom AAI in adult population in the region of Plovdiv was relatively low for the specified period (9.5 per 100000 residents); the snake venom AAI increases or decreases every other year, with no clearly delineated trend for now. The prevalence of envenomation by poisons of biological origin increased from 2.3% in 1990-1998 to 9.5-10.33% between 2007 and 2012. The main sociodemographic characteristics of snake bite victims are similar to those in other Balkan and Central European countries. The clinical response to poisons of biological origin is generally identical with the response to the viper (Vipera ammodytes)--mild to medium intensity with predominantly local toxic syndrome. The algorithm of Clinical Pathway 293 (CP) is effective and conducive to the reduction of duration of the morbid condition. There are, however, still aspects of it that can be optimised.

Safe Handling of Snakes in an ED Setting.

PubMed

Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

2017-01-01

Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED. A local snake consultation vendor and zoo Herpetologist assisted with development of a process for snake identification and disposal. All snakes have been identified and securely disposed of using the newly implemented process and no safety incidents have been reported. Other emergency department settings may consider developing a standardized process for snake disposal using listed specialized consultants combined with local resources and suppliers to promote employee and patient safety. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Technology Demonstration Plan. Evaluation of Explosives Field Analytical Techniques

DTIC Science & Technology

1999-08-01

threatening. Some symptoms of heat-related injuries are pale clammy skin , sweating, headache, weakness, dizziness, and nausea. Signs of heat stroke...include dry, hot, red skin , chills, and confusion. In the case of a suspected heat-related injury , try to cool the person down and contact medical...during the day. 9.8.6 Insect and Other Animal Stings and Bites A potential for insect (e.g., honey bees , wasps, yellow jackets), snake (e.g

Snakebite! Crotalinae Envenomation of a Man in Rhode Island.

PubMed

Zhang, Xiao C; Kearney, Alexis; Gibbs, Frantz J; Hack, Jason B

2016-01-04

The incidence of poisonous snakebites has regional variance. Health care providers' knowledge and comfort in treating these envenomated patients depends on the density of poisonous snakes in their environment, with practitioners in the southern U.S. typically treating more exposed patients than those in colder regions in the North. We present a rare case of a confirmed copperhead snakebite that occurred in Rhode Island. We will review Copperhead bites, clinical management and treatment options.

When snakes bite: the management of North American Crotalinae snake envenomation.

PubMed

Ashton, Jenny; Baker, Stephanie N; Weant, Kyle A

2011-01-01

There are more than 120 species of snakes indigenous to the United States, 25 of which are venomous. Although snake envenomation carries a relatively low risk of mortality in the United States, it can result in significant morbidity if left untreated. The venom of Crotalinae snakes contains a complex mixture of enzymatic proteins with various clinical implications. Of these complications, the most significant are consumptive coagulopathy, compartment syndrome, and hypovolemic shock. The development of ovine Crotalidae polyvalent immune Fab antivenin (CroFab) has greatly changed the approach to snake envenomation. Nevertheless, multiple factors complicate its use and the overall management of this clinical presentation. The intent of this review is to discuss relevant management issues associated with Crotalinae envenomation in the emergency department.

Environmental Impact Analysis Process. Environmental Impact Statement. Supersonic Flight Operations in the Reserve Military Operations Area, Holloman AFB, New Mexico

DTIC Science & Technology

1983-09-01

tailed Rattlesnake Crotalus molossus Western Rattlesnake Crotalus viridis CAUTION Most snake bites occur to people who are trying to kill or catch snakes...Strawberry Fragaria bracteata Yarrow Achillea lanulosa Yellow Sweetclover Melilotus indicus IX L-2 List of Preparers Jim Battis; AFGL/LWH, Ha’-com

Clinically Significant Envenomation From Postmortem Copperhead (Agkistrodon contortrix).

PubMed

Emswiler, Michael P; Griffith, F Phillip; Cumpston, Kirk L

2017-03-01

Over 14,000 copperhead (Agkistrodon contortrix) bites were reported to United States poison centers between 1983 and 2008, and 1809 cases were reported to poison centers in 2014. The copperhead is primarily found in the southeastern United States and belongs to the pit viper subfamily Crotalinae, which also includes the water moccasin (Agkistrodon piscivorus) and rattlesnakes (Crotalus and Sistrurus genera). Postmortem rattlesnakes have been reported to cause clinically significant envenomation; we report a case of a postmortem copperhead causing clinically significant envenomation after inadvertent puncture with the deceased copperhead fang. The copperhead was transected twice, leaving the snake in 3 separate pieces. While handling the snake head, an inadvertent puncture occurred on the right index finger followed by pain and swelling in the affected extremity necessitating antivenom administration. Care should be taken when handling deceased pit vipers due to the continued risk of envenomation. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

The Australian Snakebite Project, 2005-2015 (ASP-20).

PubMed

Johnston, Christopher I; Ryan, Nicole M; Page, Colin B; Buckley, Nicholas A; Brown, Simon Ga; O'Leary, Margaret A; Isbister, Geoffrey K

2017-08-07

To describe the epidemiology, treatment and adverse events after snakebite in Australia. Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation. Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths. 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours). Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.

Territorial behavior in Taiwanese kukrisnakes (Oligodon formosanus)

PubMed Central

Huang, Wen-San; Greene, Harry W.; Chang, Tien-Jye; Shine, Richard

2011-01-01

The independent evolutionary origin of a complex trait, within a lineage otherwise lacking it, provides a powerful opportunity to test hypotheses on selective forces. Territorial defense of an area containing resources (such as food or shelter) is widespread in lizards but not snakes. Our studies on an insular population of Taiwanese kukrisnakes (Oligodon formosanus) show that females of this species actively defend sea turtle nests by repelling conspecifics for long periods (weeks) until the turtle eggs hatch or are consumed. A clutch of turtle eggs comprises a large, long-lasting food resource, unlike the prey types exploited by other types of snakes. Snakes of this species have formidable weaponry (massively enlarged teeth that are used for slitting eggshells), and when threatened, these snakes wave their tails toward the aggressor (an apparent case of head-tail mimicry). Bites to the tail during intraspecific combat bouts thus can have high fitness costs for males (because the hemipenes are housed in the tail). In combination, unusual features of the species (ability to inflict severe damage to male conspecifics) and the local environment (a persistent prey resource, large relative to the snakes consuming it) render resource defense both feasible and advantageous for female kukrisnakes. The (apparently unique) evolution of territorial behavior in this snake species thus provides strong support for the hypothesis that resource defensibility is critical to the evolution of territoriality. PMID:21502515

Venomous snakebite in Thailand. I: Medically important snakes.

PubMed

Chanhome, L; Cox, M J; Wilde, H; Jintakoon, P; Chaiyabutr, N; Sitprija, V

1998-05-01

Thailand has an abundance of venomous snakes. Among the neurotoxic family Elapidae, there are three species of the genus Naja (cobras), three of the genus Bungarus (kraits), and the king cobra of the genus Ophiophagus. Other Elapidae snakes in Thailand include sea snakes and Asian coral snakes of the genus Calliophis. They have potent venoms but rarely bite humans. Tissue and hemotoxic snakes are represented by family Viperidae, subfamilies Viperinae and Crotalinae. They remain an occupational hazard for farmers and rubber tappers, causing serious morbidity but only rare deaths, since competent treatment is now widely available throughout Thailand. Purified equine antivenin is manufactured locally for the monocled and Siamese spitting cobras (Naja kaouthia and N. siamensis), king cobra (Ophiophagus hannah), banded krait (Bungarus fasciatus), most green pit vipers (Trimeresurus sp.), Malayan pit viper (Calloselasma rhodostoma), and the Siamese Russell's viper (Daboia russelli siamensis).

Snake bite envenomation: experience at King Abdulaziz Medical City, Riyadh.

PubMed

Al-Durihim, H; Al-Hussaini, M; Bin Salih, S; Hassan, I; Harakati, M; Al Hajjaj, A

2010-04-01

We surveyed the records of 21 of the 28 snakebite victims seen at King Fahad National Guard Hospital in Riyadh over the 20-year period 1986-2005. The most common symptoms were local pain and swelling and the most common signs oedema and tenderness. Neurotoxicity was not noted in any case. Coagulopathy was recorded for 14/21 patients (66.7%) and 5/19 (26.4%) had leukocytosis. All patients were given tetanus toxoid (100%) and 20 (95.2%) received antivenom. Blood products were administered in 2 cases and prophylactic antibiotics in 10 (47.6%). No allergic reaction to antivenom was reported.

Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin.

PubMed

Larson, Kenneth W; Schaefer, Keith R; Austin, Cindy; Norton, Rhy; Finley, Phillip J

2016-01-01

Although initially created for the treatment of rattlesnake (genus: Crotalus) bites, Crotalidae-Fab antivenin is used to treat many different pit viper envenomations. However, the efficacy of Crotalidae-Fab in preventing tissue loss from copperhead (Agkistrodon contortrix) or cottonmouth (Agkistrodon piscivorus) snakebites remains unclear. Recent reports show that Agkistrodon-related bites rarely require treatment beyond simple observation and pain control. The purpose of this study was to examine the amount of tissue loss in patients who received Crotalidae-Fab compared with those who did not after an Agkistrodon bite. After institutional review board approval, a retrospective study was completed at a Level 1 trauma center. Between 2009 and 2013, a total of 57 snakebites were identified. Of the 57 bites, the snake species was documented in 36 cases including 31 copperheads, 1 cottonmouth, and 4 rattlesnakes. The other 21 bites were from unknown or nonvenomous species. Of the 32 Agkistrodon-related bites, 15 patients received Crotalidae-Fab (average of 3 vials administered) and 17 did not receive Crotalidae-Fab. None of the 32 patients, regardless of treatment option, had tissue loss or required surgical interventions. Only 1 patient received Crotalidae-Fab and debridement of a vesicle associated with the bite. No clinically significant differences were observed between the groups. These findings support previous literature that failed to show added benefit of Crotalidae-Fab treatment for Agkistrodon bites beyond patient comfort and pain control. Evaluation of current protocols for Agkistrodon envenomations is warranted. Snakebite wound education in trauma physicians and nurses may decrease unnecessary use of antivenom medication.

Characterization of the aqueous extract of the root of Aristolochia indica: evaluation of its traditional use as an antidote for snake bites.

PubMed

Bhattacharjee, Payel; Bhattacharyya, Debasish

2013-01-09

The aqueous extract of the roots of Aristolochia indica is used as a decoction for the ailment of a number of diseases including snake bite treatment. Though the alcoholic extract of the different parts of the plant are well studied, information on the aqueous extract is limited. We have estimated aristolochic acid, different enzymes, enzyme inhibitors and anti-snake venom potency of its root extract. Reverse phase-HPLC was used to quantify aristolochic acid. Zymography, DQ-gelatin assay and atomic force microscopy were done to demonstrate gelatinase and collagenase activities of the extract. SDS-PAGE followed by MS/MS analysis revealed the identity of major protein components. Toxicity of the extract was estimated on animal model. Interaction of the extract with Russell's viper venom components was followed by Rayleigh scattering and enzyme assay. The aristolochic acid content of the root extract is 3.08 ± 1.88 × 10(-3)mg/ml. The extract possesses strong gelatinolytic, collagenase, peroxidase and nuclease activities together with l-amino acid oxidase and protease inhibitory potencies. Partial proteomic studies indicated presence of starch branching enzymes as major protein constituent of the extract. The extract did not show any acute and sub-chronic toxicity in animals at lower doses, but high dose causes liver and kidney damage. The extract elongated duration of survival of animals after application of Russell's viper venom. Considering the low aristolochic acid content of the extract, its consumption for a short time at moderate dose does not appear to cause serious toxicity. Strong inhibition of l-amino acid oxidase may give partial relief from snake bite after topical application of the extract. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Childhood Victims of Snakebites: 2000-2013.

PubMed

Schulte, Joann; Domanski, Kristina; Smith, Eric Anthony; Menendez, Annelle; Kleinschmidt, Kurt C; Roth, Brett A

2016-11-01

Snakebites are not a reportable condition (to state health departments), and 1 major assessment of US children with snakebites was published 50 years ago. Increasing urbanization, population shifts south and west, newer antivenom therapy, and the importation of exotic snakes may have changed snakebites. Poison control centers are often consulted on treatment and collect surveillance data. Generic codes for venomous, nonvenomous, and unknown snakebites were used to characterize victims aged ≤18 years reported to US poison control centers between 2000 and 2013. Data included demographic characteristics, snake types, and outcomes. Callers reported 18 721 pediatric snakebites (annual mean, 1337). Two-thirds were male (n = 12 688 [68%]), with a mean age of 10.7 years. One-half of the snakebites were venomous (n = 9183 [49%]), with copperheads (n = 3602 [39%]) and rattlesnakes (n = 2859 [31%]) the most frequently identified. Reported copperhead bites increased 137% and unknown crotalids (venomous) increased 107%. Exotic (nonnative) exposures were reported in 2% of cases. All 50 states reported snakebites, but one-quarter occurred in Texas and Florida. Rates for total snakebites and venomous snakebites were highest in West Virginia, Oklahoma, and Louisiana. One-fifth required ICU admission. Limited data for 28% of bites for antivenom treatment suggests increasing use. Four victims died. The epidemiology of pediatric snakebites is changing. One-half of the reported exposures were venomous, and copperhead bites and exotic species are being reported more frequently. Although snakebite-related deaths are rare, ICU admission is common. Antivenom treatment is incompletely reported, but its use is increasing. Copyright © 2016 by the American Academy of Pediatrics.

Identification and molecular characterization of five putative toxins from the venom gland of the snake Philodryas chamissonis (Serpentes: Dipsadidae).

PubMed

Urra, Félix A; Pulgar, Rodrigo; Gutiérrez, Ricardo; Hodar, Christian; Cambiazo, Verónica; Labra, Antonieta

2015-12-15

Philodryas chamissonis is a rear-fanged snake endemic to Chile. Its bite produces mild to moderate symptoms with proteolytic and anti-coagulant effects. Presently, the composition of the venom, as well as, the biochemical and structural characteristics of its toxins, remains unknown. In this study, we cloned and reported the first full-length sequences of five toxin-encoding genes from the venom gland of this species: Type III snake venom metalloprotease (SVMP), snake venom serine protease (SVSP), Cysteine-rich secretory protein (CRISP), α and β subunits of C-type lectin-like protein (CLP) and C-type natriuretic peptide (NP). These genes are highly expressed in the venom gland and their sequences exhibited a putative signal peptide, suggesting that these are components of the venom. These putative toxins had different evolutionary relationships with those reported for some front-fanged snakes, being SVMP, SVSP and CRISP of P. chamissonis closely related to the toxins present in Elapidae species, while NP was more related to those of Viperidae species. In addition, analyses suggest that the α and β subunits of CLP of P. chamissonis might have a α-subunit scaffold in common with Viperidae species, whose highly variable C-terminal region might have allowed the diversification in α and β subunits. Our results provide the first molecular description of the toxins possibly implicated in the envenomation of prey and humans by the bite of P. chamissonis. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Pre-hospital treatment of ophidian accidents: review, update, and current problems].

PubMed

Gil-Alarcón, Guillermo; Sánchez-Villegas, María Del Carmen; Hugo Reynoso, Víctor

2011-01-01

Mythic, out-dated, ambiguous and sometimes iatrogenic procedures, still remain in pre-hospital and hospital ophidian accident treatment. Errors, omissions and ignorance make ophidian accidents appear more dangerous than they truly are, resulting in a general public contempt toward snakes. Here we present an updated review of current knowledge on pre-hospital and hospital treatment of ophidian bite incidents, including indications, recommendations and logic errors. We describe an appropriate treatment for native Mexican poisonous snakebites using fabotherapics, based on our experience. Adequate initial pre-hospital and hospital management is crucial for a successful outcome of this medical emergency. We describe the state of the art in snake bite research discussing those procedures where research is needed to implement them either by the patient, first responders, paramedics and doctors. We suggest proposals to achieve even more efficient management of fabotherapics based on support networks. Finally, we emphasize prevention as the main subject of venom bite treatment, as it is always more adequate and economic to invest in prevention than to spend on mitigation during emergency and recovery.

Current challenges for confronting the public health problem of snakebite envenoming in Central America

PubMed Central

2014-01-01

Snakebite envenoming is a serious public health problem in Central America, where approximately 5,500 cases occur every year. Panama has the highest incidence and El Salvador the lowest. The majority, and most severe, cases are inflicted by the pit viper Bothrops asper (family Viperidae), locally known as ‘terciopelo’, ‘barba amarilla’ or ‘equis’. About 1% of the bites are caused by coral snakes of the genus Micrurus (family Elapidae). Despite significant and successful efforts in Central America regarding snakebite envenomings in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, and prevention of snakebites, much remains to be done in order to further reduce the impact of this medical condition. This essay presents seven challenges for improving the confrontation of snakebite envenoming in Central America. Overcoming these challenges demands a coordinated partnership of highly diverse stakeholders though inter-sectorial and inter-programmatic interventions. PMID:24602234

Non-native (exotic) snake envenomations in the U.S., 2005-2011.

PubMed

Warrick, Brandon J; Boyer, Leslie V; Seifert, Steven A

2014-09-29

Non-native (exotic) snakes are a problematic source of envenomation worldwide. This manuscript describes the current demographics, outcomes and challenges of non-native snakebites in the United States (U.S.). We performed a retrospective case series of the National Poison Data System (NPDS) database between 2005 and 2011. There were 258 human exposures involving at least 61 unique exotic venomous species (average = 37 per year; range = 33-40). Males comprised 79% and females 21%. The average age was 33 years with 16% less than 20 years old. 70% of bites occurred in a private residence and 86% were treated at a healthcare facility. 35% of cases received antivenom and 10% were given antibiotics. This study is compared to our previous study (1994-2004) in which there was a substantial coding error rate. Software modifications significantly reduced coding errors. Identification and acquisition of appropriate antivenoms pose a number of logistical difficulties in the management of these envenomations. In the U.S., poison centers have valuable systems and clinical roles in the provision of expert consultation and in the management of these cases.

Non-Native (Exotic) Snake Envenomations in the U.S., 2005–2011

PubMed Central

Warrick, Brandon J.; Boyer, Leslie V.; Seifert, Steven A.

2014-01-01

Non-native (exotic) snakes are a problematic source of envenomation worldwide. This manuscript describes the current demographics, outcomes and challenges of non-native snakebites in the United States (U.S.). We performed a retrospective case series of the National Poison Data System (NPDS) database between 2005 and 2011. There were 258 human exposures involving at least 61 unique exotic venomous species (average = 37 per year; range = 33–40). Males comprised 79% and females 21%. The average age was 33 years with 16% less than 20 years old. 70% of bites occurred in a private residence and 86% were treated at a healthcare facility. 35% of cases received antivenom and 10% were given antibiotics. This study is compared to our previous study (1994–2004) in which there was a substantial coding error rate. Software modifications significantly reduced coding errors. Identification and acquisition of appropriate antivenoms pose a number of logistical difficulties in the management of these envenomations. In the U.S., poison centers have valuable systems and clinical roles in the provision of expert consultation and in the management of these cases. PMID:25268980

Use of Molecular Diagnostic Tools for the Identification of Species Responsible for Snakebite in Nepal: A Pilot Study

PubMed Central

Sharma, Sanjib Kumar; Kuch, Ulrich; Höde, Patrick; Bruhse, Laura; Pandey, Deb P.; Ghimire, Anup; Chappuis, François; Alirol, Emilie

2016-01-01

Snakebite is an important medical emergency in rural Nepal. Correct identification of the biting species is crucial for clinicians to choose appropriate treatment and anticipate complications. This is particularly important for neurotoxic envenoming which, depending on the snake species involved, may not respond to available antivenoms. Adequate species identification tools are lacking. This study used a combination of morphological and molecular approaches (PCR-aided DNA sequencing from swabs of bite sites) to determine the contribution of venomous and non-venomous species to the snakebite burden in southern Nepal. Out of 749 patients admitted with a history of snakebite to one of three study centres, the biting species could be identified in 194 (25.9%). Out of these, 87 had been bitten by a venomous snake, most commonly the Indian spectacled cobra (Naja naja; n = 42) and the common krait (Bungarus caeruleus; n = 22). When both morphological identification and PCR/sequencing results were available, a 100% agreement was noted. The probability of a positive PCR result was significantly lower among patients who had used inadequate “first aid” measures (e.g. tourniquets or local application of remedies). This study is the first to report the use of forensic genetics methods for snake species identification in a prospective clinical study. If high diagnostic accuracy is confirmed in larger cohorts, this method will be a very useful reference diagnostic tool for epidemiological investigations and clinical studies. PMID:27105074

Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming — Australian Snakebite Project (ASP-14)

PubMed Central

Allen, George E.; Brown, Simon G. A.; Buckley, Nicholas A.; O’Leary, Margaret A.; Page, Colin B.; Currie, Bart J.; White, Julian; Isbister, Geoffrey K.

2012-01-01

Background Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required. Methods and Finding This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42y (2–81y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15–210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1–40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients. Conclusions Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming. PMID:23300888

Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming--Australian snakebite project (ASP-14).

PubMed

Allen, George E; Brown, Simon G A; Buckley, Nicholas A; O'Leary, Margaret A; Page, Colin B; Currie, Bart J; White, Julian; Isbister, Geoffrey K

2012-01-01

Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required. This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42 y (2-81 y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15-210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1-40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients. Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.

[Bacteriologic study of abscesses caused by bites of snakes of the genus Bothrops].

PubMed

de Andrade, J G; Pinto, R N; de Andrade, A L; Martelli, C M; Zicker, F

1989-01-01

The bacterial flora of 99 cases of abscesses following Bothrops snakebite were analysed. They corresponded to 61.1% of all snakebite abscesses observed in 1030 patients attending the Hospital de Doenças Tropicais de Goiánia in Goiás, Brazil, from January 1984 to April 1988. An exsudate sample of each abscess was examined by Gram stain, culture and susceptibility tests. The Gram negative bacillis, Morganella morganii, Escherichia coli and Providencia sp were the most frequent bacterias isolated. They were identified in 44.4%, 20.2% and 13.1% of the samples respectively. This flora was similar to those described in snake mouth and venom by other researchers. Based on the results of the susceptibility tests the authors suggested the use of chloramphenicol for the treatment of those abscesses which do not respond to simple drainage.

Risks to infants from bites of the brown tree snake (Boiga irregularis)

USGS Publications Warehouse

Fritts, T.H.; McCoid, M.J.; Haddock, R.H.

1990-01-01

The brown tree snake, Boiga irregularis, is abundant on Guam and commonly invades human habitations. Data on emergency room visits on Guam document a high freguency of snakebites on Guam. Over 50% of the emergency room visits for snakebite involved children <4 years old. Records exist of 4 infants, 1, 2, 5, and 10 months old, who displayed significant symptoms after being bitten, while sleeping, by snakes. Two infants developed respiratory problems within a few hours and required medical treatment for asphyxiation. Lethargy, diminished sensory perceptions, drooping eyelids, swelling, discoloration, and bleb formation were variable in occurrence in the patients.

Risks to infants on Guam from bites of the Brown Tree Snake (Boiga irregularis)

USGS Publications Warehouse

Fritts, T.H.; McCoid, M.J.; Haddock, R.H.

1990-01-01

The brown tree snake, Boiga irregularis, is abundant on Guam and commonly invades human habitations. Data on emergency room visits on Guam document a high frequency of snakebites on Guam. Over 50% of the emergency room visits for snakebite involved children less than 4 years old. Records exist of 4 infants, 1, 2, 5, and 10 months old, who displayed significant symptoms after being bitten, while sleeping, by snakes. Two infants developed respiratory problems within a few hours and required medical treatment for asphyxiation. Lethargy, diminished sensory perceptions, drooping eyelids, swelling, discoloration, and bleb formation were variable in occurrence in the patients.

Culturable Aerobic and Facultative Anaerobic Intestinal Bacterial Flora of Black Cobra (Naja naja karachiensis) in Southern Pakistan

PubMed Central

Iqbal, Junaid; Sagheer, Mehwish; Tabassum, Nazneen; Siddiqui, Ruqaiyyah; Khan, Naveed Ahmed

2014-01-01

Using morphological analysis and biochemical testing, here for the first time, we determined the culturable gut bacterial flora (aerobes and facultative anaerobes) in the venomous Black Cobra (Naja naja karachiensis) from South Asia. The findings revealed that these snakes inhabit potentially pathogenic bacteria including Serratia marcescens, Pseudomonas aeruginosa, Shewanella putrefaciens, Aeromonas hydrophila, Salmonella sp., Moraxella sp., Bacillus sp., Ochrobactrum anthropi, and Providencia rettgeri. These findings are of concern, as injury from snake bite can result in wound infections and tissue necrosis leading to sepsis/necrotizing fasciitis and/or expose consumers of snake meat/medicine in the community to infections. PMID:25002979

The belonging of gpMuc, a glycoprotein from Mucuna pruriens seeds, to the Kunitz-type trypsin inhibitor family explains its direct anti-snake venom activity.

PubMed

Scirè, Andrea; Tanfani, Fabio; Bertoli, Enrico; Furlani, Emiliano; Nadozie, Hope-Onyekwere N; Cerutti, Helena; Cortelazzo, Alessio; Bini, Luca; Guerranti, Roberto

2011-07-15

In Nigeria, Mucuna pruriens seeds are locally prescribed as an oral prophylactic for snake bite and it is claimed that when two seeds are swallowed they protect the individual for a year against snake bites. In order to understand the Mucuna pruriens antisnake properties, the proteins from the acqueous extract of seeds were purified by three chromatographic steps: ConA affinity chromatography, tandem anionic-cationic exchange and gel filtration, obtaining a fraction conventionally called gpMucB. This purified fraction was analysed by SDS-PAGE obtaining 3 bands with apparent masses ranging from 20 to 24 kDa, and by MALDI-TOF which showed two main peaks of 21 and 23 kDa and another small peak of 19 kDa. On the other hand, gel filtration analysis of the native protein indicated a molecular mass of about 70 kDa suggesting that in its native form, gpMucB is most likely an oligomeric multiform protein. Infrared spectroscopy of gpMucB indicated that the protein is particularly thermostable both at neutral and acidic pHs and that it is an all beta protein. All data suggest that gpMucB belongs to the Kunitz-type trypsin inhibitor family explaining the direct anti-snake venom activity of Mucuna pruriens seeds. Copyright © 2011 Elsevier GmbH. All rights reserved.

Struan Sutherland--Doyen of envenomation in Australia.

PubMed

Tibballs, James

2006-12-01

Struan Sutherland (1936-2002) was the doyen of medical research in the field of envenomation and the ultimate authority on the medical management of envenomated victims in Australia for almost 3 decades. In 1981 as Head of Immunology Research of Commonwealth Serum Laboratories (CSL), he produced an antivenom against the Sydney Funnel-web Spider (Atrax robustus)-an accomplishment that had defied numerous previous attempts. Struan also invented the pressure-immobilisation technique of first-aid for snake bite. This ingenious, simple but safe and effective technique revolutionised first-aid management of snake bite and of some other types of envenomation. It made redundant the use of tourniquets and other dangerous first-aid treatments. Similarly, he helped to develop a snake venom detection kit, which enables doctors working at a victim's bedside to ascertain which snake was responsible and which antivenom should be administered. He had a very wide range of research interests and was a prodigious researcher publishing over 200 scientific and medical articles, numerous chapters in books and the standard Australian medical textbook on the management of envenomation, Australian Animal Toxins. He made major contributions to the understanding of the venoms of Australia's remarkable range of fauna including snakes, spiders, Blue-ringed octopus, ants, jellyfish and stinging fish. Struan served the medical fraternity and the public selflessly. He was always available to doctors, or to anybody, to give advice at any hour of the day or night, on management of envenomated victims. Members of the Australian Venom Research Unit, which he founded in 1994 at The University of Melbourne, now continue this 24-h advisory service.

Proteome analysis of snake venom toxins: pharmacological insights.

PubMed

Georgieva, Dessislava; Arni, Raghuvir K; Betzel, Christian

2008-12-01

Snake venoms are an extremely rich source of pharmacologically active proteins with a considerable clinical and medical potential. To date, this potential has not been fully explored, mainly because of our incomplete knowledge of the venom proteome and the pharmacological properties of its components, in particular those devoid of enzymatic activity. This review summarizes the latest achievements in the determination of snake venom proteome, based primarily on the development of new strategies and techniques. Detailed knowledge of the venom toxin composition and biological properties of the protein constituents should provide the scaffold for the design of new more effective drugs for the treatment of the hemostatic system and heart disorders, inflammation, cancer and consequences of snake bites, as well as new tools for clinical diagnostic and assays of hemostatic parameters.

Venomous adversaries: a reference to snake identification, field safety, and bite-victim first aid for disaster-response personnel deploying into the hurricane-prone regions of North America.

PubMed

Wozniak, Edward J; Wisser, John; Schwartz, Michael

2006-01-01

Each hurricane season, emergency-preparedness deployment teams including but not limited to the Office of Force Readiness and Deployment of the US Public Health Service, Federal Emergency Management Agency, Deployment Medical Assistance Teams, Veterinary Medical Assistance Teams, and the US Army and Air Force National Guard are at risk for deploying into hurricane-stricken areas that harbor indigenous hazards, including those posed by venomous snakes. North America is home to 2 distinct families of venomous snakes: 1) Viperidae, which includes the rattlesnakes, copperheads, and cottonmouths; and 2) Elapidae, in which the only native species are the coral snakes. Although some of these snakes are easily identified, some are not, and many rank among the most feared and misunderstood animals. This article specifically addresses all the native species of venomous snakes that inhabit the hurricane-prone regions of North America and is intended to serve as a reference to snake identification, basic field safety procedures, and the currently recommended first-aid measures for snakebite casualties.

Recurrent Coagulopathy after Rattlesnake Bite Requiring Continuous Intravenous Dosing of Antivenom

PubMed Central

2015-01-01

Context. Snakebite envenomation is common and may result in systemic coagulopathy. Antivenom can correct resulting laboratory abnormalities; however, despite antivenom use, coagulopathy may recur, persist, or result in death after a latency period. Case Details. A 50-year-old previously healthy man presented to the emergency department after a rattlesnake bite to his right upper extremity. His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy. His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days. However, over the subsequent two weeks, he continued to have refractory coagulopathy requiring multiple units of antivenom. The coagulopathy finally resolved after starting a continuous antivenom infusion. Discussion. Envenomation may result in latent venom release from soft tissue depots that can last for two weeks. This case report illustrates the importance of close hemodynamic and laboratory monitoring after snakebites and describes the administration of continuous antivenom infusion, instead of multidose bolus, to neutralize latent venom release and correct residual coagulopathy. PMID:25664187

The Hidden Snake in the Grass: Superior Detection of Snakes in Challenging Attentional Conditions

PubMed Central

Soares, Sandra C.; Lindström, Björn; Esteves, Francisco; Öhman, Arne

2014-01-01

Snakes have provided a serious threat to primates throughout evolution. Furthermore, bites by venomous snakes still cause significant morbidity and mortality in tropical regions of the world. According to the Snake Detection Theory (SDT Isbell, 2006; 2009), the vital need to detect camouflaged snakes provided strong evolutionary pressure to develop astute perceptual capacity in animals that were potential targets for snake attacks. We performed a series of behavioral tests that assessed snake detection under conditions that may have been critical for survival. We used spiders as the control stimulus because they are also a common object of phobias and rated negatively by the general population, thus commonly lumped together with snakes as “evolutionary fear-relevant”. Across four experiments (N = 205) we demonstrate an advantage in snake detection, which was particularly obvious under visual conditions known to impede detection of a wide array of common stimuli, for example brief stimulus exposures, stimuli presentation in the visual periphery, and stimuli camouflaged in a cluttered environment. Our results demonstrate a striking independence of snake detection from ecological factors that impede the detection of other stimuli, which suggests that, consistent with the SDT, they reflect a specific biological adaptation. Nonetheless, the empirical tests we report are limited to only one aspect of this rich theory, which integrates findings across a wide array of scientific disciplines. PMID:25493937

The Hidden Snake in the Grass: Superior Detection of Snakes in Challenging Attentional Conditions.

PubMed

Soares, Sandra C; Lindström, Björn; Esteves, Francisco; Ohman, Arne

2014-01-01

Snakes have provided a serious threat to primates throughout evolution. Furthermore, bites by venomous snakes still cause significant morbidity and mortality in tropical regions of the world. According to the Snake Detection Theory (SDT Isbell, 2006; 2009), the vital need to detect camouflaged snakes provided strong evolutionary pressure to develop astute perceptual capacity in animals that were potential targets for snake attacks. We performed a series of behavioral tests that assessed snake detection under conditions that may have been critical for survival. We used spiders as the control stimulus because they are also a common object of phobias and rated negatively by the general population, thus commonly lumped together with snakes as "evolutionary fear-relevant". Across four experiments (N = 205) we demonstrate an advantage in snake detection, which was particularly obvious under visual conditions known to impede detection of a wide array of common stimuli, for example brief stimulus exposures, stimuli presentation in the visual periphery, and stimuli camouflaged in a cluttered environment. Our results demonstrate a striking independence of snake detection from ecological factors that impede the detection of other stimuli, which suggests that, consistent with the SDT, they reflect a specific biological adaptation. Nonetheless, the empirical tests we report are limited to only one aspect of this rich theory, which integrates findings across a wide array of scientific disciplines.

Appraisal of snakebite incidence and mortality in Bolivia.

PubMed

Chippaux, Jean-Philippe; Postigo, Jorge R

2014-06-01

No information has been yet published on snakebite in Bolivia. The country includes very different ecological situations leading to various epidemiological risks. A study has been carried out to evaluate the incidence and location of snakebite, particularly in relation with altitude, in order to improve management. Investigations on snakebite epidemiology were based on a) cases treated in health facilities as reported by health authorities and b) household surveys carried out in areas with high variations of altitude, in various regions of Bolivia. An average of 700 bites was treated each year in Bolivia (national annual incidence = 8 bites per 100,000 people) with a great disparity between districts. Household surveys showed annual incidences ranged from 30 to 110 bites per 100,000 inhabitants depending on location. Annual mortality ranged 0.1-3.9 per 100,000 people. A significant and constant inverse correlation was shown between snakebite incidence and altitude, which may be explained by both snake and human distributions and activities. Notification of snakebite is useful for improving patient management and informing antivenom distribution. It should also involve the report of deaths and clinical details of envenomation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interspecific aggression and habitat partitioning in garter snakes.

PubMed

Edgehouse, Michael; Latta, Leigh C; Brodie, Edmund D; Brodie, Edmund D

2014-01-01

Defense of a limited resource, such as space or food, has recently been discovered in snakes and has been widely documented in lizards. Garter snakes (Thamnophis spp.) are historically considered generalist predators such that food is not a limiting resource. However, in this study we show that the common garter snake (Thamnophis sirtalis) and the aquatic garter snake (Thamnophis atratus) show a strong preference for amphibians as their primary food source at the Santa Lucia Preserve (SLP), Monterey County, California. This food preference forces these snake species at SLP to exploit aquatic habitats. Our principle goal was to investigate the aggressive behavior of T. sirtalis and the potential that this aggression displaces T. atratus from its preferred habitat. We found that when individuals from either species are alone, a 100% preference for aquatic or near aquatic habitat is observed. In contrast, when these species are together, T. sirtalis occupy the aquatic habitat and T. atratus occupy an area far removed from water. Thamnophis sirtalis often physically force T. atratus from the aquatic habitat through repeated biting and other displays of aggression.

Interspecific Aggression and Habitat Partitioning in Garter Snakes

PubMed Central

Edgehouse, Michael; Latta, Leigh C.; Brodie, Edmund D.; Brodie, Edmund D.

2014-01-01

Defense of a limited resource, such as space or food, has recently been discovered in snakes and has been widely documented in lizards. Garter snakes (Thamnophis spp.) are historically considered generalist predators such that food is not a limiting resource. However, in this study we show that the common garter snake (Thamnophis sirtalis) and the aquatic garter snake (Thamnophis atratus) show a strong preference for amphibians as their primary food source at the Santa Lucia Preserve (SLP), Monterey County, California. This food preference forces these snake species at SLP to exploit aquatic habitats. Our principle goal was to investigate the aggressive behavior of T. sirtalis and the potential that this aggression displaces T. atratus from its preferred habitat. We found that when individuals from either species are alone, a 100% preference for aquatic or near aquatic habitat is observed. In contrast, when these species are together, T. sirtalis occupy the aquatic habitat and T. atratus occupy an area far removed from water. Thamnophis sirtalis often physically force T. atratus from the aquatic habitat through repeated biting and other displays of aggression. PMID:24465962

Experimental Bothrops atrox envenomation: Efficacy of antivenom therapy and the combination of Bothrops antivenom with dexamethasone

PubMed Central

dos Anjos, Isabelle Valle; Chalkidis, Hipocrates de Menezes; Mourão, Rosa Helena Veras; Moura-da-Silva, Ana Maria; Sano-Martins, Ida Sigueko; Gonçalves, Luis Roberto de Camargo

2017-01-01

Bothrops atrox snakes are the leading cause of snake bites in Northern Brazil. The venom of this snake is not included in the antigen pool used to obtain the Bothrops antivenom. There are discrepancies in reports on the effectiveness of this antivenom to treat victims bitten by B. atrox snakes. However, these studies were performed using a pre-incubation of the venom with the antivenom and, thus, did not simulate a true case of envenomation treatment. In addition, the local lesions induced by Bothrops venoms are not well resolved by antivenom therapy. Here, we investigated the efficacy of the Bothrops antivenom in treating the signs and symptoms caused by B. atrox venom in mice and evaluated whether the combination of dexamethasone and antivenom therapy enhanced the healing of local lesions induced by this envenomation. In animals that were administered the antivenom 10 minutes after the envenomation, we observed an important reduction of edema, dermonecrosis, and myonecrosis. When the antivenom was given 45 minutes after the envenomation, the edema and myonecrosis were reduced, and the fibrinogen levels and platelet counts were restored. The groups treated with the combination of antivenom and dexamethasone had an enhanced decrease in edema and a faster recovery of the damaged skeletal muscle. Our results show that Bothrops antivenom effectively treats the envenomation caused by Bothrops atrox and that the use of dexamethasone as an adjunct to the antivenom therapy could be useful to improve the treatment of local symptoms observed in envenomation caused by Bothrops snakes. PMID:28306718

Spotted black snake (Pseudechis guttatus) envenomation in a maned wolf (Chrysocyon brachyurus).

PubMed

Portas, Timothy J; Montali, Richard J

2007-09-01

Envenomation by a spotted black snake (Pseudechis guttatus), following multiple bites on the buccal mucosa of a captive maned wolf (Chrysocyon brachyurus), caused the animal's collapse, hemolysis, rhabdomyolysis, local tissue necrosis, hepatic and renal failure, and subsequent death. The wolf died despite intensive supportive care including antivenom administration, fluid support, and a blood transfusion. Gross necropsy findings included myocardial and intestinal hemorrhage, pulmonary congestion, hepatomegaly, and splenomegaly. Microscopic examination of formalin-fixed tissues demonstrated pulmonary and abdominal visceral hemorrhage, acute nephrosis with casts, multifocal hepatic necrosis, and splenic congestion.

Use of CroFab antivenin in the management of a very young pediatric copperhead envenomation.

PubMed

Trinh, Hai H; Hack, Jason B

2005-08-01

The use of crotalid Fab antivenin (CroFab) in the treatment of snake envenomations in the pediatric population is still an underexplored area. There are very limited data to confirm the efficacy and safety of dosing children the same as adults and even less information available to evaluate this antivenin use in copperhead snake bites in children. We report the first use of crotalid Fab antivenin in an adult dose for a copperhead snake envenomation in a 2-year-old child. She had rapid resolution of symptoms with no adverse effects. The report serves to increase the literature supporting the current dosing recommendations of crotalid Fab antivenin in very young pediatric patients evidenced by its effectiveness in this patient.

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments

PubMed Central

Lubich, Carol; Krenzelok, Edward P

2009-01-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms. PMID:21686401

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments.

PubMed

Lubich, Carol; Krenzelok, Edward P

2009-01-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms.

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments

PubMed Central

Lubich, Carol; Krenzelok, Edward P

2007-01-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms. PMID:17954846

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments.

PubMed

Lubich, Carol; Krenzelok, Edward P

2007-11-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms.

Inhibition of local effects of Indian Daboia/Vipera russelli venom by the methanolic extract of grape (Vitis vinifera L.) seeds.

PubMed

Mahadeswaraswamy, Y H; Devaraja, S; Kumar, M S; Goutham, Y N J; Kemparaju, K

2009-04-01

Although anti-venom therapy is available for the treatment of fatal bite by snakes, it offers less or no protection against the local effects such as dermo- and myonecrosis, edema, hemorrhage and inflammation at the bitten region. The viper species are known for their violent local effects and such effects have been commonly treated with plant extracts without any scientific validation in rural India. In this investigation, the methanolic extract of grapes (Vitis vinifera L.) seed was studied against the Indian Daboia/Vipera russelli venom-induced local effects. The extract abolished the proteolytic and hyaluronidase activities and also efficiently neutralized the hemorrhage, edema-inducing and myonecrotic properties of the venom. In addition, the extract also inhibited partially the pro-coagulant activity of the venom and abolished the degradation of Aalpha and Bbeta chains of human fibrinogen. Thus, the extract possesses potent anti-snake venom property, especially against the local effects of viper bites.

A new Pan African polyspecific antivenom developed in response to the antivenom crisis in Africa.

PubMed

Laing, G D; Renjifo, J M; Ruiz, F; Harrison, R A; Nasidi, A; Gutierrez, J-M; Rowley, P D; Warrell, D A; Theakston, R D G

2003-07-01

Currently there is a crisis in the supply of antivenom for treatment of snake bite in sub-Saharan Africa. Commercial pressures have resulted in the reduction or even cessation of production of antivenom by European manufacturers while continued production of antivenom in Africa has been threatened by the privatisation of the only remaining company based in Africa. As a consequence, there has been an increase in snake bite morbidity and mortality in many African countries. Two Latin American antivenom manufacturers have agreed to produce antivenom suitable for Africa, using venoms from the species which are of the greatest medical importance in sub-Saharan Africa. Preclinical in vivo assays of neutralising potency demonstrated that a new Pan African antivenom produced in Colombia compared favourably with the existing commercial monospecific and polyspecific antivenoms. This new antivenom, and a similar product being manufactured in Costa Rica, are now candidates for clinical testing at an appropriate site in Africa.

Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25).

PubMed

Johnston, Christopher I; Ryan, Nicole M; O'Leary, Margaret A; Brown, Simon G A; Isbister, Geoffrey K

2017-02-01

Taipans (Oxyuranus spp.) are medically important venomous snakes from Australia and Papua New Guinea. The objective of this study was to describe taipan envenoming in Australian and its response to antivenom. Confirmed taipan bites were recruited from the Australian Snakebite Project. Data were collected prospectively on all snakebites, including patient demographics, bite circumstances, clinical effects, laboratory results, complications and treatment. Blood samples were taken and analysed by venom specific immunoassay to confirm snake species and measure venom concentration pre- and post-antivenom. There were 40 confirmed taipan bites: median age 41 years (2-85 years), 34 were males and 21 were snake handlers. Systemic envenoming occurred in 33 patients with neurotoxicity (26), complete venom induced consumption coagulopathy (VICC) (16), partial VICC (15), acute kidney injury (13), myotoxicity (11) and thrombocytopenia (7). Venom allergy occurred in seven patients, three of which had no evidence of envenoming and one died. Antivenom was given to 34 patients with a median initial dose of one vial (range 1-4), and a median total dose of two vials (range 1-9). A greater total antivenom dose was associated with VICC, neurotoxicity and acute kidney injury. Early antivenom administration was associated with a decreased frequency of neurotoxicity, acute kidney injury, myotoxicity and intubation. There was a shorter median time to discharge of 51 h (19-432 h) in patients given antivenom <4 h post-bite, compared to 175 h (27-1104 h) in those given antivenom >4 h. Median peak venom concentration in 25 patients with systemic envenoming and a sample available was 8.4 ng/L (1-3212 ng/L). No venom was detected in post-antivenom samples, including 20 patients given one vial initially and five patients bitten by inland taipans. Australian taipan envenoming is characterised by neurotoxicity, myotoxicity, coagulopathy, acute kidney injury and thrombocytopenia. One vial of antivenom binds all measurable venom and early antivenom was associated with a favourable outcome.

The Epidemiology, Clinical Course, and Management of Snakebites in the North American Snakebite Registry.

PubMed

Ruha, Anne-Michelle; Kleinschmidt, Kurt C; Greene, Spencer; Spyres, Meghan B; Brent, Jeffrey; Wax, Paul; Padilla-Jones, Angela; Campleman, Sharan

2017-12-01

The American College of Medical Toxicology established the North American Snakebite Registry (NASBR), a national database of detailed, prospectively collected information regarding snake envenomation in the United States, in 2013. This report describes the epidemiology, clinical course, and management of snakebites in the NASBR. All cases entered into the NASBR between January 1, 2013 and December 31, 2015 were identified. Descriptive statistics are used to report results. Fourteen sites in 10 states entered 450 snakebites. Native species comprised 99% of cases, almost all of which were pit viper bites. 56.3% were identified as rattlesnakes and 29.4% as copperheads. 69.3% were male and 28.2% were children age 12 and under. Fifty-four percent of bites were on the lower extremity. Twenty-seven percent of patients with lower extremity bites were not wearing shoes. Common tissue findings associated with envenomation were swelling, ecchymosis, and erythema. Systemic effects and hematologic toxicity were more common in rattlesnake than copperhead or cottonmouth envenomations. Crotalidae Polyvalent Immune Fab antivenom was given to 84% of patients. Twelve patients (4.3%) were re-admitted to the hospital after completion of treatment. Eight were re-treated with antivenom. The NASBR gathers detailed data on venomous snakebites across the US. In its initial years, useful information has already been gained. Data regarding footwear will inform public health interventions and education, and information regarding the clinical presentation may help physicians better anticipate effects and manage snakebite. As the number of cases in the NASBR grows, associations between patient-related factors and outcomes may be studied.

Treatment of US crotalidae bites: comparisons of serum and globulin-based polyvalent and antigen-binding fragment antivenins.

PubMed

Seger, Donna; Kahn, Stephen; Krenzelok, Edward P

2005-01-01

In the US, two antivenins are marketed for the treatment of snake envenomation. The horse-derived serum-globulin-based Antivenin (Crotalidae) Polyvalent (ACP) has been available since 1954. There are few data on the efficacy and incidence of adverse events that occur following the administration of ACP. Most of the data are retrospective, anecdotal, or case reports. In 2000, ovine-derived serum-globulin-based ACP (Crofab) became available. Crofab is said to cause fewer reactions than ACP, but there are few comparative data to substantiate this claim. Although both antivenins ameliorate the systemic symptoms following snake envenomation, the efficacy of either antivenin in decreasing oedema and swelling is unknown for a number of reasons. Clinical trials are small and have not included control arms. The degree of oedema, as well as the efficacy of the antivenin in decreasing oedema, may depend on the genera of the snake (usually unknown) that envenomated the patient. This article compares available data on clinical aspects of the two antivenins. More prospective data are needed to determine the comparative efficacy of the two antivenins, or the efficacy of Crofab in preventing tissue oedema. There are still unanswered questions regarding the optimal dosing regimen of Crofab.

[Epidemiology of ophidism in Venezuela (1996-2004)].

PubMed

De Sousa, Leonardo; Bastouri-Carrasco, Jessica; Matos, Mercedes; Borges, Adolfo; Bónoli, Stefano; Vásquez-Suárez, Aleikar; Guerrero, Belsy; Rodríguez-Acosta, Alexis

2013-06-01

The data of accidents caused by snakebites in Venezuela, registered at the morbidity statistics of the Direction of Epidemiology and Strategic Analysis of the Ministry of Health and Social Development were analyzed. During the years of 1996-2004, 53,792 snakebites were registered in Venezuela (5,976 cases average per year), with a higher incidence during the year 2004 (7,486 incidents). Zulia reported the highest frequency of all the states (5,975 cases); meanwhile the Midwestern region, constituted by Lara, Portuguesa, Falc6n and Yaracuy states, had a higher morbidity for snake bites. The highest incidence, distributed per states was registered in Cojedes, during the year 2001, with 228.72 cases per 100,000 inhabitants. When it was determined by regions, the highest incidence occurred during the year 2004 at los Llanos with 63.81 per 100,000 inhabitants. The median of the incidence rate for Venezuela during the period was of 21.46 accidents per 100,000 inhabitants. The classification of the endemic areas for ophidism, according to the percentiles 23, 50, 75 and 90, organized the country in: (a) states and regions of very high endemicity, (b) high endemicity, (c) middle, (d) low and (e) very low endemicity. These epidemiological data indicated that the accidents caused by snakes constitute a collective health problem in Venezuela.

+Ophitoxaemia and myocardial infarction—the issues during primary angioplasty: a review

PubMed Central

Gupta, Prabha Nini; Thomas, Jinesh; Francis, Preetham Kumar; Shylaja, Sajith Vamadevan

2014-01-01

‘The Big four’ are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours. PMID:25342187

46 CFR 160.041-1 - Applicable specification and publication.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Kits, First-Aid, for Merchant... specification, of the issue in effect on the date first-aid kits are manufactured, forms a part of this subpart: (1) Federal specification: GG-K-391, Kits (Empty), First Aid, Burn Treatment, and Snake Bite; and Kit...

46 CFR 160.041-1 - Applicable specification and publication.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Kits, First-Aid, for Merchant... specification, of the issue in effect on the date first-aid kits are manufactured, forms a part of this subpart: (1) Federal specification: GG-K-391, Kits (Empty), First Aid, Burn Treatment, and Snake Bite; and Kit...

Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan

DTIC Science & Technology

2013-01-01

with at least 1 dose of intravenous polyvalent antivenom (Razi Vaccine & Serum Research Institute, Iran; or Favirept, Sanofi Pasteur SA, France), most...Razi indicates Razi Vaccine & Serum Research Institute, Iran; Favirep indicates Favirept, Sanofi Pasteur SA, France. b Indicates abnormal laboratory

46 CFR 160.041-1 - Applicable specification and publication.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Kits, First-Aid, for Merchant... specification, of the issue in effect on the date first-aid kits are manufactured, forms a part of this subpart: (1) Federal specification: GG-K-391, Kits (Empty), First Aid, Burn Treatment, and Snake Bite; and Kit...

The protective effect of Mucuna pruriens seeds against snake venom poisoning.

PubMed

Tan, Nget Hong; Fung, Shin Yee; Sim, Si Mui; Marinello, Enrico; Guerranti, Roberto; Aguiyi, John C

2009-06-22

The seed, leaf and root of Mucuna pruriens have been used in traditional medicine for treatments of various diseases. In Nigeria, the seed is used as oral prophylactics for snakebite. To study the protective effects of Mucuna pruriens seed extract against the lethalities of various snake venoms. Rats were pre-treated with Mucuna pruriens seed extract and challenged with various snake venoms. The effectiveness of anti-Mucuna pruriens (anti-MPE) antibody to neutralize the lethalities of snake venoms was investigated by in vitro neutralization. In rats, MPE pre-treatment conferred effective protection against lethality of Naja sputatrix venom and moderate protection against Calloselasma rhodostoma venom. Indirect ELISA and immunoblotting studies showed that there were extensive cross-reactions between anti-MPE IgG and venoms from many different genera of poisonous snakes, suggesting the involvement of immunological neutralization in the protective effect of MPE pre-treatment against snake venom poisoning. In vitro neutralization experiments showed that the anti-MPE antibodies effectively neutralized the lethalities of Asiatic cobra (Naja) venoms, but were not very effective against other venoms tested. The anti-MPE antibodies could be used in the antiserum therapy of Asiatic cobra (Naja) bites.

Identification and phylogeny of Arabian snakes: Comparison of venom chromatographic profiles versus 16S rRNA gene sequences.

PubMed

Al Asmari, Abdulrahman; Manthiri, Rajamohammed Abbas; Khan, Haseeb Ahmad

2014-11-01

Identification of snake species is important for various reasons including the emergency treatment of snake bite victims. We present a simple method for identification of six snake species using the gel filtration chromatographic profiles of their venoms. The venoms of Echis coloratus, Echis pyramidum, Cerastes gasperettii, Bitis arietans, Naja arabica, and Walterinnesia aegyptia were milked, lyophilized, diluted and centrifuged to separate the mucus from the venom. The clear supernatants were filtered and chromatographed on fast protein liquid chromatography (FPLC). We obtained the 16S rRNA gene sequences of the above species and performed phylogenetic analysis using the neighbor-joining method. The chromatograms of venoms from different snake species showed peculiar patterns based on the number and location of peaks. The dendrograms generated from similarity matrix based on the presence/absence of particular chromatographic peaks clearly differentiated Elapids from Viperids. Molecular cladistics using 16S rRNA gene sequences resulted in jumping clades while separating the members of these two families. These findings suggest that chromatographic profiles of snake venoms may provide a simple and reproducible chemical fingerprinting method for quick identification of snake species. However, the validation of this methodology requires further studies on large number of specimens from within and across species.

Hypopituitarism following envenoming by Russell's vipers (Daboia siamensis and D. russelii) resembling Sheehan's syndrome: first case report from Sri Lanka, a review of the literature and recommendations for endocrine management.

PubMed

Antonypillai, C N; Wass, J A H; Warrell, D A; Rajaratnam, H N

2011-02-01

Russell's vipers (Daboia russelii and D. siamensis) inhabit 10 South and South East Asian countries. People envenomed by these snakes suffer coagulopathy, bleeding, shock, neurotoxicity, acute kidney injury and local tissue damage leading to severe morbidity and mortality. An unusual complication of Russell's viper bite envenoming in Burma (D. siamensis) and southern India (D. russelii) is hypopituitarism but until now it has not been reported elsewhere. Here, we describe the first case of hypopituitarism following Russell's viper bite in Sri Lanka, review the literature on this subject and make recommendations for endocrine investigation and management. A 49-year-old man was bitten and seriously envenomed by D. russelii in 2005. He was treated with antivenom but although he recovered from the acute effects he remained feeling unwell. Hypopituitarism, with deficiencies of gonadal, steroid and thyroid axes, was diagnosed 3 years later. He showed marked improvement after replacement of anterior pituitary hormones. We attribute his hypopituitarism to D. russelii envenoming. Russell's viper bite is known to cause acute and chronic hypopituitarism and diabetes insipidus, perhaps through deposition of fibrin microthrombi and haemorrhage in the pituitary gland resulting from the action of venom procoagulant enzymes and haemorrhagins. Forty nine cases of hypopituitarism following Russell's viper bite have been described in the English language literature. Patients with acute hypopituitarism may present with hypoglycaemia and hypotension during the acute phase of envenoming. Those with chronic hypopituitarism seem to have recovered from envenoming but present later with features of hypopituitarism. Over 85% of these patients had suffered acute kidney injury immediately after the bite. Steroid replacement in acute hypopituitarism is life saving. All 11 patients with chronic hypopituitarism in whom the outcome of treatment was reported, showed marked improvement with hormone replacement. Unrecognized acute hypopituitarism is potentially fatal while chronic hypopituitarism can be debilitating. Physicians should therefore be aware of this complication of severe envenoming by Russell's vipers, especially in Burma and South India, so that the diagnosis may be made without delay and replacement started with essential hormones such as hydrocortisone and thyroxine.

Foraging mode and evolution of strike-induced chemosensory searching in lizards.

PubMed

Cooper, William E

2003-04-01

Strike-induced chemosensory searching (SICS) in lizards and snakes is a means of relocating prey by scent-trailing. The two main components of SICS are an elevated tongue-flick rate for vomerolfactory sampling after biting prey (PETF) and searching movements. In combination, these behaviors permit scent-trailing. Prey chemical discrimination, which is a prerequisite for SICS, is present in active foragers, but not in ambush foragers. Using comparative data. I show that searching movements and SICS have undergone correlated evolution with foraging mode and with prey chemical discrimination in lizards. This suggests that active foraging selects for prey chemical discrimination, which is then employed to search for escaped prey using the typical movements and tongue-flicking behaviors of active foragers. SICS in lizards is simply heightened active foraging after biting prey. In nonvenomous snakes, SICS is similar to that in lizards but is not restricted to active foragers. Only highly venomous snakes voluntarily release dangerous prey upon envenomation, pause to let the venom incapacitate the prey, and then relocate the prey by scent-trailing. PETF was observed in two ambush foragers and is not evolutionarily correlated with foraging mode or searching movements. Because it occurs in species lacking prey chemical discrimination, such PETF may be a response to gustatory cues or to internal chemicals not encountered on surfaces or trails of uninjured prey.

Cross neutralization of coral snake venoms by commercial Australian snake antivenoms.

PubMed

Ramos, Henrique Roman; Vassão, Ruth Camargo; de Roodt, Adolfo Rafael; Santos E Silva, Ed Carlos; Mirtschin, Peter; Ho, Paulo Lee; Spencer, Patrick Jack

2017-01-01

Although rare, coral snake envenomation is a serious health threat in Brazil, because of the highly neurotoxic venom and the scarcely available antivenom. The major bottleneck for antivenom production is the low availability of venom. Furthermore, the available serum is not effective against all coral snake species found in Brazil. An alternative to circumvent the lack of venom for serum production and the restricted protection of the actually available antivenom would be of great value. We compared the Brazilian coral snake and mono and polyvalent Australian antivenoms in terms of reactivity and protection. The immunoreactivity of venoms from 9 coral snakes species were assayed by ELISA and western blot using the Brazilian Micrurus and the Australian pentavalent as well as monovalent anti-Notechis, Oxyuranus and Pseudechis antivenoms. Neutralization assays were performed in mice, using 3 LD 50 of the venoms, incubated for 30 minutes with 100 μL of antivenom/animal. All the venoms reacted against the autologous and heterologous antivenoms. Nevertheless, the neutralization assays showed that the coral snake antivenom was only effective against M. corallinus, M. frontalis, M. fulvius, M. nigrocinctus and M. pyrrhocryptus venoms. On the other hand, the Australian pentavalent antivenom neutralized all venoms except the one from M. spixii. A combination of anti-Oxyuranus and Pseudechis monovalent sera, extended the protection to M. altirostris and, partially, to M. ibiboboca. By adding Notechis antivenom to this mixture, we obtained full protection against M. ibiboboca and partial neutralization against M. lemniscatus venoms. Our findings confirm the limited effectiveness of the Brazilian coral snake antivenom and indicate that antivenoms made from Australian snakes venoms are an effective alternative for coral snake bites in South America and also in the United States were coral snake antivenom production has been discontinued.

Stigma of tiger attack: Study of tiger-widows from Sundarban Delta, India*

PubMed Central

Chowdhury, Arabinda N.; Brahma, Arabinda; Mondal, Ranajit; Biswas, Mrinal K.

2016-01-01

Aims: Human-tiger conflict (HTC) is a serious public health issue in Sundarban Reserve Forest, India. HTC is a continued concern for significant mortality and morbidity of both human and tiger population. This study examined 49 widows, whose husbands were killed by tigers, in order to explore the cultural stigma related with tiger-killing and consequent discrimination and social rejection. Different psychosocial aspects of community stigma associated with tiger-killings is discussed in the context of local culture. Methods: A mix of both quantitative and qualitative methods was used in this ethnographic study in two mouzas of Sundarban adjacent to Reserve Forest, involving (1) Village Survey for Tiger-widows, (2) In-depth interview of the widows, (3) Focus Group discussions, (4) Participatory mapping and (5) Stigma assessment by using a 28 item stigma scale especially devised for this research. For comparison of stigma-burden snake-bite widows and normal widows were taken from the same community. Results: Tiger-widows showed significantly higher stigma scores on all the clusters (fear, negative feelings, disclosure, discrimination, community attitudes, and spiritual dimension) than from both normal and snake-bite widows. They also showed higher total stigma score (65.9 ± 9.8) than normal widows (35.8 ± 8.0) and snake-bite widows (40.1 ± 7.1) and this difference was highly significant (P < 0.001). IDIs and FGDs helped to unfold the cultural construct of stigma related to tiger-killing. This can be seen in how the tiger-widows’ quality of life has been negatively impacted with a multitude of post-trauma psychological scars, deprivation, abuse and exploitation. Conclusions: The study proposes that administrative strategy for sustainable alternative income generation and conservation policy with integrated participatory forest management may save both human and tiger. A community ecocultural mental health programme addressing to eradicate the cultural stigma related with tiger attack, with environmental awareness may help to reduce the social miseries of the tiger-widows. PMID:26985099

Toxicologic information resources for reptile envenomations.

PubMed

McNally, Jude; Boesen, Keith; Boyer, Leslie

2008-05-01

The United States is the largest importer of reptiles in the world, with an estimated 1.5 to 2.0 million households keeping one or more reptiles. Snakes account for about 11% of these imports and it has been estimated that as many as 9% of these reptiles are venomous. Envenomations by nonindigenous venomous species are a rare but often serious medical emergency. Bites may occur during the care and handling of legitimate collections found in universities, zoos, or museums. The other predominant source of exotic envenomation is from amateur collectors participating in importation, propagation, and trade of non-native species. This article provides toxicologic information resources for snake envenomations.

Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species.

PubMed

Israel, Jacqueline S; McCarthy, James E; Rose, Katherine R; Rao, Venkat K

2017-11-01

Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects. The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria. The hand infection in the man who sustained an opossum bite at the authors' institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial. Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.

Accidents caused by Bothrops and Bothropoides in the State of Paraiba: epidemiological and clinical aspects.

PubMed

Oliveira, Fagner Neves; Brito, Monalisa Taveira; Morais, Isabel Cristina Oliveira de; Fook, Sayonara Maria Lia; Albuquerque, Helder Neves de

2010-01-01

Bothrops and Bothropoides snakes cause 70% of the ophidic accidents in Brazil. The species that cause ophidic accidents in State of Paraíba are Bothropoides erythromelas, Bothrops leucurus and Bothropoides neuwiedi. This is a prospective and transverse study, following a quantitative approach of accidents involving Bothrops and Bothropoides admitted to the Toxicological Assistance and Information Centers of Campina Grande and João Pessoa (Ceatox-CG and Ceatox-JP), aimed at identifying the epidemiological and clinical profile of such accidents. All of the patients admitted had medical diagnoses and were monitored at Ceatox-CG or Ceatox-JP. The genera Bothrops and Bothropoides caused 91.7% of the ophidic accidents reported. Snake bites were frequent in men (75.1%), rural workers (65.1%), literate individuals (69%) between 11 and 20 years-old (21.7%), and toes the most common area attacked (52.7%). Most (86.6%) patients were admitted within 6 hours after the accident/bite, with a predominance of mild cases (64.6%). The annual occurrence in Paraíba was 5.5 accidents/100,000 inhabitants and lethality was 0.2%. Positive changes in the profiles of these accidents were verified, such as the non-application of inadequate solutions, including the use of tourniquet, coffee grounds, garlic, suction and/or cutting the bitten area. Moreover, the Itinerant Laboratory project, linked to Paraíba State University in partnership with Ceatox-CG, has contributed positively, providing several cities of the state with information regarding the prevention of accidents involving venomous animals. The local press has also contributed, reporting the educational work developed by the centers.

Snakebite in Australia: a practical approach to diagnosis and treatment.

PubMed

Isbister, Geoffrey K; Brown, Simon G A; Page, Colin B; McCoubrie, David L; Greene, Shaun L; Buckley, Nicholas A

2013-12-16

Snakebite is a potential medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. Patients should be treated in hospitals with onsite laboratory facilities, appropriate antivenom stocks and a clinician capable of treating complications such as anaphylaxis. All patients with suspected snakebite should be admitted to a suitable clinical unit, such as an emergency short-stay unit, for at least 12 hours after the bite. Serial blood testing (activated partial thromboplastin time, international normalised ratio and creatine kinase level) and neurological examinations should be done for all patients. Most snakebites will not result in significant envenoming and do not require antivenom. Antivenom should be administered as soon as there is evidence of envenoming. Evidence of systemic envenoming includes venom-induced consumption coagulopathy, sudden collapse, myotoxicity, neurotoxicity, thrombotic microangiopathy and renal impairment. Venomous snake groups each cause a characteristic clinical syndrome, which can be used in combination with local geographical distribution information to determine the probable snake involved and appropriate antivenom to use. The Snake Venom Detection Kit may assist in regions where the range of possible snakes is too broad to allow the use of monovalent antivenoms. When the snake identification remains unclear, two monovalent antivenoms (eg, brown snake and tiger snake antivenom) that cover possible snakes, or a polyvalent antivenom, can be used. One vial of the relevant antivenom is sufficient to bind all circulating venom. However, recovery may be delayed as many clinical and laboratory effects of venom are not immediately reversible. For expert advice on envenoming, contact the National Poisons Information Centre on 13 11 26.

Neutralization of toxicological activities of medically-relevant Bothrops snake venoms and relevant toxins by two polyvalent bothropic antivenoms produced in Peru and Brazil.

PubMed

Estevao-Costa, Maria I; Gontijo, Silea S; Correia, Barbara L; Yarleque, Armando; Vivas-Ruiz, Dan; Rodrigues, Edith; Chávez-Olortegui, Carlos; Oliveira, Luciana S; Sanchez, Eladio F

2016-11-01

Snakebite envenoming is a neglected public pathology, affecting especially rural communities or isolated areas of tropical and subtropical Latin American countries. The parenteral administration of antivenom is the mainstay and the only validated treatment of snake bite envenoming. Here, we assess the efficacy of polyspecific anti-Bothrops serum (α-BS) produced in the Instituto Nacional de Salud (INS, Peru) and at the Fundação Ezequiel Dias (FUNED, Brazil), to neutralize the main toxic activities induced by five medically-relevant venoms of: Bothrops atrox, B. barnetti, and B. pictus from Peru, and the Brazilian B. jararaca and B. leucurus, all of them inhabiting different geographical locations. Protein electrophoretic patterns of these venoms showed significant differences in composition, number and intensity of bands. Another goal was to evaluate the efficacy and safety of lyophilized α-BS developed at INS to neutralize the detrimental effects of these venoms using in vivo and in vitro assays. The availability of lyophilized α-BS has relevant significance in its distribution to distant rural communities where the access to antivenom in health facilities is more difficult. Despite the fact that different antigen mixtures were used for immunization during antivenom production, our data showed high toxin-neutralizing activity of α-BS raised against Bothrops venoms. Moreover, the antivenom cross-reacted even against venoms not included in the immunization mixture. Furthermore, we have evaluated the efficacy of both α-BS to neutralize key toxic compounds belonging to the predominant protein families of Bothrops snakes. Most significantly, both α-BS cross-specifically neutralized the main toxicological activities e.g. lethality and hemorrhage induced by these venoms. Thus, our data indicate that both α-BS are equally effective to treat snake bite victims inflicted by Bothrops snakes particularly B. atrox, responsible for the largest numbers of human envenomations in the Amazon regions of some South American countries including Peru and Brazil. Copyright © 2016 Elsevier Ltd. All rights reserved.

[About Snake bites in children at the Fez University Hospital (Morocco)].

PubMed

Chippaux, Jean-Philippe

2014-01-01

The author stresses the importance of the specificity of immunotherapy and identifies the two appropriate antivenoms for North Africa and the Middle East in general, and Morocco in particular. Due to the very good tolerance of new generation antivenoms, the author recommends systematically administer antivenom as early as possible to avoid unfavorable clinical progression, particularly in children and pregnant women..

Retrospective review of snake bite victims.

PubMed

Nazim, Muhammad H; Gupta, Sanjay; Hashmi, Syed; Zuberi, Jamshed; Wilson, Alison; Roberts, Lawrence; Karimi, Kamran

2008-01-01

Venomous snakebites are a rare but dangerous and potentially deadly condition in the U.S.. Most bites in the U. S. result from envenomation with snakes of the family Viperidae, subfamily Crotalinae, which includes rattlesnakes and copperheads. Treatment includes a comprehensive work-up to look for possible hematologic, neurologic, renal, and cardiovascular abnormalities, local wound care, systemic antivenom administration, tetanus prophylaxis, antibiotics in the presence of infection and surgical treatment if needed, which may include debridement, fasciotomy and rarely amputation. All these patients should be observed for a minimum of 8 hours. Any evidence of envenomation mandates a minimum of 24 hours of in-hospital observation. A grading system to classify the severity of envenomation is described. The most commonly used antivenom in the U.S. is CroFab, which has a much lower incidence of acute or delayed allergic reactions compared to the older antivenoms. When allergic reactions do occur, they are usually of mild to moderate severity. With the improved risk-benefit ratio of CroFab, antivenom is indicated with any grade of envenomation. In this a retrospective study, we will review our experience with 25 snakebite victims admitted to the West Virginia University over a five years period.

Recognizing dangerous snakes in the United States and Canada: a novel 3-step identification method.

PubMed

Cardwell, Michael D

2011-12-01

The rapid and accurate recognition of dangerously venomous snakes following bites is crucial to making appropriate decisions regarding first aid, evacuation, and treatment. Past recommendations for identification of dangerous North American pit vipers have often required subjective determinations of head shape or relied on traits shared with some nondangerous species (elliptical pupils and undivided subcaudal scales). Heat-sensitive facial pits are diagnostic but require close examination of the dangerous head, and cephalic traits are useless when working with a decapitated carcass. Exclusive of cephalic traits, pit vipers north of Mexico can be recognized by the combination of keeled middorsal scales and undivided subcaudal scales. The order of colored rings is usually suggested to identify coral snakes in the United States, yet extension of the colored rings across the ventral scales must be added as an essential identifying factor to ensure elimination of all harmless look-alikes. A novel 3-step flow chart is presented that allows dangerous snakes in the United States and Canada to be recognized quickly and dependably without relying on cephalic traits. This process cannot be used in other countries, however, due to greater variability of these characteristics in snakes from other parts of the world. Finally, close examination of potentially venomous snakes is extraordinarily dangerous and steps to safeguard those making such observations are discussed. Copyright © 2011 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Assessment of the potential toxicological hazard of the Green Parrot Snake (Leptophis ahaetulla marginatus): Characterization of its venom and venom-delivery system.

PubMed

Sánchez, Matías N; Teibler, Gladys P; López, Carlos A; Mackessy, Stephen P; Peichoto, María E

2018-04-27

Snakes are the major group of venomous vertebrates, and the rear-fanged snakes represent the vast majority of species and occur worldwide; however, relatively few studies have characterized their venoms and evaluated their potential hazards for humans. Herein we explore the protein composition and properties of the venom of the rear-fanged Green Parrot Snake, Leptophis ahaetulla marginatus, the most common snake found in the Iguazu National Park (Argentina), as well as the main features of its venom delivery system. This species has venom reminiscent of elapid venoms, composed mainly of components such as 3FTxs, CRiSPs and AChE, but it shows low toxicity toward mammals (LD 50  > 20 μg/g mouse). The histology of its Duvernoy's venom gland is similar to that of other colubrids, with serous secretory cells arranged in densely packed secretory tubules. The posterior end of its maxilla exhibits 1-3 blade-shaped and slightly recurved fangs but without grooves. This study provides an initial analysis of the biological role of venom in Leptophis, with implications for potential symptoms that might be anticipated from bites by this species. Copyright © 2018 Elsevier Ltd. All rights reserved.

Viper and Cobra Venom Neutralization by Alginate Coated Multicomponent Polyvalent Antivenom Administered by the Oral Route

PubMed Central

Bhattacharya, Sourav; Chakraborty, Mousumi; Mukhopadhyay, Piyasi; Kundu, P. P.; Mishra, Roshnara

2014-01-01

Background Snake bite causes greater mortality than most of the other neglected tropical diseases. Snake antivenom, although effective in minimizing mortality in developed countries, is not equally so in developing countries due to its poor availability in remote snake infested areas as, and when, required. An alternative approach in this direction could be taken by making orally deliverable polyvalent antivenom formulation, preferably under a globally integrated strategy, for using it as a first aid during transit time from remote trauma sites to hospitals. Methodology/Principal Findings To address this problem, multiple components of polyvalent antivenom were entrapped in alginate. Structural analysis, scanning electron microscopy, entrapment efficiency, loading capacity, swelling study, in vitro pH sensitive release, acid digestion, mucoadhesive property and venom neutralization were studied in in vitro and in vivo models. Results showed that alginate retained its mucoadhesive, acid protective and pH sensitive swelling property after entrapping antivenom. After pH dependent release from alginate beads, antivenom (ASVS) significantly neutralized phospholipaseA2 activity, hemolysis, lactate dehydrogenase activity and lethality of venom. In ex vivo mice intestinal preparation, ASVS was absorbed significantly through the intestine and it inhibited venom lethality which indicated that all the components of antivenom required for neutralization of venom lethality were retained despite absorption across the intestinal layer. Results from in vivo studies indicated that orally delivered ASVS can significantly neutralize venom effects, depicted by protection against lethality, decreased hemotoxicity and renal toxicity caused by russell viper venom. Conclusions/Significance Alginate was effective in entrapping all the structural components of ASVS, which on release and intestinal absorption effectively reconstituted the function of antivenom in neutralizing viper and cobra venom. Further research in this direction can strategize to counter such dilemma in snake bite management by promoting control release and oral antivenom rendered as a first aid. PMID:25102172

The rhinoceros among Serpents: Comparative anatomy and experimental biophysics of Calabar burrowing python (Calabaria reinhardtii) skin.

PubMed

Han, Dawei; Young, Bruce A

2018-01-01

The Calabar burrowing python (Calabaria reinhardtii) has a unique combination of marked thickness of the integumentary layers, a highly organized lamellate arrangement of the dermal collagen bundles, and a reduction in the size of the interscale hinge region of the integument. Biomechanical testing demonstrates that the skin of C. reinhardtii is more resistant to penetration than the skin of other snakes. The laminar arrangement of the collagen bundles provides for penetrative resistance, even while maintaining the flexibility characteristic of snake skin. Considering the life history of this species, it is hypothesized that the specialized integument of C. reinhardtii is a passive defensive mechanism against penetrative bites from maternal rodents and predators. © 2017 Wiley Periodicals, Inc.

Has snake fang evolution lost its bite? New insights from a structural mechanics viewpoint.

PubMed

Broeckhoven, Chris; du Plessis, Anton

2017-08-01

Venomous snakes-the pinnacle of snake evolution-are characterized by their possession of venom-conducting fangs ranging from grooved phenotypes characterizing multiple lineages of rear-fanged taxa to tubular phenotypes present in elapids, viperids and atractaspidines. Despite extensive research, controversy still exists on the selective pressures involved in fang phenotype diversification. Here, we test the hypothesis that larger fangs and consequently a shift to an anterior position in the maxilla evolved to compensate for the costs of structural changes, i.e. higher stress upon impact in tubular fangs compared to grooved fangs. Direct voxel-based stress simulations conducted on high-resolution µCT scans, analysed within a phylogenetic framework, showed no differences in stress distribution between the three fang phenotypes, despite differences in (relative) fang length. These findings suggest that additional compensatory mechanisms are responsible for the biomechanical optimization and that fang length might instead be related to differential striking behaviour strategies. © 2017 The Author(s).

False positive immunoassay for acetyl choline receptor antibody (AChR Ab) in patients exposed to polyvalent antisnake venom.

PubMed

Sundar, Kaushik; Venkatasubramanian, Shankar; Shanmugam, Sundar; Arthur, Preetam; Subbaraya, Ramakrishnan; Hazeena, Philo

2017-10-15

Acute flaccid paralysis is a neuromuscular emergency characterized by rapidly worsening weakness that evolves quickly to cause diaphragmatic failure. The challenge for the treating physician is to stabilize the patient, generate the differential diagnosis and determine the management; all in quick time. Neurotoxic snake bites have inadequate signs of inflammation and are easily missed. Myasthenic crisis, on the other hand, could be the first sign of myasthenia gravis in up to 20% of patients. Both present with acute respiratory failure and inadequate history. Two of our patients presented with similar clinical picture, and received polyvalent anti-snake venom obtained from hyperimmunised horses (Equus caballus). Both tested positive for anti-acetyl choline receptor antibody. After recovery, both patients narrated a history suggestive of neurotoxic envenomation. We later discovered that patients, who are exposed to polyvalent anti-snake venom (Equus caballus) prior to radioimmunoassay, demonstrate high titers of Anti-AChR Ab in their serum erroneously. Copyright © 2017 Elsevier B.V. All rights reserved.

Snakebite poisoning in Spain.

PubMed

Martín-Sierra, Cristina; Nogué-Xarau, Santiago; Pinillos Echeverría, Miguel Ángel; Rey Pecharromán, José Miguel

2018-01-01

Emergencies due to snakebites, although unusual in Spain, are potentially serious. Of the 13 species native to the Iberian peninsula, only 5 are poisonous: 2 belong to the Colubridae family and 3 to the Viperidae family. Bites from these venemous snakes can be life-threatening, but the venomous species can be easily identified by attending to certain physical traits. Signs denoting poisoning from vipers, and the appropriate treatment to follow, have changed in recent years.

Emergency treatment of a snake bite: Pearls from literature

PubMed Central

Ahmed, Syed Moied; Ahmed, Mohib; Nadeem, Abu; Mahajan, Jyotsna; Choudhary, Adarash; Pal, Jyotishka

2008-01-01

Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. This occupational hazard is no more an issue restricted to a particular part of the world; it has become a global issue. Accurate statistics of the incidence of snakebite and its morbidity and mortality throughout the world does not exist; however, it is certain to be higher than what is reported. This is because even today most of the victims initially approach traditional healers for treatment and many are not even registered in the hospital. Hence, registering such patients is an important goal if we are to have accurate statistics and reduce the morbidity and mortality due to snakebite. World Health Organization/South East Asian Region Organisation (WHO/SEARO) has published guidelines, specific for the South East Asian region, for the clinical management of snakebites. The same guidelines may be applied for managing snakebite patients in other parts of the world also, since no other professional body has come up with any other evidence-based guidelines. In this article we highlight the incidence and clinical features of different types of snakebite and the management guidelines as per the WHO/SEARO recommendation. PMID:19561988

[Philoctetes--a theme with variations].

PubMed

Thomasen, A L

1983-01-01

The legend of Philoctetes and his snake bite is found in so many versions seen from the most differing aspects, that each new attempt to throw light on this throng of literary and artistic interpretations must be based on the author's personal choice of and attitude to the almost limitless material. Since the time of Homer the legend has spread from ancient Greece across Europe, all the way to the utmost northern base of our culture; very early the tradition of the famous archer of the Trojan war was known and written down in Iceland. The author of the present essay has stressed the psychological interpretations of the legend as seen in the great Greek tragedies and in painting and sculpture, especially from the point of view of medical history. Furthermore the interplay of art and medicine in the Philoctetes legend has inspired the author to a closer examination of the role in the fate of mankind played by the snake from the beginning of time, seen in a religious as well as a secular context. For heathens as well as Christians the snake could bring fortune or calamity. Sometimes a vile demon, it brought harm; but the copper snake of Moses in the desert and the snake in the service of Asclepios protected and healed mankind. This creature so full of contrary powers and intentions almost became a mirror to the complex nature and unpredictable fate of man.

Main plants used in traditional medicine for the treatment of snake bites n the regions of the department of Antioquia, Colombia.

PubMed

Vásquez, Julieta; Alarcón, Juan C; Jiménez, Silvia L; Jaramillo, Gloria I; Gómez-Betancur, Isabel C; Rey-Suárez, J Paola; Jaramillo, Karen M; Muñoz, Diana C; Marín, Daniela M; Romero, Jefferson O

2015-07-21

In Colombia, more than 4.000 ophidian accidents occur per year and due to the scarce distribution and limited availability of antivenom, the use of traditional medicine has been perpetuated in some of its rural communities, in which initially, those affected are treated by healers and shamans using medicinal plants in different ways. Research was conducted with renowned healers or connoisseurs of plants on the ethnobotany of ophidian accidents in five different areas and their municipalities of Antioquia: Magdalena Medio (Caracolí, Puerto Berrío); Bajo Cauca (Caucasia, Zaragoza); Nordeste (San Roque, Yalí); Norte (Gómez Plata, Valdivia); Suroeste (Ciudad Bolívar, Salgar); collecting information related to experience and time of use of plants in the treatment of these poisonings, amounts used, ways of use (beverage, bathing, ointment, chupaderas, vapors), preparation types (maceration or decoction) and treatment duration. 71 plant species were identified and collected, 49.29% of them without previous reports as antiophidian and 38.0% employed for the same purpose in other geographical areas. The leaves (24.82%), stems (11.68%) and flowers (10.95%) were found to be the most frequently employed structures in the preparation of the extracts, which are usually prepared by decoction (83.94%), maceration (6.57%). In this work, specimens lacking previous ethnobotanical reports have been found, plants used by ethnic groups from other regions of Antioquia and the world to treat snake bites; and herbaceous plants whose inhibitory activity of symptoms produced by some snake venoms, has been experimentally verified by in vivo and in vitro tests. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Phylogeny of courtship and male-male combat behavior in snakes.

PubMed

Senter, Phil; Harris, Shannon M; Kent, Danielle L

2014-01-01

Behaviors involved in courtship and male-male combat have been recorded in a taxonomically broad sample (76 species in five families) of snakes in the clade Boidae + Colubroidea, but before now no one has attempted to find phylogenetic patterns in such behaviors. Here, we present a study of phylogenetic patterns in such behaviors in snakes. From the literature on courtship and male-male combat in snakes we chose 33 behaviors to analyze. We plotted the 33 behaviors onto a phylogenetic tree to determine whether phylogenetic patterns were discernible. We found that phylogenetic patterns are discernible for some behaviors but not for others. For behaviors with discernible phylogenetic patterns, we used the fossil record to determine minimum ages for the addition of each behavior to the courtship and combat behavioral repertoire of each snake clade. The phylogenetic patterns of behavior reveal that male-male combat in the Late Cretaceous common ancestors of Boidae and Colubridae involved combatants raising the head and neck and attempting to topple each other. Poking with spurs was added in Boidae. In Lampropeltini the toppling behavior was replaced by coiling without neck-raising, and body-bridging was added. Phylogenetic patterns reveal that courtship ancestrally involved rubbing with spurs in Boidae. In Colubroidea, courtship ancestrally involved chin-rubbing and head- or body-jerking. Various colubroid clades subsequently added other behaviors, e.g. moving undulations in Natricinae and Lampropeltini, coital neck biting in the Eurasian ratsnake clade, and tail quivering in Pantherophis. The appearance of each group in the fossil record provides a minimum age of the addition of each behavior to combat and courtship repertoires. Although many gaps in the story of the evolution of courtship and combat in snakes remain, this study is an important first step in the reconstruction of the evolution of these behaviors in snakes.

Snakebites notified to the poison control center of Morocco between 2009 and 2013.

PubMed

Chafiq, Fouad; El Hattimy, Faiçal; Rhalem, Naima; Chippaux, Jean-Philippe; Soulaymani, Abdelmajid; Mokhtari, Abdelrhani; Soulaymani-Bencheikh, Rachida

2016-01-01

Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013. This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone. During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % (n = 18) and vipers 67 % (n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %). Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.

Safety and cost-effectiveness of a clinical protocol implemented to standardize the use of Crotalidae polyvalent immune Fab antivenom at an academic medical center.

PubMed

Weant, Kyle A; Bowers, Rebecca C; Reed, Janelle; Braun, Kristopher A; Dodd, David M; Baker, Stephanie N

2012-05-01

To evaluate the safety and cost-effectiveness of a clinical protocol adopted in June 2006 that included a comprehensive, objective assessment of snake bite envenomations and standardized the use of Crotalidae polyvalent immune Fab antivenom (FabAV). Retrospective medical record review. Academic medical center that serves as the regional level I trauma center. Seventy-five adults treated with FabAV for snake envenomations in the emergency department between June 1, 2003, and June 1, 2009; 30 patients received treatment according to the protocol (treatment group), and 45 patients received treatment that did not adhere to the protocol (control group). Demographic and envenomation characteristics, as well as treatment details, were collected for all patients. In addition, information on quantity of FabAV vials required, length of hospital stay, and length of intensive care unit stay were compared between the treatment and control groups. In the treatment group, significantly fewer vials of FabAV were used (2.5 vs 4.727 vials, p=0.007). This decreased in usage correlated to a cost savings of approximately $2000/patient. Despite no significant difference in the severity of the envenomations between the two groups (p=0.379), the treatment group experienced a significantly shorter hospital length of stay (1.933 vs 2.791 days, p=0.030). No significant difference in the progression to fasciotomy or the development of allergic reactions was noted between the two groups. Use of a clinical protocol related to snake envenomations resulted in approximately two fewer vials of FabAV required for each patient. In addition, the treatment group experienced a shorter hospital length of stay without a corresponding increase in adverse events or envenomation progression. Data show that use of the protocol was cost-effective. The development of institution-specific multidisciplinary protocols regarding snake bite envenomations is recommended. Clinical pharmacists can play a vital role in the protocol development to ensure that optimal care is provided for this distinct patient population. © 2012 Pharmacotherapy Publications, Inc.

Ancient Diversification of Three-Finger Toxins in Micrurus Coral Snakes.

PubMed

Dashevsky, Daniel; Fry, Bryan G

2018-01-01

Coral snakes, most notably the genus Micrurus, are the only terrestrial elapid snakes in the Americas. Elapid venoms are generally known for their potent neurotoxicity which is usually caused by Three-Finger Toxin (3FTx) proteins. These toxins can have a wide array of functions that have been characterized from the venom of other elapids. We examined publicly available sequences from Micrurus 3FTx to show that they belong to 8 monophyletic clades that diverged as deep in the 3FTx phylogenetic tree as the other clades with characterized functions. Functional residues from previously characterized clades of 3FTx are not well conserved in most of the Micrurus toxin clades. We also analyzed the patterns of selection on these toxins and find that they have been diversifying at different rates, with some having undergone extreme diversifying selection. This suggests that Micrurus 3FTx may contain a previously underappreciated functional diversity that has implications for the clinical outcomes of bite victims, the evolution and ecology of the genus, as well as the potential for biodiscovery efforts focusing on these toxins.

Reversible atrial fibrillation following Crotalinae envenomation.

PubMed

Quan, Dan; Zurcher, Kenneth

2017-01-01

Cardiotoxicity is a documented complication of Crotalinae envenomation. Reported cardiac complications following snake envenomation have included acute myocardial infarction, electrocardiogram abnormalities and arrhythmias. Few reports exist describing arrhythmia induced by viper envenomation and to our knowledge none describe arrhythmia induced by Crotalinae envenomation. This report concerns the first known case of atrial fibrillation precipitated by rattlesnake bite. A 73-year-old Caucasian man with a past medical history of hypertension, hyperlipidemia, type 1 diabetes mellitus, and a baseline first-degree atrioventricular block presented to the emergency department following a rattlesnake bite to his left lower leg. He developed pain and swelling in his left leg two-hour post-envenomation and subsequently received four vials of Crotalidae polyvalent immune fab (ovine). At three-hour post-envenomation following transfer to the intensive care unit, an electrocardiogram revealed new-onset atrial fibrillation. An amiodarone drip was started and the patient successfully converted to normal sinus rhythm approximately six hours after he was found to be in atrial fibrillation. A transthoracic echocardiogram revealed mild concentric left ventricular hypertrophy and an ejection fraction of 72%. He was discharged the following day with no hematological abnormalities and a baseline first-degree atrioventricular block. This is the first documented case of reversible atrial fibrillation precipitated by Crotalinae envenomation. In patients with pertinent risk factors for developing atrial fibrillation, physicians should be aware of the potential for this arrhythmia. Direct toxic effects of venom or structural and electrophysiological cardiovascular abnormalities may predispose snakebite patients to arrhythmia, warranting extended and attentive cardiac monitoring.

Venomous spiders, snakes, and scorpions in the United States.

PubMed

Holve, Steve

2009-04-01

Venomous bites and stings are complex poisonings that have local and systemic effects. Mild envenomations can be treated with supportive care. Severe envenomations can be treated definitively with species-specific antivenom, although the use of these products has potential risk of immediate and a more delayed onset form of hypersensitivity reactions. Consultation with a toxicologist is recommended to help guide therapy. Field treatments such as tourniquets and incision likely cause more harm than benefit and should be avoided.

A Guide to the George Palmiter River Restoration Techniques.

DTIC Science & Technology

1982-03-01

reduction. The raft is driven by a 35 h.p. ’ outboard engine, weighs 4 tons, and has 1500 lb. of flotation material under it. Additionally, the raft has a...Sycamore (Platanus occidentalis) 4. Red Maple (Acer rubrum) 5. Silver Maple (Acer saccharinum) 6. Pin Oak (Quercus palustris) 7. Red Oak (Quercus...safety goggles 5 - ear protectors 5 - flotation jackets 1, - industrial first aid kit--one that floats and is waterproof 1 - snake bite kit several

Identification and evaluation of agents isolated from traditionally used herbs against Ophiophagus hannah venom.

PubMed

Salama, R; Sattayasai, J; Gande, A K; Sattayasai, N; Davis, M; Lattmann, E

2012-02-01

The aim of this study was firstly to identify active molecules in herbs, that are traditionally used for the treatment of snake bite, such as Curcuma antinaia, Curcuma contravenenum, Andrographis paniculata, and Tanacetum parthenium; secondly to test similar structurally related molecules and finally to prepare and evaluate an efficient formulation against Ophiophagus hannah venom intoxification. Three labdane based compounds, including labdane dialdehyde, labdane lactone, and labdane trialdehyde and two lactones including 14-deoxy-11,12-didehydroandrographolide and parthenolide were isolated by column chromatography and characterised. Using the isolated rat phrenic nerve-hemidiaphragm preparation, the antagonistic effect of crude extracts, isolated compounds and prepared formulations were measured in vitro on the inhibition of the neuromuscular transmission. Inhibition on muscle contraction, produced by the 5 μg/mL venom, was reversed by test agents in organ bath preparations. A labdane trialdehyde, isolated from C. contravenenum, was identified as the best antagonising agent in the low micromolar range. Tests on formulations of the most potent C. contravenenum extract showed, that the suppository with witepsol H15 was an effective medicine against O. hannah venom. This study elucidated the active compounds, accounting for the antivenin activity of traditionally used herbs and suggested the most suitable formulation, which may help to develop potent medicines for the treatment of snake bite in the future.

Toxins not neutralized by brown snake antivenom

DOE Office of Scientific and Technical Information (OSTI.GOV)

Judge, Roopwant K.; Henry, Peter J.; Mirtschin, Peter

2006-06-01

The Australian snakes of the genus Pseudonaja (dugite, gwardar and common brown) account for the majority of snake bite related deaths in Australia. Without antivenom treatment, the risk of mortality is significant. There is an accumulating body of evidence to suggest that the efficacy of the antivenom is limited. The current study investigates the protein constituents recognized by the antivenom using 2-DE, immuno-blot techniques and rat tracheal organ bath assays. The 2-DE profiles for all three snake venoms were similar, with major species visualized at 78-132 kDa, 32-45 kDa and 6-15 kDa. Proteins characterized by LC-MS/MS revealed a coagulant toxinmore » ({approx}42 kDa) and coagulant peptide ({approx}6 kDa), as well as two PLA{sub 2} ({approx}14 kDa). Peptides isolated from {approx}78 kDa and 15-32 kDa protein components showed no similarity to known protein sequences. Protein recognition by the antivenom occurred predominantly for the higher molecular weight components with little recognition of 6-32 kDa MW species. The ability of antivenom to neutralize venom activity was also investigated using rat tracheal organ bath assays. The venoms of Pseudonaja affinis affinis and Pseudonaja nuchalis incited a sustained, significant contraction of the trachea. These contractions were attributed to PLA{sub 2} enzymatic activity as pre-treatment with the PLA{sub 2} inhibitor 4-BPB attenuated the venom-induced contractions. The venom of Pseudonaja textilis incited tracheal contractility through a non-PLA{sub 2} enzymatic activity. Neither activity was attenuated by the antivenom treatment. These results represent the first proteomic investigation of the venoms from the snakes of the genus Pseudonaja, revealing a possible limitation of the brown snake antivenom in binding to the low MW protein components.« less

Electric shocks are ineffective in treatment of lethal effects of rattlesnake envenomation in mice.

PubMed

Johnson, E K; Kardong, K V; Mackessy, S P

1987-01-01

Electrical shocks, even crudely delivered from 'stun guns' and gasoline engine spark plugs, have been reported to be effective in the treatment of snake bite. We thus applied similar electric shocks to mice artificially injected with reconstituted rattlesnake venom at various LD50 multiples. Those envenomated mice treated with electric shock survived no better than the controls. We thus found no evidence that electric shocks crudely administered had any life saving effect in mice.

Diversity of Micrurus Snake Species Related to Their Venom Toxic Effects and the Prospective of Antivenom Neutralization

PubMed Central

Tanaka, Gabriela D.; Furtado, Maria de Fátima D.; Portaro, Fernanda C. V.; Sant'Anna, Osvaldo Augusto; Tambourgi, Denise V.

2010-01-01

Background Micrurus snake bites can cause death by muscle paralysis and respiratory arrest, few hours after envenomation. The specific treatment for coral snake envenomation is the intravenous application of heterologous antivenom and, in Brazil, it is produced by horse immunization with a mixture of M. corallinus and M. frontalis venoms, snakes that inhabit the South and Southeastern regions of the country. However, this antivenom might be inefficient, considering the existence of intra- and inter-specific variations in the composition of the venoms. Therefore, the aim of the present study was to investigate the toxic properties of venoms from nine species of Micrurus: eight present in different geographic regions of Brazil (M. frontalis, M. corallinus, M. hemprichii, M. spixii, M. altirostris, M. surinamensis, M. ibiboboca, M. lemniscatus) and one (M. fulvius) with large distribution in Southeastern United States and Mexico. This study also analyzed the antigenic cross-reactivity and the neutralizing potential of the Brazilian coral snake antivenom against these Micrurus venoms. Methodology/Principal Findings Analysis of protein composition and toxicity revealed a large diversity of venoms from the nine Micrurus species. ELISA and Western blot assays showed a varied capability of the therapeutic antivenom to recognize the diverse species venom components. In vivo and in vitro neutralization assays indicated that the antivenom is not able to fully neutralize the toxic activities of all venoms. Conclusion These results indicate the existence of a large range of both qualitative and quantitative variations in Micrurus venoms, probably reflecting the adaptation of the snakes from this genus to vastly dissimilar habitats. The data also show that the antivenom used for human therapy in Brazil is not fully able to neutralize the main toxic activities present in the venoms from all Micrurus species occurring in the country. It suggests that modifications in the immunization scheme, with the inclusion of other venoms in the antigenic mixture, should occur in order to generate effective therapeutic coral snake antivenom. PMID:20231886

Phylogeny of Courtship and Male-Male Combat Behavior in Snakes

PubMed Central

Senter, Phil; Harris, Shannon M.; Kent, Danielle L.

2014-01-01

Background Behaviors involved in courtship and male-male combat have been recorded in a taxonomically broad sample (76 species in five families) of snakes in the clade Boidae + Colubroidea, but before now no one has attempted to find phylogenetic patterns in such behaviors. Here, we present a study of phylogenetic patterns in such behaviors in snakes. Methodology/Principal Findings From the literature on courtship and male-male combat in snakes we chose 33 behaviors to analyze. We plotted the 33 behaviors onto a phylogenetic tree to determine whether phylogenetic patterns were discernible. We found that phylogenetic patterns are discernible for some behaviors but not for others. For behaviors with discernible phylogenetic patterns, we used the fossil record to determine minimum ages for the addition of each behavior to the courtship and combat behavioral repertoire of each snake clade. Conclusions/Significance The phylogenetic patterns of behavior reveal that male-male combat in the Late Cretaceous common ancestors of Boidae and Colubridae involved combatants raising the head and neck and attempting to topple each other. Poking with spurs was added in Boidae. In Lampropeltini the toppling behavior was replaced by coiling without neck-raising, and body-bridging was added. Phylogenetic patterns reveal that courtship ancestrally involved rubbing with spurs in Boidae. In Colubroidea, courtship ancestrally involved chin-rubbing and head- or body-jerking. Various colubroid clades subsequently added other behaviors, e.g. moving undulations in Natricinae and Lampropeltini, coital neck biting in the Eurasian ratsnake clade, and tail quivering in Pantherophis. The appearance of each group in the fossil record provides a minimum age of the addition of each behavior to combat and courtship repertoires. Although many gaps in the story of the evolution of courtship and combat in snakes remain, this study is an important first step in the reconstruction of the evolution of these behaviors in snakes. PMID:25250782

Diversity of Micrurus snake species related to their venom toxic effects and the prospective of antivenom neutralization.

PubMed

Tanaka, Gabriela D; Furtado, Maria de Fátima D; Portaro, Fernanda C V; Sant'Anna, Osvaldo Augusto; Tambourgi, Denise V

2010-03-09

Micrurus snake bites can cause death by muscle paralysis and respiratory arrest, few hours after envenomation. The specific treatment for coral snake envenomation is the intravenous application of heterologous antivenom and, in Brazil, it is produced by horse immunization with a mixture of M. corallinus and M. frontalis venoms, snakes that inhabit the South and Southeastern regions of the country. However, this antivenom might be inefficient, considering the existence of intra- and inter-specific variations in the composition of the venoms. Therefore, the aim of the present study was to investigate the toxic properties of venoms from nine species of Micrurus: eight present in different geographic regions of Brazil (M. frontalis, M. corallinus, M. hemprichii, M. spixii, M. altirostris, M. surinamensis, M. ibiboboca, M. lemniscatus) and one (M. fulvius) with large distribution in Southeastern United States and Mexico. This study also analyzed the antigenic cross-reactivity and the neutralizing potential of the Brazilian coral snake antivenom against these Micrurus venoms. Analysis of protein composition and toxicity revealed a large diversity of venoms from the nine Micrurus species. ELISA and Western blot assays showed a varied capability of the therapeutic antivenom to recognize the diverse species venom components. In vivo and in vitro neutralization assays indicated that the antivenom is not able to fully neutralize the toxic activities of all venoms. These results indicate the existence of a large range of both qualitative and quantitative variations in Micrurus venoms, probably reflecting the adaptation of the snakes from this genus to vastly dissimilar habitats. The data also show that the antivenom used for human therapy in Brazil is not fully able to neutralize the main toxic activities present in the venoms from all Micrurus species occurring in the country. It suggests that modifications in the immunization scheme, with the inclusion of other venoms in the antigenic mixture, should occur in order to generate effective therapeutic coral snake antivenom.

Clinical studies of the effectiveness and safety of antivenoms.

PubMed

Williams, David J; Habib, Abdulrazaq G; Warrell, David A

2018-05-07

In the 1890s, hyperimmune sera proved effective in animals against challenge by the snake venom against which they had been raised. They were first used, apparently successfully, in a human patient in about 1895. Since then, antivenoms have become accepted as the only reliable specific treatment for snake-bite envenoming. Despite decades of accumulated clinical experience and a number of published randomized comparative and observational studies, the clinical effectiveness and safety of some antivenoms remain open to question, due to a lack of robust randomized controlled trial data. Antivenoms in some poorly regulated markets may have high rates of potentially fatal adverse effects and their use must be balanced by demonstrable effectiveness. Even those manufactured to strict regulatory requirements may pose a rare risk of severe adverse reactions. Most antivenoms currently marketed around the world were registered without first being studied clinically. There is increasing pressure to subject antivenoms, even those that are long-established, to the same protocols of rigorous pre-clinical and clinical assessment that are standard regulatory requirements for other drugs. Conventional clinical testing progresses through Phases I, II, III to IV. Most authorities consider antivenoms too dangerous to be used in Phase I studies in healthy volunteers. An alternative method for preliminary estimation of safety, dose-finding and effectiveness, is proposed - the "3 + 3" dose escalation or de-escalation design, in volunteer patients, as used in oncology to test cytotoxic drugs. Antivenoms are so widely used and well trusted, that there are few ethical justifications for placebo controls. However, placebo might be ethically justified if there were no proven effective treatment and or if withholding or delaying treatment posed acceptably negligible risks to the participants. Antivenom trials are most urgently needed in low-to middle-income countries where there are many practical, logistical and funding challenges. Basic requirements for clinical trials include identification of the biting species of snake in every case; the use of objective, clinically-relevant endpoints, such as restoration of blood coagulability; definition of inclusion, exclusion and withdrawal criteria; assurance of antivenom safety; ethical considerations; inclusion of one or more control (comparator) groups; and analysis based on intention to treat. The highest quality evidence comes from Phase II and larger Phase III studies that have been designed as statistically powerful, randomized, controlled trials (RCTs), ideally with blinding of patients and investigators to avoid bias. Because of the challenges to carrying out clinical trials of antivenoms, Phase IV trials (post-marketing surveillance) are potentially more important and useful than for most other drugs. Copyright © 2018 Elsevier Ltd. All rights reserved.

Novel Apigenin Based Small Molecule that Targets Snake Venom Metalloproteases

PubMed Central

Anusha, Sebastian; Hemshekhar, Mahadevappa; Chandra Nayaka, Siddaiah; Kemparaju, Kempaiah; Basappa; Girish, Kesturu S.; Rangappa, Kanchugarakoppal S.

2014-01-01

The classical antivenom therapy has appreciably reduced snakebite mortality rate and thus is the only savior drug available. Unfortunately, it considerably fails to shield the viper bite complications like hemorrhage, local tissue degradation and necrosis responsible for severe morbidity. Moreover, the therapy is also tagged with limitations including anaphylaxis, serum sickness and poor availability. Over the last decade, snake venom metalloproteases (SVMPs) are reported to be the primary component responsible for hemorrhage and tissue degradation at bitten site. Thus, antivenom inability to offset viper venom-induced local toxicity has been a basis for an insistent search for SVMP inhibitors. Here we report the inhibitory effect of compound 5d, an apigenin based molecule against SVMPs both in silico and in vivo. Several apigenin analogues are synthesized using multicomponent Ugi reactions. Among them, compound 5d effectively abrogated Echis carinatus (EC) venom-induced local hemorrhage, tissue necrosis and myotoxicity in a dose dependant fashion. The histopathological study further conferred effective inhibition of basement membrane degradation, and accumulation of inflammatory leucocytes at the site of EC venom inoculation. The compound also protected EC venom-induced fibrin and fibrinogen degradation. The molecular docking of compound 5d and bothropasin demonstrated the direct interaction of hydroxyl group of compound with Glu146 present in hydrophobic pocket of active site and does not chelate Zn2+. Hence, it is concluded that compound 5d could be a potent agent in viper bite management. PMID:25184206

[Snakes as pets - consequences of an exotic hobby].

PubMed

Minkley, L; Overkamp, D; Fischer, J

2013-12-01

We report on a young man who presented at our emergency unit with pain and swelling of his left hand, after he had been bitten into his left middle finger by a sidewinder rattlesnake one hour ago. Local findings were a swollen left middle finger, a red-livid discoloration along his nail rim with paleness of the surrounding skin. Vital signs were stable, ECG showed sinus rhythm, laboratory parameters were normal, without signs of liver or kidney damage and without coagulopathy. Diagnosis was local tissue reaction due to a snake bite of a sidewinder rattlesnake without evidence of systemic toxic effect. Due to the absence of systemic toxic effects the patient received monitoring of his vital signs and we controlled local tissue reaction constantly and laboratory parameters every 6 hours, as recommended by the "Giftnotrufzentrale" (poison emergency advisory service). The patient left hospital on his own will against medical advice in the night after first laboratory control, which showed no signs of organ damage and we recommended reasessment the following morning. At that time the swelling had extended to the whole arm, furthermore large hematoma reaching up to the axilla had developed over night. Again we contacted the "Giftnotrufzentrale" and decided to begin the administration of an antivenom, after allergic testing. The administration was without complications, the swelling decreased constantly and since laboratory controll still showed no signs of systemic toxin effect, we could discharge the patient on day 3. Follow-up visit 6 months later showed complete and natural healing. Snake bites are altogether rare among our patients, nevertheless since possible toxin effects and its dynamics are unpredictable and can vary highly, they demand monitoring at close intervals of vitals signs, local swelling and laboratory parameters. As early as possible an advisory service, such as "Giftnotrufzentrale" should be contacted to acquire information on possible toxin effects and availability of antivenoms. Contact to other medical disciplines (e.g. dermatology, intensive care unit, surgery, neurology, dialysis…) should be sought, depending on the further course of toxin effects. Possible comorbidities as well as allergisation due to previous bites strongly influence the course of the disease and should be evaluated. We recommend to keep precise records on the ocurrence of systemic toxin effects, as well as on local findings (e.g. fotodocumentation, marking of erythema, measurement of swelling). Manipulation of the wound is usually ineffective and therefore not recommended, also in respect of self-endangerment. After stabilization of the patient a vaccination against tetanus, if necessary, should not be forgotten. © Georg Thieme Verlag KG Stuttgart · New York.

First documented case of snake fungal disease in a free-ranging wild snake in Louisiana

USGS Publications Warehouse

Glorioso, Brad M.; Waddle, J. Hardin; Green, David E.; Lorch, Jeffrey M.

2016-01-01

Snake fungal disease (SFD) is a recently documented mycotic disease characterized by scabs or crusty scales, subcutaneous nodules, abnormal molting, cloudiness of the eyes (not associated with molting), and localized thickening or crusting of the skin. SFD has been documented in many species in the Eastern and Midwestern United States within the last decade. SFD has proven lethal in many snakes, and the disease is recognized as an emerging threat to wild snake populations. Here, we describe the first documented case of SFD in Louisiana in a free-ranging wild snake.

Venomics of Bungarus caeruleus (Indian krait): Comparable venom profiles, variable immunoreactivities among specimens from Sri Lanka, India and Pakistan.

PubMed

Oh, Angeline Mei Feng; Tan, Choo Hock; Ariaranee, Gnanathasan Christeine; Quraishi, Naeem; Tan, Nget Hong

2017-07-05

The Indian krait (Bungarus caeruleus) is one of the "Big Four" venomous snakes widely distributed in South Asia. The present venomic study reveals that its venom (Sri Lankan origin) is predominated by phospholipases A 2 (64.5% of total proteins), in which at least 4.6% are presynaptically-acting β-bungarotoxin A-chains. Three-finger toxins (19.0%) are the second most abundant, comprising 15.6% κ-neurotoxins, the potent postsynaptically-acting long neurotoxins. Comparative chromatography showed that venom samples from Sri Lanka, India and Pakistan did not exhibit significant variation. These venoms exhibited high immunoreactivity toward VINS Indian Polyvalent Antivenom (VPAV). The Pakistani krait venom, however, had a relatively lower degree of binding, consistent with its moderate neutralization by VPAV (potency=0.3mg venom neutralized per ml antivenom) while the Sri Lankan and Indian venoms were more effectively neutralized (potency of 0.44 mg/ml and 0.48 mg/ml, respectively). Importantly, VPAV was able to neutralize the Sri Lankan and Indian venoms to a comparable extent, supporting its use in Sri Lanka especially in the current situation where Sri Lanka-specific antivenom is unavailable against this species. The findings also indicate that the Pakistani B. caeruleus venom is immunologically less comparable and should be incorporated in the production of a pan-regional, polyspecific antivenom. The Indian krait or blue krait, Bungarus caeruleus, is a highly venomous snake that contributes to the snakebite envenoming problem in South Asia. This is a less aggressive snake species but its accidental bite can cause rapid and severe neurotoxicity, in which the patient may succumb to paralysis, respiratory failure and death within a short frame of time. The proteomic analysis of its venom (sourced from Sri Lanka) unveils its content that well correlates to its envenoming pathophysiology, driven primarily by the abundant presynaptic and postsynaptic neurotoxins (β-bungarotoxins and κ-neurotoxins, respectively). The absence of cytotoxins in the venom proteome also correlates with the lack of local envenoming sign (pain, swelling), and explains why the bite may be insidious until later stage when paralysis sets in. The muscarinic toxin-like proteins in the venom may be the cause of severe abdominal pain that precedes paralysis in many cases, and justifies the need of closely monitoring this symptom in suspected cases. Venom samples from Sri Lanka, India and Pakistan exhibited no remarkable variation in protein profiling and reacted immunologically toward the VINS Indian Polyvalent Antivenom, though to a varying extent. The antivenom is effective in neutralizing the Sri Lankan and Indian venoms, confirming its clinical use in the countries. The antivenom efficacy against the Pakistani venom, however, may be further optimized by incorporating the Pakistani venom in the antivenom production. Copyright © 2017. Published by Elsevier B.V.

Marine Envenomation.

PubMed

Hornbeak, Kirsten B; Auerbach, Paul S

2017-05-01

Venomous aquatic animals are hazardous to swimmers, surfers, divers, and fishermen. Exposures include mild stings, bites, abrasions, and lacerations. Severe envenomations can be life threatening. This article reviews common marine envenomations, exploring causative species, clinical presentation, and current treatment recommendations. Recommendations are included for cnidaria, sponges, bristle worms, crown-of-thorns starfish, sea urchins, venomous fish, stingrays, cone snails, stonefish, blue-ringed octopus, and sea snakes. Immediate and long-term treatment options and management of common sequelae are reviewed. Antivenom administration, treatment of anaphylaxis, and surgical indications are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Micrurus snake venoms activate human complement system and generate anaphylatoxins

PubMed Central

2012-01-01

Background The genus Micrurus, coral snakes (Serpentes, Elapidae), comprises more than 120 species and subspecies distributed from the south United States to the south of South America. Micrurus snake bites can cause death by muscle paralysis and further respiratory arrest within a few hours after envenomation. Clinical observations show mainly neurotoxic symptoms, although other biological activities have also been experimentally observed, including cardiotoxicity, hemolysis, edema and myotoxicity. Results In the present study we have investigated the action of venoms from seven species of snakes from the genus Micrurus on the complement system in in vitro studies. Several of the Micrurus species could consume the classical and/or the lectin pathways, but not the alternative pathway, and C3a, C4a and C5a were generated in sera treated with the venoms as result of this complement activation. Micrurus venoms were also able to directly cleave the α chain of the component C3, but not of the C4, which was inhibited by 1,10 Phenanthroline, suggesting the presence of a C3α chain specific metalloprotease in Micrurus spp venoms. Furthermore, complement activation was in part associated with the cleavage of C1-Inhibitor by protease(s) present in the venoms, which disrupts complement activation control. Conclusion Micrurus venoms can activate the complement system, generating a significant amount of anaphylatoxins, which may assist due to their vasodilatory effects, to enhance the spreading of other venom components during the envenomation process. PMID:22248157

Micrurus snake venoms activate human complement system and generate anaphylatoxins.

PubMed

Tanaka, Gabriela D; Pidde-Queiroz, Giselle; de Fátima D Furtado, Maria; van den Berg, Carmen; Tambourgi, Denise V

2012-01-16

The genus Micrurus, coral snakes (Serpentes, Elapidae), comprises more than 120 species and subspecies distributed from the south United States to the south of South America. Micrurus snake bites can cause death by muscle paralysis and further respiratory arrest within a few hours after envenomation. Clinical observations show mainly neurotoxic symptoms, although other biological activities have also been experimentally observed, including cardiotoxicity, hemolysis, edema and myotoxicity. In the present study we have investigated the action of venoms from seven species of snakes from the genus Micrurus on the complement system in in vitro studies. Several of the Micrurus species could consume the classical and/or the lectin pathways, but not the alternative pathway, and C3a, C4a and C5a were generated in sera treated with the venoms as result of this complement activation. Micrurus venoms were also able to directly cleave the α chain of the component C3, but not of the C4, which was inhibited by 1,10 Phenanthroline, suggesting the presence of a C3α chain specific metalloprotease in Micrurus spp venoms. Furthermore, complement activation was in part associated with the cleavage of C1-Inhibitor by protease(s) present in the venoms, which disrupts complement activation control. Micrurus venoms can activate the complement system, generating a significant amount of anaphylatoxins, which may assist due to their vasodilatory effects, to enhance the spreading of other venom components during the envenomation process.

Distribution and outcome of ocular lesions in snakes examined at a veterinary teaching hospital: 67 cases (1985-2010).

PubMed

Hausmann, Jennifer C; Hollingsworth, Steven R; Hawkins, Michelle G; Kass, Philip H; Maggs, David J

2013-07-15

To determine the distribution and clinical outcome of ocular lesions in snakes. Retrospective case series. 67 snakes with ocular lesions. Signalment, lesion duration, diagnosis, treatment, and clinical outcome were recorded for all snakes with ocular lesions that were examined at a veterinary teaching hospital from 1985 to 2010. 71 ocular lesions were detected in 67 of 508 (13%) snakes examined. Affected snakes were of the families Boidae, Pythonidae, Colubridae, and Viperidae. The distribution of ocular lesions did not vary by taxonomic family, age, or sex; however, snakes from the genus Epicrates with ocular lesions were overrepresented in the population. The most commonly diagnosed ocular lesions were retained spectacle (n = 41), pseudobuphthalmos or subspectacular abscess (13), trauma (8), and cataracts (4). Pseudobuphthalmos or subspectacular abscess developed more frequently in Colubridae than in non-Colubridae snakes. Of the 16 snakes with retained spectacles for which data were available, the lesion recurred once in 4 snakes and multiple times in 5 snakes. Results indicated that retained spectacle was the most common ocular lesion diagnosed in snakes. Compared with other snakes with ocular lesions, snakes of the genus Epicrates had a higher than expected frequency of ocular lesions in general and snakes of the family Colubridae had a higher than expected frequency of pseudobuphthalmos or subspectacular abscess.

Human cytokine response to Texas crotaline envenomation before and after antivenom administration.

PubMed

Crocker, Patrick; Zad, Omid; Milling, Truman; Maxson, Todd; King, Benjamin; Whorton, Elbert

2010-10-01

The aim of this study was to characterize the human cytokine response to Texas crotaline envenomation before and after antivenom administration. This study enrolled crotaline bite victims presenting to a regional trauma center and children's hospital from March to November 2007 and age-matched unbitten controls. Blood spot cards were obtained from bite victims at presentation and at 1 and 6 hours after antivenom administration. One control sample was drawn from each of the age-matched controls selected from urgent care patients presenting for minor complaints. Samples were delivered to a laboratory using a proprietary method for quantitative evaluation of a large number of biomarkers in parallel with bead-based multiplex immunoassays. After obtaining informed consent, 14 crotaline bite victims (age range, 5-85 years; median age, 45 years; 50% female) (Snakebite Severity Score, 2-7; median, 3) and 14 age-matched controls were enrolled. There were 7 copperhead (Agkistrodon contortrix) bites, 4 rattlesnake (probably Western Diamondback Crotalus atrox) bites, 2 cottonmouth (Agkistrodon piscivorus) bites, and 1 bite from a snake that was not identified by the victim. In t tests, the means in the presentation samples for apolipoprotein A-I (Apo A-I), Apo C3, interleukin 4 (IL-4), myeloperoxidase, plasminogen activator inhibitor 1 (PAI-1), epidermal growth factor, and regulated upon activation, normal t-cell expressed and secreted were significantly lower and Apo H was significantly higher in the bite patients than in the controls. In the 1-hour sample, α(1)-antitrypsin, Apo A-I, Apo C3, eotaxin, IL-4, myeloperoxidase, and PAI-1 levels were lower and prostatic acid phosphatase and cancer antigen 125 levels were higher in the bite patients than in the controls. And in the 6-hour sample, α(1)-antitrypsin, Apo A-I, Apo C3, endothelin-1, IL-4, macrophage inflammatory protein 1β, myeloperoxidase, and epidermal growth factor levels were lower and Apo H level was higher in the bite patients than in controls (all P values < .05). Crotaline venom produces a broad cytokine response in human bite victims. In particular, IL-4, myeloperoxidase, and Apo A-I and C3 levels remain altered despite antivenom therapy, whereas PAI-1 and regulated upon activation, normal t-cell expressed and secreted levels seem to normalize after antivenin as other markers are affected. Understanding this profile and further study of the markers identified might lead to improved therapies and better prognostic indicators. Copyright © 2010 Elsevier Inc. All rights reserved.

Functional proteomic analyses of Bothrops atrox venom reveals phenotypes associated with habitat variation in the Amazon.

PubMed

Sousa, Leijiane F; Portes-Junior, José A; Nicolau, Carolina A; Bernardoni, Juliana L; Nishiyama, Milton Y; Amazonas, Diana R; Freitas-de-Sousa, Luciana A; Mourão, Rosa Hv; Chalkidis, Hipócrates M; Valente, Richard H; Moura-da-Silva, Ana M

2017-04-21

Venom variability is commonly reported for venomous snakes including Bothrops atrox. Here, we compared the composition of venoms from B. atrox snakes collected at Amazonian conserved habitats (terra-firme upland forest and várzea) and human modified areas (pasture and degraded areas). Venom samples were submitted to shotgun proteomic analysis as a whole or compared after fractionation by reversed-phase chromatography. Whole venom proteomes revealed a similar composition among the venoms with predominance of SVMPs, CTLs, and SVSPs and intermediate amounts of PLA 2 s and LAAOs. However, when distribution of particular isoforms was analyzed by either method, the venom from várzea snakes showed a decrease in hemorrhagic SVMPs and an increase in SVSPs, and procoagulant SVMPs and PLA 2 s. These differences were validated by experimental approaches including both enzymatic and in vivo assays, and indicated restrictions in respect to antivenom efficacy to variable components. Thus, proteomic analysis at the isoform level combined to in silico prediction of functional properties may indicate venom biological activity. These results also suggest that the prevalence of functionally distinct isoforms contributes to the variability of the venoms and could reflect the adaptation of B. atrox to distinct prey communities in different Amazon habitats. In this report, we compared isoforms present in venoms from snakes collected at different Amazonian habitats. By means of a species venom gland transcriptome and the in silico functional prediction of each isoform, we were able to predict the principal venom activities in vitro and in animal models. We also showed remarkable differences in the venom pools from snakes collected at the floodplain (várzea habitat) compared to other habitats. Not only was this venom less hemorrhagic and more procoagulant, when compared to the venom pools from the other three habitats studied, but also this enhanced procoagulant activity was not efficiently neutralized by Bothrops antivenom. Thus, using a functional proteomic approach, we highlighted intraspecific differences in B. atrox venom that could impact both in the ecology of snakes but also in the treatment of snake bite patients in the region. Copyright © 2017 Elsevier B.V. All rights reserved.

The genesis of an exceptionally lethal venom in the timber rattlesnake (Crotalus horridus) revealed through comparative venom-gland transcriptomics

PubMed Central

2013-01-01

Background Snake venoms generally show sequence and quantitative variation within and between species, but some rattlesnakes have undergone exceptionally rapid, dramatic shifts in the composition, lethality, and pharmacological effects of their venoms. Such shifts have occurred within species, most notably in Mojave (Crotalus scutulatus), South American (C. durissus), and timber (C. horridus) rattlesnakes, resulting in some populations with extremely potent, neurotoxic venoms without the hemorrhagic effects typical of rattlesnake bites. Results To better understand the evolutionary changes that resulted in the potent venom of a population of C. horridus from northern Florida, we sequenced the venom-gland transcriptome of an animal from this population for comparison with the previously described transcriptome of the eastern diamondback rattlesnake (C. adamanteus), a congener with a more typical rattlesnake venom. Relative to the toxin transcription of C. adamanteus, which consisted primarily of snake-venom metalloproteinases, C-type lectins, snake-venom serine proteinases, and myotoxin-A, the toxin transcription of C. horridus was far simpler in composition and consisted almost entirely of snake-venom serine proteinases, phospholipases A2, and bradykinin-potentiating and C-type natriuretic peptides. Crotalus horridus lacked significant expression of the hemorrhagic snake-venom metalloproteinases and C-type lectins. Evolution of shared toxin families involved differential expansion and loss of toxin clades within each species and pronounced differences in the highly expressed toxin paralogs. Toxin genes showed significantly higher rates of nonsynonymous substitution than nontoxin genes. The expression patterns of nontoxin genes were conserved between species, despite the vast differences in toxin expression. Conclusions Our results represent the first complete, sequence-based comparison between the venoms of closely related snake species and reveal in unprecedented detail the rapid evolution of snake venoms. We found that the difference in venom properties resulted from major changes in expression levels of toxin gene families, differential gene-family expansion and loss, changes in which paralogs within gene families were expressed at high levels, and higher nonsynonymous substitution rates in the toxin genes relative to nontoxins. These massive alterations in the genetics of the venom phenotype emphasize the evolutionary lability and flexibility of this ecologically critical trait. PMID:23758969

Long-term complications of rattlesnake bites: a telephone survey from Central California.

PubMed

Spano, Susanne J; Vohra, Rais; Macias, Fernando

2014-06-01

The purpose of this institutional review board-approved, cross-sectional study was to identify residual symptoms and signs of envenomation reported by snakebite survivors via a telephone survey. Victims of rattlesnake bite who were treated at a single hospital center during a 10-year period were contacted through a telephone survey. Study subjects were included through a diagnosis-based retrospective chart review of snakebite victims, and excluded if they did not receive rattlesnake antivenom. Data collection was done using a standardized form that included sections about residual, recurrent, or new pain, weakness, paresthesias, or other limitations of the bitten limb. We identified 46 snakebite cases including 5 of 46 "dry" bites. The remaining cases (41 of 46) all received Crofab. Interviews were completed for 31% of these patients (13 of 41), and the remainder were lost to follow-up. Most bites occurred in men (12 cases, 92% males) and on the arms (9 cases, 69%). Six of the 13 respondents (46%) reported residual symptoms from the bite. Persistent symptoms described included localized pain at the bite site (3 cases), numbness or paresthesias (2 cases), abnormal skin peeling and discoloration at the bite site (2 cases), and persistent weakness of the bitten extremity (1 case). Among patients reporting persistent symptoms, the bite-to-survey interval ranged from 7 months to 12 years, with a median interval of 4 years. Our study population demonstrated a notable incidence (43%) of self-reported persistent symptoms related to their rattlesnake bites, although the overall level of disability from these injuries seems low. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Identification of continuous interaction sites in PLA(2)-based protein complexes by peptide arrays.

PubMed

Fortes-Dias, Consuelo Latorre; Santos, Roberta Márcia Marques dos; Magro, Angelo José; Fontes, Marcos Roberto de Mattos; Chávez-Olórtegui, Carlos; Granier, Claude

2009-01-01

Crotoxin (CA.CB) is a beta-neurotoxin from Crotalus durissus terrificus snake venom that is responsible for main envenomation effects upon biting by this snake. It is a heterodimer of an acidic protein (CA) devoid of any biological activity per se and a basic, enzymatically active, PLA(2) counterpart (CB). Both lethal and enzymatic activities of crotoxin have been shown to be inhibited by CNF, a protein from the blood of C. d. terrificus snakes. CNF replaces CA in the CA.CB complex, forming a stable, non-toxic complex CNF.CB. The molecular sites involved in the tight interfacial protein-protein interactions in these PLA(2)-based complexes have not been clearly determined. To help address this question, we used the peptide arrays approach to map possible interfacial interaction sites in CA.CB and CNF.CB. Amino acid stretches putatively involved in these interactions were firstly identified in the primary structure of CB. Further analysis of the interfacial availability of these stretches in the presumed biologically active structure of CB, suggested two interaction main sites, located at the amino-terminus and beta-wing regions. Peptide segments at the carboxyl-terminus of CB were also suggested to play a secondary role in the binding of both CA and CNF.

Isolation and partial purification of anticoagulant fractions from the venom of the Iranian snake Echis carinatus.

PubMed

Babaie, Mahdi; Zolfagharian, Hossein; Salmanizadeh, Hossein; Mirakabadi, Abbas Zare; Alizadeh, Hafezeh

2013-01-01

Many snake venoms comprise different factors, which can either promote or inhibit the blood coagulation pathway. Coagulation disorders and hemorrhage belong to the most prominent features of bites of the many vipers. A number of these factors interact with components of the human blood coagulation. This study is focused on the effect of Echis carinatus snake venom on blood coagulation pathway. Anticoagulant factors were purified from the Iranian Echis carinatus venom by two steps: gel filtration (Sephadex G-75) and ion-exchange (DEAE-Sephadex) chromatography, in order to study the anticoagulant effect of crude venom and their fractions. The prothrombin time was estimated on human plasma for each fraction. Our results showed that protrombin time value was increase from 13.4 s to 170 s for F2C and to 280 s for F2D. Our study showed that these fractions of the venom delay the prothrombine time and thus can be considered as anticoagulant factors. They were shown to exhibit proteolytic activity. The molecular weights of these anticoagulants (F2C, F2D) were estimated by SDS/PAGE electrophoresis. F2C comprises two protein bands with molecular weights of 50 and 79 kDa and F2D a single band with a molecular weight of 42 kDa.

Chemical recognition of kingsnakes by crotalines: effects of size on the ophiophage defensive response.

PubMed

Gutzke, W H; Tucker, C; Mason, R T

1993-01-01

When confronted by an ophiophagous (snake-eating) kingsnake, venomous snakes of the subfamily Crotalinae exhibit a suite of defensive responses including head hiding, thrashing, and an unusual response termed 'body bridging'. Other responses observed, such as biting and 'freezing', are more general in nature and can occur in a variety of contexts. Various crotalines of differing sizes were tested for their responses to kingsnakes (Lampropeltis getulus). Responses of individuals were recorded for up to 18 months. The results indicate that, if habituation can be overcome by periodically allowing a kingsnake to confront but not harm the crotaline, the response is dependent on the size of the crotaline, in that smaller specimens (< 0.9 m) respond readily, while larger snakes (> 1.0 m) tend not to respond. The size of the kingsnake apparently does not have an effect on the crotaline response. These data appear to resolve apparent conflicts in the literature regarding whether certain species respond to ophidian ophiophages. In addition, hexane extracts of kingsnake skin were fractionated using an alumina column. The various fractions obtained were tested to determine which elicited the defensive response. Activity was found only in the most non-polar fraction. Preliminary analysis by gas chromatography/mass spectrometry indicated that this fraction contained straight and branched, saturated and polyunsaturated long-chain hydrocarbons.

Pitfalls to avoid when using phage display for snake toxins.

PubMed

Laustsen, Andreas Hougaard; Lauridsen, Line Præst; Lomonte, Bruno; Andersen, Mikael Rørdam; Lohse, Brian

2017-02-01

Antivenoms against bites and stings from snakes, spiders, and scorpions are associated with immunological side effects and high cost of production, since these therapies are still derived from the serum of hyper-immunized production animals. Biotechnological innovations within envenoming therapies are thus warranted, and phage display technology may be a promising avenue for bringing antivenoms into the modern era of biologics. Although phage display technology represents a robust and high-throughput approach for the discovery of antibody-based antitoxins, several pitfalls may present themselves when animal toxins are used as targets for phage display selection. Here, we report selected critical challenges from our own phage display experiments associated with biotinylation of antigens, clone picking, and the presence of amber codons within antibody fragment structures in some phage display libraries. These challenges may be detrimental to the outcome of phage display experiments, and we aim to help other researchers avoiding these pitfalls by presenting their solutions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adjuvant effects and antiserum action potentiation by a (herbal) compound 2-hydroxy-4-methoxy benzoic acid isolated from the root extract of the Indian medicinal plant 'sarsaparilla' (Hemidesmus indicus R. Br.).

PubMed

Alam, M I; Gomes, A

1998-10-01

The adjuvant effect and antiserum potentiation of a compound 2-hydroxy-4-methoxy benzoic acid were explored in the present investigation. This compound, isolated and purified from the Indian medicinal plant Hemidesmus indicus R. Br, possessed antisnake venom activity. Rabbits immunized with Vipera russellii venom in the presence and absence of the compound along with Freund's complete adjuvant, produced a precipitating band in immunogel diffusion and immunogel electrophoresis. The venom neutralizing capacity of this antiserum showed positive adjuvant effects as evident by the higher neutralization capacity (lethal and hemorrhage) when compared with the antiserum raised with venom alone. The pure compound potentiated the lethal action neutralization of venom by commercial equine polyvalent snake venom antiserum in experimental models. These observations raised the possibility of the use of chemical antagonists (from herbs) against snake bite, which may provide a better protection in presence of antiserum, especially in the rural parts of India.

Venomous snake bites, scorpions, and spiders.

PubMed

Kularatne, S A M; Senanayake, Nimal

2014-01-01

Neurologic dysfunction due to natural neurotoxins is an important, but neglected, public health hazard in many parts of the world, particularly in the tropics. These toxins are produced by or found among a variety of live forms that include venomous snakes, arthropods such as scorpions, spiders, centipedes, stinging insects (Hymenoptera), ticks, certain poisonous fish, shellfish, crabs, cone shells, skin secretions of dart-poison frogs, and bacterial poisons such as botulinum toxin. These toxins commonly act on neuromuscular transmission at the neuromuscular junction where acetylcholine is the neurotransmitter, but in certain situations the toxins interfere with neurotransmitters such as GABA, noradrenaline, adrenaline, dopamine, and γ-aminobutyrate. Of the toxins, α-toxins and κ-toxins (e.g., Chinese krait, Bungarus multicinctus) act on the postsynaptic membrane, blocking the receptors, whilst β-toxin (e.g., common krait, B. caeruleus) acts on the presynaptic membrane, causing impairment of acetylcholine release. Conversely, dendrotoxins of the African mamba enhance acetylcholine release. The toxins of scorpions and spiders commonly interfere with voltage-gated ion channels. Clinically, the cardinal manifestation is muscle paralysis. In severe cases respiratory paralysis could be fatal. Effective antivenoms are the mainstay of treatment of envenoming, but their lack of availability is the major concern in the regions of the globe where they are desperately needed. Interestingly, some toxins have proved to be valuable pharmaceutical agents, while some others are widely exploited to study neuromuscular physiology and pathology. © 2014 Elsevier B.V. All rights reserved.

Factor X activating Atractaspis snake venoms and the relative coagulotoxicity neutralising efficacy of African antivenoms.

PubMed

Oulion, Brice; Dobson, James S; Zdenek, Christina N; Arbuckle, Kevin; Lister, Callum; Coimbra, Francisco C P; Op den Brouw, Bianca; Debono, Jordan; Rogalski, Aymeric; Violette, Aude; Fourmy, Rudy; Frank, Nathaniel; Fry, Bryan G

2018-05-15

Atractaspis snake species are enigmatic in their natural history, and venom effects are correspondingly poorly described. Clinical reports are scarce but bites have been described as causing severe hypertension, profound local tissue damage leading to amputation, and deaths are on record. Clinical descriptions have largely concentrated upon tissue effects, and research efforts have focused upon the blood-pressure affecting sarafotoxins. However, coagulation disturbances suggestive of procoagulant functions have been reported in some clinical cases, yet this aspect has been uninvestigated. We used a suite of assays to investigate the coagulotoxic effects of venoms from six different Atractaspis specimens from central Africa. The procoagulant function of factor X activation was revealed, as was the pseudo-procoagulant function of direct cleavage of fibrinogen into weak clots. The relative neutralization efficacy of South African Antivenom Producer's antivenoms on Atractaspis venoms was boomslang>polyvalent>saw-scaled viper. While the boomslang antivenom was the most effective on Atractaspis venoms, the ability to neutralize the most potent Atractaspis species in this study was up to 4-6 times less effective than boomslang antivenom neutralizes boomslang venom. Therefore, while these results suggest cross-reactivity of boomslang antivenom with the unexpectedly potent coagulotoxic effects of Atractaspis venoms, a considerable amount of this rare antivenom may be needed. This report thus reveals potent venom actions upon blood coagulation that may lead to severe clinical effects with limited management strategies. Copyright © 2018 Elsevier B.V. All rights reserved.

Level and pattern of human rabies and dog bites in Techiman Municipality in the Middle Belt of Ghana: a six year retrospective records review

PubMed Central

Punguyire, Damien Tioyire; Osei-Tutu, Anthony; Aleser, Emmanuel Vikpenibe; Letsa, Timothy

2017-01-01

Introduction Rabies is a viral zoonotic disease that is transmitted primarily by bites from rabid dogs and has the highest case fatality rate of most infectious diseases in humans. We described a 6-year trend of rabies and dog bites in a peri-urban district in Ghana. Methods A record review was conducted in the health facilities in Techiman to identify all human rabies and dog bite cases reported from January 2011 to December 2016. Rabies and dog bite data were extracted from health facilities records. Vaccination status of implicated dogs was extracted from the veterinary records at the Techiman Disease Investigation Farm. Data were summarized using proportions and presented using tables, charts and figures. Results Thirteen (13) cases of human rabies were recorded from 2011 to 2016. Complete data was available for 10 cases. Median age of rabies victims was 30 (range 3-80 years). A majority were males (8 representing 61.5%). Eight cases came from rural farming communities, 8 had a previous history of dog bite ranging from two weeks to five months before the onset of rabies symptoms and one reported with non-bite rabies. Case fatality was 100%. A total of 680 dog bites were reported by health facilities. About 50.3% (342) of the victims were males, a majority of bites (47.9%) occurred among children aged 1-15 years. Positive rabies cases among offending dogs ranged from 3.3% in 2016 to 17.6% in 2014. Conclusion Mass vaccination of dogs and provision of post-exposure vaccination are needed to reduce rabies transmission. PMID:29942413

Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control.

PubMed

Salomão, Cristolde; Nacima, Amílcar; Cuamba, Lutero; Gujral, Lorna; Amiel, Olga; Baltazar, Cynthia; Cliff, Julie; Gudo, Eduardo Samo

2017-07-01

In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities. We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age <15 years (p = 0.05), bite by stray dog (p = 0.002), deep wound (p = 0.02), bite in the head (p = 0.001), bite by unimmunized dog (p = 0.01), no use of soap and water (p = 0.001), and no post-exposure prophylaxis (p = 0.01). Implementation of control measures for rabies is poor in Maputo and Matola cities, where cases of human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures.

Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control

PubMed Central

Salomão, Cristolde; Nacima, Amílcar; Cuamba, Lutero; Gujral, Lorna; Amiel, Olga; Baltazar, Cynthia; Cliff, Julie

2017-01-01

Background In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities. Methodology/Principal findings We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age <15 years (p = 0.05), bite by stray dog (p = 0.002), deep wound (p = 0.02), bite in the head (p = 0.001), bite by unimmunized dog (p = 0.01), no use of soap and water (p = 0.001), and no post-exposure prophylaxis (p = 0.01). Conclusions/Significance Implementation of control measures for rabies is poor in Maputo and Matola cities, where cases of human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures. PMID:28742094

Vellozia flavicans Mart. ex Schult. hydroalcoholic extract inhibits the neuromuscular blockade induced by Bothrops jararacussu venom.

PubMed

Tribuiani, Natália; da Silva, Alexandro Mateus; Ferraz, Miriéle Cristina; Silva, Magali Glauzer; Bentes, Ana Paula Guerreiro; Graziano, Talita Signoreti; dos Santos, Marcio Galdino; Cogo, José Carlos; Varanda, Eliana Aparecida; Groppo, Francisco Carlos; Cogo, Karina; Oshima-Franco, Yoko

2014-02-08

Snakebite is a significant public health issue in tropical countries. In Brazil, some of the most common snake envenomations are from Bothrops. Bothrops bites trigger local and systemic effects including edema, pain, erythema, cyanosis, infections, and necrosis. Vellozia flavicans is a plant from the Brazilian "cerrado" (savanna) that is popularly used as an anti-inflammatory medicine. Since inflammation develops quickly after Bothrops bites, which can lead to infection, the aim of the present study was to observe possible anti-snake venom and antimicrobial activities of V. flavicans (Vf). The chromatographic profile of the main constituents from the Vf leaf hydroalcoholic extract was obtained by thin-layer chromatography (TLC). The anti-snake venom activity was measured by Vf's ability to neutralize the in vitro neuromuscular blockade caused by Bothrops jararacussu venom (Bjssu) in a mouse phrenic nerve-diaphragm model (PND). After a 20 min incubation, preparations of PND were added to Tyrode's solution (control); Vf (0.2, 0.5, 1, and 2 mg/mL); 40 μg/mL Bjssu; pre-incubation for 30 min with Bjssu and 1 mg/mL Vf; and a Bjssu pretreated preparation (for 10 min) followed by 1 mg/mL Vf. Myographic recording was performed, and the contractile responses were recorded. The antimicrobial activity (minimum inhibitory concentration [MIC] and minimum bactericidal concentration [MBC]) was obtained for Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis, using gentamicin and vancomycin as positive controls. TLC analysis yielded several compounds from Vf, such as flavonoids (quercetin) and phenolic acids (chlorogenic acid). Bjssu completely blocked the contractile responses of PND preparations, while Vf preserved 97% (±10%) of the contractile responses when incubated with Bjssu. In the PND pretreated with Bjssu, Vf was able to inhibit the neuromuscular blockade progress. MIC and MBC of Vf ranged from 2.5 to 5.0 mg/mL for P. aeruginosa and S. aureus strains, while no antimicrobial activity was observed for E. coli and E. faecalis. The hydroalcoholic extract from Vf leaves was able to neutralize and decrease the in vitro neuromuscular blockade caused by Bjssu. However, it did not show significant antimicrobial activity against the tested bacteria.

A fatal mongoose bite.

PubMed

Tumram, Nilesh Keshav; Bardale, Rajesh Vaijnathrao; Dixit, Pradeep Gangadhar; Deshmukh, Ashutosh Yashwant

2012-11-19

Animal bite is a bite wound from a pet, farm or wild animal. Dog bites make up 80-85% of all reported incidents. Cats amount for about 10% of reported bites and other animals such as rodents, rabbits, horses, raccoons, bats and monkeys amount to 5-10%. Bites by mongoose are uncommon. Here, we present a case of fatal mongoose bite to an elderly woman who died as a complication of streptococcal infection at the bite site.

Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System

PubMed Central

Zaidi, Syed Mohammad Asad; Labrique, Alain B.; Khowaja, Saira; Lotia-Farrukh, Ismat; Irani, Julia; Salahuddin, Naseem; Khan, Aamir Javed

2013-01-01

Background Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi. Methodology and Principal Findings A total of 6212 dog-bite cases were identified over two years starting in February 2009 with largest number reported from Karachi (59.7%), followed by Peshawar (13.1%) and Hyderabad (11.4%). Severity of dog-bites was assessed using the WHO classification. Forty percent of patients had Category I (least severe) bites, 28.1% had Category II bites and 31.9% had Category III (most severe bites). Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non-medical facilities (Odds Ratio = 0.20, 95% CI 0.17–0.23, p-value<0.01), and had shorter mean travel time to emergency rooms, adjusted for age and gender (32.78 min, 95% CI 31.82–33.78, p-value<0.01) than patients visiting hospitals in smaller cities. Spatial analysis of dog-bites in Karachi suggested clustering of cases (Moran's I = 0.02, p value<0.01), and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city's largest abattoir in Landhi. The direct cost of operating the mHealth surveillance system was USD 7.15 per dog-bite case reported, or approximately USD 44,408 over two years. Conclusions Our findings suggest significant differences in access to care and health-seeking behaviors in Pakistan following dog-bites. The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease-control efforts in the city. Mobile phone technologies for health (mHealth) allowed for the operation of a national-level disease reporting and surveillance system at a low cost. PMID:24349590

Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation.

PubMed

German, Benjamin T; Hack, Jason B; Brewer, Kori; Meggs, William J

2005-06-01

Pressure-immobilization bandages are used in countries where neurotoxic snake envenomations are common. They impede lymphatic egress from the bite site and delay systemic venom toxicity. The effectiveness of these devices has not been evaluated in coral snake envenomations. We investigated the efficacy of pressure-immobilization bandages in delaying the onset of systemic toxicity in a porcine model of coral snake envenomation. A randomized controlled trial of pressure-immobilization bandages was conducted in a university animal care center. Subjects were 12 anesthetized, spontaneously breathing pigs, ranging from 9.1 to 11.4 kg. After injection with 10 mg of Micrurus fulvius fulvius venom in the subcutaneous tissue of the distal foreleg, subjects were randomized to receive no treatment or application of a pressure-immobilization bandage at 1 minute after injection. Treated animals had elastic bandages applied to the extremity and splinting for immobilization. Vital signs and quality of respirations were recorded. Outcome was the onset of respiratory failure or survival to 8 hours. Necropsies and histologic analysis of the envenomation site was performed. One animal from each group was removed because of the discovery of pre-existing respiratory pathology. Four of 5 pigs in the treatment group survived to 8 hours, but none in the control group survived. Mean time to onset of respiratory compromise was 170.4 +/- 33.3 minutes in the control group. None of the pigs had histologic changes at the envenomation site consistent with ischemia or pressure-related injury. Pressure-immobilization bandages delayed the onset of systemic toxicity in our porcine model of M fulvius envenomation.

Cutaneous Chromatophoromas in Captive Snakes.

PubMed

Muñoz-Gutiérrez, J F; Garner, M M; Kiupel, M

2016-11-01

Chromatophoromas are neoplasms arising from pigment-bearing cells (chromatophores) of the dermis. While isolated cases have been reported in the literature, the prevalence and biological behavior of chromatophoromas in snakes are unknown. Forty-two chromatophoromas were identified among 4663 submissions (0.9%) to a private diagnostic laboratory in a 16-year period. The most commonly affected snakes were colubrids (23 cases, 55%) and vipers (8 cases, 19%). The San Francisco garter snake was the most commonly affected species (6 cases; 14% of all affected snake species and 3.7% of all garter snake submissions). No sex predilection was found. The age of 28 snakes ranged from 5 to 27 years. Single cutaneous chromatophoromas were most commonly observed and presented as pigmented cutaneous masses or plaques along any body segment. Euthanasia or death due to progressive neoplastic disease or metastasis was reported in 8 (19%) and 4 (10%) cases, respectively. The survival time of 4 animals ranged from 4 to 36 months. Microscopically, xanthophoromas, iridophoromas, melanocytic neoplasms, and mixed chromatophoromas were identified, with melanocytic neoplasms being most common. Microscopic examination alone was generally sufficient for the diagnosis of chromatophoroma, but immunohistochemistry for S-100 and PNL-2 may be helpful for diagnosing poorly pigmented cases. Moderate to marked nuclear atypia appears to be consistently present in cutaneous chromatophoromas with a high risk of metastasis, while mitotic count, lymphatic invasion, the level of infiltration, and the degree of pigmentation or ulceration were not reliable predictors of metastasis. © The Author(s) 2016.

How informative are case studies of spider bites in the medical literature?

PubMed

Stuber, Marielle; Nentwig, Wolfgang

2016-05-01

We analyzed the reliability and information content of 134 medical case studies on spider bites, published in 91 journal articles. Overall, we found that only 22% of these studies fulfilled the criteria for a verified spider bite. This means that the majority of such case studies cannot be attributed to a given spider species and usually not even to a spider. Their scientific value is negligible, moreover, such publications are even dangerous because they suggest incorrect conclusions. Secondly, we found that such case studies usually do not follow an obvious structure and many details on the development of symptoms, therapy and healing process are widely lacking. So even for verified spider bites, the comparability of case studies is limited. We discuss the obvious failure of a reviewing process for case studies and give recommendations how to increase the currently low information content of medical case studies on spider bites. Copyright © 2016 Elsevier Ltd. All rights reserved.

Death Adder Envenoming Causes Neurotoxicity Not Reversed by Antivenom - Australian Snakebite Project (ASP-16)

PubMed Central

Johnston, Christopher I.; O'Leary, Margaret A.; Brown, Simon G. A.; Currie, Bart J.; Halkidis, Lambros; Whitaker, Richard; Close, Benjamin; Isbister, Geoffrey K.

2012-01-01

Background Death adders (Acanthophis spp) are found in Australia, Papua New Guinea and parts of eastern Indonesia. This study aimed to investigate the clinical syndrome of death adder envenoming and response to antivenom treatment. Methodology/Principal Findings Definite death adder bites were recruited from the Australian Snakebite Project (ASP) as defined by expert identification or detection of death adder venom in blood. Clinical effects and laboratory results were collected prospectively, including the time course of neurotoxicity and response to treatment. Enzyme immunoassay was used to measure venom concentrations. Twenty nine patients had definite death adder bites; median age 45 yr (5–74 yr); 25 were male. Envenoming occurred in 14 patients. Two further patients had allergic reactions without envenoming, both snake handlers with previous death adder bites. Of 14 envenomed patients, 12 developed neurotoxicity characterised by ptosis (12), diplopia (9), bulbar weakness (7), intercostal muscle weakness (2) and limb weakness (2). Intubation and mechanical ventilation were required for two patients for 17 and 83 hours. The median time to onset of neurotoxicity was 4 hours (0.5–15.5 hr). One patient bitten by a northern death adder developed myotoxicity and one patient only developed systemic symptoms without neurotoxicity. No patient developed venom induced consumption coagulopathy. Antivenom was administered to 13 patients, all receiving one vial initially. The median time for resolution of neurotoxicity post-antivenom was 21 hours (5–168). The median peak venom concentration in 13 envenomed patients with blood samples was 22 ng/mL (4.4–245 ng/mL). In eight patients where post-antivenom bloods were available, no venom was detected after one vial of antivenom. Conclusions/Significance Death adder envenoming is characterised by neurotoxicity, which is mild in most cases. One vial of death adder antivenom was sufficient to bind all circulating venom. The persistent neurological effects despite antivenom, suggests that neurotoxicity is not reversed by antivenom. PMID:23029595

Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16).

PubMed

Johnston, Christopher I; O'Leary, Margaret A; Brown, Simon G A; Currie, Bart J; Halkidis, Lambros; Whitaker, Richard; Close, Benjamin; Isbister, Geoffrey K

2012-01-01

Death adders (Acanthophis spp) are found in Australia, Papua New Guinea and parts of eastern Indonesia. This study aimed to investigate the clinical syndrome of death adder envenoming and response to antivenom treatment. Definite death adder bites were recruited from the Australian Snakebite Project (ASP) as defined by expert identification or detection of death adder venom in blood. Clinical effects and laboratory results were collected prospectively, including the time course of neurotoxicity and response to treatment. Enzyme immunoassay was used to measure venom concentrations. Twenty nine patients had definite death adder bites; median age 45 yr (5-74 yr); 25 were male. Envenoming occurred in 14 patients. Two further patients had allergic reactions without envenoming, both snake handlers with previous death adder bites. Of 14 envenomed patients, 12 developed neurotoxicity characterised by ptosis (12), diplopia (9), bulbar weakness (7), intercostal muscle weakness (2) and limb weakness (2). Intubation and mechanical ventilation were required for two patients for 17 and 83 hours. The median time to onset of neurotoxicity was 4 hours (0.5-15.5 hr). One patient bitten by a northern death adder developed myotoxicity and one patient only developed systemic symptoms without neurotoxicity. No patient developed venom induced consumption coagulopathy. Antivenom was administered to 13 patients, all receiving one vial initially. The median time for resolution of neurotoxicity post-antivenom was 21 hours (5-168). The median peak venom concentration in 13 envenomed patients with blood samples was 22 ng/mL (4.4-245 ng/mL). In eight patients where post-antivenom bloods were available, no venom was detected after one vial of antivenom. Death adder envenoming is characterised by neurotoxicity, which is mild in most cases. One vial of death adder antivenom was sufficient to bind all circulating venom. The persistent neurological effects despite antivenom, suggests that neurotoxicity is not reversed by antivenom.

Snake fungal disease in North America: U.S. Geological Survey updates

USGS Publications Warehouse

Thompson, Noelle E.; Lankau, Emily W.; Moede Rogall, Gail

2018-01-12

Snake fungal disease (SFD) results from a skin infection that has been documented only in snakes. Historically, reports of snakes with skin infections of unknown origin have been sporadic. Recently, the number of reported cases of skin infections in snakes has increased substantially. This emerging infectious disease, confirmed in numerous species of snakes, is caused by the fungus Ophidiomyces ophiodiicola. As of August 2017, O. ophiodiicola has been detected in at least 23 States and one Canadian Province. However, researchers suspect that SFD may be more widely distributed than these documented cases suggest, because efforts to monitor the health of many snake populations are limited. Snake fungal disease may also be underreported in populations where it affects snakes infrequently or in species that develop less severe illness. Signs of SFD include crusted or ulcerated scales, nodules (that is, abnormal bumps) under the skin, and facial disfiguration that can be quite severe, leading to emaciation and death. Many snake populations are already in decline due to habitat loss and dwindling prey populations, and the recent emergence of SFD may accelerate this decline, causing certain species to disappear entirely from some locations.

Distribution and medical aspects of Loxosceles rufescens, one of the most invasive spiders of the world (Araneae: Sicariidae).

PubMed

Nentwig, Wolfgang; Pantini, Paolo; Vetter, Richard S

2017-06-15

Loxosceles rufescens is a circum-Mediterranean spider species, potentially harmful to humans. Its native area covers the Mediterranean Basin and Near East. Easily spread with transported goods, it is meanwhile an alien and invasive species to nearly all other continents and many islands. This species occurs in semi-arid steppe-like habitats, typically under stones and in cavities, which enables it to settle inside buildings when invading the synanthropic environment. This review analyses the literature of L. rufescens bites to humans (38 publications) of which only 11 publications refer to 12 verified spider bites (11% of the reported bites). Two published allegedly deadly spider bites (Thailand 2014 and Italy 2016) involve non-verified spider bites and are thus not reliable. The symptoms and therapy of these 11 verified bites are described: only five cases showed moderate systemic effects, nine cases developed necrosis, four cases needed surgical debridement, all cases healed without complications within a few weeks. In conclusion, L. rufescens is a spider species globally spread by human activity, it rarely bites humans and the bites are less harmful than often described. There is no known fatal issue. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of antivenom for snakebites reported to United States poison centers.

PubMed

Spiller, Henry A; Bosse, George M; Ryan, Mark L

2010-09-01

In 2001, a new antivenin was introduced to the United States and became widely available in the snakebite season of 2002. We investigated what impact this may have had on snakebite treatment and medical outcome. The study used a retrospective review of all snakebites to humans reported to the National Poison Center Database System from 2000 to 2007. During the 8 years, there were 37,760 snakebites, with a mean of 4720 bites per year. There was a 27% increase in bites reported to a Poison center for the 8-year period and an overall 13.5% increase in the use of antivenin. The 2 categories primarily responsible for the increased use of antivenin were copperhead and crotaline-unknown. Rattlesnake bites remained the category most frequently treated with antivenin with a mean 52.5% treatment rate and only moderate increase for the 8 years. There was no change in the percentage or number of patients with a major outcome (mean, 3.8%) or death (mean, 0.5%). There was a decrease in patients with a minor outcome and an increase in patients with a moderate outcome. The new antivenin is reported to have a reduced potential for adverse reactions. This may have had a role in the decision of which snakebite victims received antivenin. With the introduction of a new antivenin, there has been a dramatic increase in the number of snakebite patients treated with antivenin. This has been most noticeable in snake bite categories that were less frequently treated with antivenin in the past. Copyright © 2010 Elsevier Inc. All rights reserved.

Severe adverse drug reaction following Crotalidae Polyvalent Immune Fab (Ovine) administration for copperhead snakebite.

PubMed

Lepak, Maryjoy R; Bochenek, Samantha H; Bush, Sean P

2015-01-01

To present the case of a severe anaphylactic/anaphylactoid reaction to Crotalidae Polyvalent Immune Fab (Ovine) in a patient bitten by a copperhead snake. A 68-year-old man presented with progressive envenomation after receiving a copperhead snakebite on each hand. Crotalinae Fab antivenom was administered. While the initial and only dose was partially infusing, the patient developed an adverse drug reaction (ADR) of urticaria and hypotension, which resolved with cessation of the infusion, recurred with resumption of the infusion, and ultimately was completed with supportive care. An additional episode of hypotension, urticaria, and angioedema occurred shortly after antivenom therapy completion. Epinephrine was administered, resolving the reaction with complete patient recovery. The event received a Naranjo score of 10, indicating a definite ADR. Treating copperhead snakebites with antivenom is a matter of debate. Concern over adverse events and cost induce some physicians to manage copperhead bites without antivenom because they are generally milder in severity. As demonstrated in this case, severe ADR can occur with Crotalinae Fab antivenom, and its efficacy for copperhead envenoming needs to be better established via placebo-controlled, randomized trials. © The Author(s) 2014.

Orthodontic treatment of a complex open-bite malocclusion with temporary anchorage devices: a case report.

PubMed

Waldman, Alexander B

2010-08-01

Orthodontic temporary anchorage devices provide a novel alternative to orthognathic surgery for the treatment of severe anterior open-bite malocclusions. These implantable devices provide skeletal anchorage for maxillary molar intrusion, allowing for mandibular autorotation and subsequent open-bite closure. This case demonstrates step-by-step treatment of a 41-year-old woman with a severe open-bite malocclusion. Detailed orthodontic mechanics are described at every stage of treatment.

Deadly case of Pasteurella multocida aortitis and mycotic aneurysm following a cat bite.

PubMed

Cho, Dennis Dane; Berliner, Yaniv; Carr, David

2016-06-16

Animal bites are frequently encountered in the emergency department (ED). Aortitis leading to mycotic abdominal aortic aneurysm is a rare and potentially deadly complication of Pasteurella multocida (P. multocida) following an animal bite. We present the case of a 68-year-old male who presented to the ED after falling at home. He complained of weakness and abdominal pain. He was in septic shock and was treated empirically with broad-spectrum antibiotics and intravenous fluids. He reported previous antibiotic treatment of a cellulitis secondary to a cat bite injury to his right thumb four weeks prior. Abdominal ultrasound and subsequent computed tomography scan revealed a leaking mycotic abdominal aneurysm that was surgically repaired. Blood cultures and aortic wall tissue cultures grew P. multocida. Given how common animal bite presentations are in the ED, this case highlights the need to consider aortitis and mycotic abdominal aortic aneurysm in an unwell patient with an animal bite.

Multiple lesions by vampire bat bites in a patient in Niterói, Brazil - Case report*

PubMed Central

Bernardes, Fred; Martins, Gustavo; Luchi, Gustavo Sabaini; Kac, Bernard Kawa; Nery, José Augusto da Costa; Azulay-Abulafia, Luna; Azulay, David Rubem

2014-01-01

Over the last few centuries, the expansion of urbanization brought bats closer to urbanized areas, increasing the risk of accidents by bat bites. The morphology of bat bites can be varied, usually having an elliptical shape, about 0.5 cm along its greatest length, and the characteristic corkscrew bite pattern. The authors present the case of a patient who was repeatedly bitten by vampire bats for two months. A polymerase chain reaction was performed in the cutaneous nerves at the base of the hair follicles which showed negativity towards the rabies virus. The authors highlight the public health importance of this case, and discuss the morphological characteristics of these hematophagous bat bites. PMID:24770518

Efficacy evaluations of Mimosa pudica tannin isolate (MPT) for its anti-ophidian properties.

PubMed

Ambikabothy, Jamunaa; Ibrahim, Halijah; Ambu, Stephen; Chakravarthi, Srikumar; Awang, Khalijah; Vejayan, Jaya

2011-09-01

Evaluations of the anti-snake venom efficacy of Mimosa pudica tannin isolate (MPT) obtained from root of the plant. MPT was investigated in vitro and in vivo for its efficacy against the venom of Naja kaouthia snake. In vitro: (1) mice injected i.p. with MPT pre-incubated with Naja kaouthia venom at concentrations as low as 0.625 mg/ml showed 100% survival after a 24-h observation period. (2) In the proteomics study, mice injected with MPT pre-incubated with the Naja kaouthia venom showed down-regulation of five serum proteins. (3) In the protein-dye-binding study, the percentage of Bradford dye-protein binding showed a reduction relative to the decrease in MPT concentration used to incubate with the venom. In vivo: the results from the animal studies showed that MPT had no in vivo protection against the Naja kaouthia venom (0.875 mg/kg) in four different rescue modes and in an oral pre-treatment experiment. The study indicated the promising ability of MPT to neutralize the Naja kaouthia venom in in vitro experiments but fell short in its in vivo potential. As such, the use of Mimosa pudica (Mimosaceae) as therapeutics for snake bites is questionable as all the possible in vivo rescue studies and pre-treatment of the active constituents showed no protection against the affected mice. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Responses by corn snakes (Elaphe guttata) to chemicals from heterospecific snakes.

PubMed

Weldon, P J; Ford, N B; Perry-Richardson, J J

1990-01-01

Young corn snakes,Elaphe guttata, were tested for responses to chemicals from heterospecific snakes. Corn snakes exhibited more tongue-flicks to swabs freshly rubbed against the skin of an ophiophagous kingsnake,Lampropeltis getulus, than to blank swabs. Responses toL. getulus and a nonophiophagous western plains garter snake,Thamnophis radix haydeni, did not differ significantly. Corn snakes exhibited more tongue-flicks to swabs treated with chloroform extracts of the shed skins ofL. getulus; an ophiophagous eastern coachwhip,Masticophis flagellum; and a nonophiophagous gray ratsnake,Elaphe obsoleta, than to blank swabs, but they did not discriminate between ophiophagous and nonophiophagous species in every case. Corn snakes, when offered shelters containing bedding from the home cages of a nonophiophagous water snake,Nerodia erythrogaster, an occasionally ophiophagous water moccasin,Agkistrodon pisdvorus; orL. getulus and untreated bedding, failed to reside under snake-scented shelters at a rate significantly different from that expected by chance. The responses of corn snakes are compared with those reported for other snakes presented with heterospecific snake chemicals.

Armoured spiderman: morphological and behavioural adaptations of a specialised araneophagous predator (Araneae: Palpimanidae).

PubMed

Pekár, Stano; Sobotník, Jan; Lubin, Yael

2011-07-01

In a predator-prey system where both intervenients come from the same taxon, one can expect a strong selection on behavioural and morphological traits involved in prey capture. For example, in specialised snake-eating snakes, the predator is unaffetced by the venom of the prey. We predicted that similar adaptations should have evolved in spider-eating (araneophagous) spiders. We investigated potential and actual prey of two Palpimanus spiders (P. gibbulus, P. orientalis) to support the prediction that these are araneophagous predators. Specific behavioural adaptations were investigated using a high-speed camera during staged encounters with prey, while morphological adaptations were investigated using electron microscopy. Both Palpimanus species captured a wide assortment of spider species from various guilds but also a few insect species. Analysis of the potential prey suggested that Palpimanus is a retreat-invading predator that actively searches for spiders that hide in a retreat. Behavioural capture adaptations include a slow, stealthy approach to the prey followed by a very fast attack. Morphological capture adaptations include scopulae on forelegs used in grabbing prey body parts, stout forelegs to hold the prey firmly, and an extremely thick cuticle all over the body preventing injury from a counter bite of the prey. Palpimanus overwhelmed prey that was more than 200% larger than itself. In trials with another araneophagous spider, Cyrba algerina (Salticidae), Palpimanus captured C. algerina in more than 90% of cases independent of the size ratio between the spiders. Evidence indicates that both Palpimanus species possesses remarkable adaptations that increase its efficiency in capturing spider prey.

Armoured spiderman: morphological and behavioural adaptations of a specialised araneophagous predator (Araneae: Palpimanidae)

NASA Astrophysics Data System (ADS)

Pekár, Stano; Šobotník, Jan; Lubin, Yael

2011-07-01

In a predator-prey system where both intervenients come from the same taxon, one can expect a strong selection on behavioural and morphological traits involved in prey capture. For example, in specialised snake-eating snakes, the predator is unaffetced by the venom of the prey. We predicted that similar adaptations should have evolved in spider-eating (araneophagous) spiders. We investigated potential and actual prey of two Palpimanus spiders ( P. gibbulus, P. orientalis) to support the prediction that these are araneophagous predators. Specific behavioural adaptations were investigated using a high-speed camera during staged encounters with prey, while morphological adaptations were investigated using electron microscopy. Both Palpimanus species captured a wide assortment of spider species from various guilds but also a few insect species. Analysis of the potential prey suggested that Palpimanus is a retreat-invading predator that actively searches for spiders that hide in a retreat. Behavioural capture adaptations include a slow, stealthy approach to the prey followed by a very fast attack. Morphological capture adaptations include scopulae on forelegs used in grabbing prey body parts, stout forelegs to hold the prey firmly, and an extremely thick cuticle all over the body preventing injury from a counter bite of the prey. Palpimanus overwhelmed prey that was more than 200% larger than itself. In trials with another araneophagous spider, Cyrba algerina (Salticidae), Palpimanus captured C. algerina in more than 90% of cases independent of the size ratio between the spiders. Evidence indicates that both Palpimanus species possesses remarkable adaptations that increase its efficiency in capturing spider prey.

A heteromeric Texas coral snake toxin targets acid-sensing ion channels to produce pain.

PubMed

Bohlen, Christopher J; Chesler, Alexander T; Sharif-Naeini, Reza; Medzihradszky, Katalin F; Zhou, Sharleen; King, David; Sánchez, Elda E; Burlingame, Alma L; Basbaum, Allan I; Julius, David

2011-11-16

Natural products that elicit discomfort or pain represent invaluable tools for probing molecular mechanisms underlying pain sensation. Plant-derived irritants have predominated in this regard, but animal venoms have also evolved to avert predators by targeting neurons and receptors whose activation produces noxious sensations. As such, venoms provide a rich and varied source of small molecule and protein pharmacophores that can be exploited to characterize and manipulate key components of the pain-signalling pathway. With this in mind, here we perform an unbiased in vitro screen to identify snake venoms capable of activating somatosensory neurons. Venom from the Texas coral snake (Micrurus tener tener), whose bite produces intense and unremitting pain, excites a large cohort of sensory neurons. The purified active species (MitTx) consists of a heteromeric complex between Kunitz- and phospholipase-A2-like proteins that together function as a potent, persistent and selective agonist for acid-sensing ion channels (ASICs), showing equal or greater efficacy compared with acidic pH. MitTx is highly selective for the ASIC1 subtype at neutral pH; under more acidic conditions (pH < 6.5), MitTx massively potentiates (>100-fold) proton-evoked activation of ASIC2a channels. These observations raise the possibility that ASIC channels function as coincidence detectors for extracellular protons and other, as yet unidentified, endogenous factors. Purified MitTx elicits robust pain-related behaviour in mice by activation of ASIC1 channels on capsaicin-sensitive nerve fibres. These findings reveal a mechanism whereby snake venoms produce pain, and highlight an unexpected contribution of ASIC1 channels to nociception. © 2011 Macmillan Publishers Limited. All rights reserved

Prairie rattlesnake envenomation in 27 New World camelids.

PubMed

Sonis, J M; Hackett, E S; Callan, R J; Holt, T N; Hackett, T B

2013-01-01

Morbidity and case fatality from rattlesnake envenomation is regionally specific because of variability in relative toxicity of the species of snake encountered. A previous report of rattlesnake envenomation in New World camelids (NWC) from the western coastal United States documented high case fatality rates and guarded prognosis for survival. To describe clinical findings, treatments, and outcome of NWC with prairie rattlesnake (Crotalus viridis viridis) envenomation in the Rocky Mountain region of the United States. Twenty-seven NWC admitted to the Colorado State University Veterinary Teaching Hospital for evaluation of acute rattlesnake envenomation between 1992 and 2012. Medical records of NWC evaluated for rattlesnake envenomation as coded by the attending clinician and identified by a database search were reviewed retrospectively. Month of admission, signalment, area of bite, clinical and clinicopathologic data, treatments, and outcome were recorded. Twenty-five llamas and 2 alpacas were admitted for envenomation. Llamas were overrepresented compared to hospital caseload. The face was the most common site of envenomation, observed in 96% of recorded cases. Presenting clinical signs included fever, tachypnea, tachycardia, and respiratory distress. Nine animals required a tracheotomy. Median hospitalization time was 3 days and overall survival rate was 69%. Case fatality rate for prairie rattlesnake envenomation in NWC was lower than that reported in the Western coastal region of the United States and similar to that reported for prairie rattlesnake envenomation in horses. Copyright © 2013 by the American College of Veterinary Internal Medicine.

California Sea Lion (Zalophus californianus) and Harbor Seal (Phoca vitulina richardii) Bites and Contact Abrasions in Open-Water Swimmers: A Series of 11 Cases.

PubMed

Nuckton, Thomas J; Simeone, Claire A; Phelps, Roger T

2015-12-01

To review cases of bites and contact abrasions in open-water swimmers from California sea lions (Zalophus californianus) and harbor seals (Phoca vitulina richardii). Open-water swimmers from a San Francisco swimming club were questioned about encounters with pinnipeds (seals and sea lions) that resulted in bites or contact abrasions. When possible, wounds were documented with photographs. Medical follow-up and treatment complications were also reviewed. From October 2011 to December 2014, 11 swimmers reported bites by a sea lion (n = 1), harbor seal (n = 7), or unidentified pinniped (n = 3). Ten of the encounters occurred in San Francisco Bay; 1 occurred in the Eld Inlet, in Puget Sound, near Olympia, WA. None of the swimmers were wearing wetsuits. All bites involved the lower extremities; skin was broken in 4 of 11 bites and antibiotics were prescribed in 3 cases. One swimmer, who was bitten by a harbor seal, also had claw scratches. A treatment failure occurred with amoxicillin/clavulanate in another swimmer who was bitten by an unidentified pinniped; the wound healed subsequently with doxycycline, suggesting an infection with Mycoplasma spp. There were no long-lasting consequences from any of the bites. The majority of cases occurred at low tide, and bumping of the swimmer by the animal before or after a bite was common, but no clear tide or attack pattern was identified. Bites and contact abrasions from sea lions and harbor seals are reported infrequently in open-water swimmers and typically involve the lower extremities. Because of the risk of Mycoplasma infection, treatment with a tetracycline is recommended in pinniped bites with signs of infection or serious trauma. Attempting to touch or pet sea lions or seals is inadvisable and prohibited by the Marine Mammal Protection Act. Swimmers should leave the water as soon as possible after a bite or encounter. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Human rabies: still a neglected preventable disease in Nigeria.

PubMed

Eke, C B; Omotowo, I B; Ukoha, O M; Ibe, B C

2015-01-01

Adequate surveillance and monitoring of dog bite incidents are veritable tools in the determination of the epidemiology of human rabies infections. There is a paucity of data with regards to rabies in Nigeria. Hence, this study was aimed at describing the pattern and outcomes of dog bites and rabies infections among patients presenting to University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. This was a 10-year (January 1, 2004 to December 31, 2013) observational retrospective study. Case definition of rabies was based on ICD 10 criteria, while relevant clinical data were retrieved from individual folders of registered victims using a semi-structured questionnaire. Data were analyzed using SPSS version 17.0 while the level of statistical significance was set at P < 0.05. A total of 149 cases of dog bites were reported during the period under review, of which 6 (4.0%) had confirmed rabies. Ninety-six (64.4%) cases presented more than 24 h after the bites. Majority of the offending dogs were stray dogs 86 (57.7%), which attacked their victims unprovoked, in 54.6% of cases. Furthermore, most of the bites were from dogs with unknown history of rabies vaccination 72 (52.3%), while the case fatality rate was 100%. All the cases of rabies reported were as a result of bites from stray dogs with unknown history of rabies vaccinations, and the outcome was 100% fatality in all cases. Efforts should be made to create and strengthen awareness campaigns on control of rabies infections through responsible dog ownership including their regular vaccinations as well as provision and use of prompt postexposure prophylaxis in human cases of dog bites at all levels of health care.

[Successful treatment of a necrotizing, multi-resistant bacterial pyoderma in a python with cold plasma therapy].

PubMed

Klinger, Christoph; Dengler, Berrett; Bauer, Thomas; Mueller, Ralf S

2018-02-01

A 4-year-old ball python was presented 3 weeks after multiple bite wounds from a prey rat with large skin lesions, a concurrent deep bacterial pyoderma and clinical signs for septicemia, including neurolo -gical symptoms. Affected tissue separated from the underlying muscular layer revealing parts of the muscles. Clinical examination and cyto -logy was consistent with bacterial pyoderma; septicemia was an additional tentative clinical diagnosis. Empirical lincomycin and marbo -floxacin (bacterial culture revealed a multi-resistant Stenotrophomonas maltophilia susceptible to fluoroquinolones) treatment improved the patient's general condition but skin wounds deteriorated to multifocal eschars with intracellular rods. Further diagnostics were limited for financial reasons, euthanasia was considered. Cold atmospheric pressure plasma (CAPP) therapy was performed six times in 4 weeks. Within 1 week, inflammatory symptoms resolved. Re-epithelialization was completed few weeks later. In the following year, the snake sloughed three times without any signs of dysecdysis. CAPP therapy may offer a viable treatment option for bacterial (especially multiresistant) pyoderma and necrotizing dermatitis in snakes. Schattauer GmbH.

Morphological and functional alteration of erythrocyte ghosts and giant unilamellar vesicles caused by Vipera latifi venom.

PubMed

Kirakosyan, Gayane; Mohamadvarzi, Maryam; Ghulikyan, Lusine; Zaqaryan, Naira; Kishmiryan, Arsen; Ayvazyan, Naira

2016-12-01

Snake bites are an endemic public health problem in Iran, both in rural and urban area. Viper venom as a hemolytic biochemical "cocktail" of toxins, primarily cause to the systemic alteration of blood cells. In the sixties and seventies, human erythrocytes were extensively studied, but the mechanical and chemical stresses commonly exerted on red blood cells continue to attract interest of scientists for the study of membrane structure and function. Here, we monitor the effect of Vipera latifi venom on human erythrocytes ghost membranes using phase contrast and fluorescent microscopy and changes in ATPase activity under snake venom influence in vitro. The ion pumps [Na + ,K + ]-ATPase and (Ca 2+ +Mg 2+ )-ATPase plays a pivotal role in the active transport of certain cations and maintenance of intracellular electrolyte homeostasis. We also describe the interaction of Vipera latifi (VL) venom with giant unilamellar vesicles (GUVs) composed of the native phospholipid mixtures visualized by the membrane fluorescence probe, ANS, used to assess the state of membrane and specifically mark the phospholipid domains. Copyright © 2016 Elsevier Inc. All rights reserved.

Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation.

PubMed

O'Brien, Nicole F; DeMott, Megan C; Suchard, Jeffrey R; Clark, Richard F; Peterson, Bradley M

2009-07-01

Report of delayed significant coagulopathy, thrombocytopenia, and bleeding after Crotaline envenomation. Recurrent coagulopathy and thrombocytopenia have been described after treatment of Crotaline envenomation with Crotalidae polyvalent immune Fab (CroFab). Until now, there have been no reports of significant spontaneous bleeding despite these abnormalities. Crotalidae polyvalent immune Fab has a relatively short half-life compared with previous antivenoms used to treat snake bite. This shorter half-life allows for recurrence of venom effects. Therefore, patients with Crotaline envenomation should undergo close monitoring for recurrence of coagulopathy or thrombocytopenia after treatment with CroFab. If coagulopathy or thrombocytopenia recurs, retreatment with CroFab should be considered to prevent significant bleeding.

The socio-economic burden of snakebite in Sri Lanka.

PubMed

Kasturiratne, Anuradhani; Pathmeswaran, Arunasalam; Wickremasinghe, A Rajitha; Jayamanne, Shaluka F; Dawson, Andrew; Isbister, Geoff K; de Silva, Hithanadura Janaka; Lalloo, David G

2017-07-01

Snakebite is a major problem affecting the rural poor in many of the poorest countries in the tropics. However, the scale of the socio-economic burden has rarely been studied. We undertook a comprehensive assessment of the burden in Sri Lanka. Data from a representative nation-wide community based household survey were used to estimate the number of bites and deaths nationally, and household and out of pocket costs were derived from household questionnaires. Health system costs were obtained from hospital cost accounting systems and estimates of antivenom usage. DALYs lost to snakebite were estimated using standard approaches using disability weights for poisoning. 79% of victims suffered economic loss following a snakebite with a median out of pocket expenditure of $11.82 (IQR 2-28.57) and a median estimated loss of income of $28.57 and $33.21 for those in employment or self-employment, respectively. Family members also lost income to help care for patients. Estimated health system costs for Sri Lanka were $ 10,260,652 annually. The annual estimated total number of DALYS was 11,101 to 15,076 per year for envenoming following snakebite. Snakebite places a considerable economic burden on the households of victims in Sri Lanka, despite a health system which is accessible and free at the point of care. The disability burden is also considerable, similar to that of meningitis or dengue, although the relatively low case fatality rate and limited physical sequelae following bites by Sri Lankan snakes means that this burden may be less than in countries on the African continent.

'Tool' use by the red-tailed hawk (Buteo jamaicensis)

USGS Publications Warehouse

Ellis, David H.; Brunson, Shawn

1993-01-01

Perhaps the best documented example of regular tool use for a falconiform is the Egyptian Vulture (Neophron percnopterus) striking an Ostrich (Struthio camelus) egg with a stone (J. van Lawick-Goodall and H. van Lawick-Goodall 1966, Nature 212:1468-1469; R.K. Brooke 1979, Ostrich 50:257-258). Another species, the Lammergeier (Gypaetus barbatus), routinely drops bones on stone slabs to gain access to the marrow within (L. Brown and D Amadon 1968, Eagles, hawks and falcons of the world, McGraw-Hill, New York, NY U.S.A.). Some, however, would argue that, because the stone is not manipulated, the bone-dropping Lammergeier is not actually using a tool. Another reported example of tool use is the Ferruginous Hawk (Buteo regalis) that allegedly cast a stone at a human intruder near its nest (C.L. Blair 1981, Raptor Research 15:120).]The following may be yet another example of tool use by a raptor. On 5 June 1985, we observed an adult Red-tailed Hawk (Buteo jamaicensis) soaring low (ca 15 m) over the grass-covered slopes of the Galiuro Mountains in southern Arizona. The bird had, probably just moments before, captured a ca I m snake (probably a glossy snake, Arizona elegans, judging by size, shape and color). When the hawk passed near us, it was holding the snake by both feet near the snake's midpoint. With head elevated and mouth open, the snake appeared intent upon biting the hawk. When the hawk was ca 100 m distant from us, it made several shallow stoops over a scattered group of large boulders. On some (and perhaps all) passes, the bird swept sharply upward as it passed over and nearly collided with a boulder. The centrifugal force associated with this change in direction caused the snake to pendulate below the hawk's talons and strike the boulder. During one pass, we observed the snake's head and tail flipping up behind the hawk after slapping the boulder. Not all swoops were over the same boulder, but one particularly obtrusive (ca 1 m tall) boulder was used at least twice. On the last two swoops, the snake hung limp and apparently lifeless from the hawk's talons After the last swoop, the hawk dropped out of sight into tall grass ca 200 m from our position and presumably ate the snake because we could observe no prey in the hawk's talons when it soared up 13 rain later.If the anvil (not held in the hand) is a tool as well as the hammer (held in the hand), then the Red-tailed Hawk may be added to the short list of raptors that have been known to use tools

[Identification of a murderer on the basis of a biting pattern on body of the victim].

PubMed

Zaba, Czesław; Lorkiewicz-Muszyńska, Dorota; Glapiński, Mariusz; Smoluch, Krzysztof; Swiderski, Paweł

2010-01-01

The authors present a case of identification of a a murderer on the basis of his dentition pattern, reflected by a biting wound on the breast of the victim. The case is exceptional not only from the viewpoint of the authors, but also in view of very sporadic reports on this subject in forensic literature. Cases of biting by humans are not frequent in the forensic/ medical practice, and instances of identification of the perpetrator by his dental pattern reflected in the biting wound are very rare. In Poland, such problems have been the domain of mainly criminologists and only occasionally of forensic medics in collaboration with dentists and anthropologists. Due to the very low number of such cases in Poland, no experts in the matter are available. For this reason, we deemed it purposeful to present respective investigative principles and techniques for identification of a human perpetrator on the basis of the dental pattern reflected in a biting wound on the victim's body.

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis.

PubMed

Rossetto, André Luiz; Corrêa, Patricia Rossetto; Cruz, Rosana Cé Bella; Pereira, Eduardo Figueiredo; Haddad Filho, Vidal

2014-01-01

We report a case of Tinea nigra in an adolescent living in Itapema, Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the left hand, close to another erythematous macule caused by a rabbit bite. The patient received guidance on accidents and animal bites and evolved well treated with topical butenafine for the dermatomycosis. The authors also highlight the efficacy of the dermoscopic exam in diagnosing Tinea nigra with animal bite lesions and other traumas.

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis*

PubMed Central

Rossetto, André Luiz; Corrêa, Patricia Rossetto; Cruz, Rosana Cé Bella; Pereira, Eduardo Figueiredo; Haddad Junior, Vidal

2014-01-01

We report a case of Tinea nigra in an adolescent living in Itapema, Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the left hand, close to another erythematous macule caused by a rabbit bite. The patient received guidance on accidents and animal bites and evolved well treated with topical butenafine for the dermatomycosis. The authors also highlight the efficacy of the dermoscopic exam in diagnosing Tinea nigra with animal bite lesions and other traumas. PMID:24626667

Inclusion body disease in snakes: a review and description of three cases in boa constrictors in Belgium.

PubMed

Vancraeynest, D; Pasmans, F; Martel, A; Chiers, K; Meulemans, G; Mast, J; Zwart, P; Ducatelle, R

2006-06-03

Inclusion body disease, a fatal disorder in Boidae, is reviewed, and three cases in boa constrictors, the first reported cases in Belgium, are described. The snakes showed nervous signs, and numerous eosinophilic intracytoplasmic inclusions, which are considered to be characteristic of the disease, were found in the liver and pancreas. The disease is suspected to be caused by a retrovirus, but transmission electron microscopic examinations of several tissues from one of the snakes did not reveal particles with a typical retroviral morphology.

Early correction of unilateral scissor bite using transforce appliance and modified twin block appliance

PubMed Central

Chandorikar, Harshal; Nagrik, Arun; Bhad, Wasundhara A; Chavan, Santosh J; Doshi, Umal H

2017-01-01

Early treatment of scissor bite has been advocated mainly to prevent function jaw shift that can eventually lead to permanent skeletal asymmetry and temporomandibular joint pathosis. Although unilateral scissor bite is more common, most of the times, bilateral mandibular expansion is indicated. Lingual transforce appliance can be useful in such cases. This article presents a patient with unilateral scissor bite in mixed dentition with alveolar narrowing. Transforce appliance was used for scissor bite correction followed by modified twin block appliance for stabilization and settling of occlusion till the eruption of premolars. The case was finished with fixed mechanotherapy. Two years after completion of treatment, results were well maintained. Our results suggest that lingual transforce appliance along with careful management of occlusion is effective in the early management of severe unilateral scissor bite. PMID:28546961

[Facial dog bite injuries in children: retrospective study of 77 cases].

PubMed

Hersant, B; Cassier, S; Constantinescu, G; Gavelle, P; Vazquez, M-P; Picard, A; Kadlub, N

2012-06-01

The face is the area most vulnerable for dog bites in children. Surgical management is an emergency to prevent infection, functional and aesthetic outcomes. The aim of this study was to define a new gravity scale, and to determine a prevention policy. In our maxillofacial and plastic surgery department, we conducted a retrospective study from 2002 to 2010, including 77 children under 16 years old, victims of facial dog bite. We analyzed epidemiological, clinical data, surgical outcomes. The mean age was 5.36 years. Dogs were principally represented by class I and II dogs; 27,7% of them had ever bitten before. In almost all the cases, the dogs belong to the family or closers. Twenty-one percent of children belong to an unfavourable social environment; 71.43% of dog bites interested the central area of the face. The bites were deep in 77% of cases with amputation or extensive loss of substance in 31% of cases. The healing time was 10.54 months. Nearly a third of patients required several surgeries; 41.56% of patients had aesthetic and functional sequelae; 35.1% of children had psychological problems afterward. Facial children dog bites require a multidisciplinary approach, and a long-term follow-up. We propose a new classification of dog bite severity, more appropriate to the face. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Vellozia flavicans Mart. ex Schult. hydroalcoholic extract inhibits the neuromuscular blockade induced by Bothrops jararacussu venom

PubMed Central

2014-01-01

Background Snakebite is a significant public health issue in tropical countries. In Brazil, some of the most common snake envenomations are from Bothrops. Bothrops bites trigger local and systemic effects including edema, pain, erythema, cyanosis, infections, and necrosis. Vellozia flavicans is a plant from the Brazilian “cerrado” (savanna) that is popularly used as an anti-inflammatory medicine. Since inflammation develops quickly after Bothrops bites, which can lead to infection, the aim of the present study was to observe possible anti-snake venom and antimicrobial activities of V. flavicans (Vf). Methods The chromatographic profile of the main constituents from the Vf leaf hydroalcoholic extract was obtained by thin-layer chromatography (TLC). The anti-snake venom activity was measured by Vf’s ability to neutralize the in vitro neuromuscular blockade caused by Bothrops jararacussu venom (Bjssu) in a mouse phrenic nerve-diaphragm model (PND). After a 20 min incubation, preparations of PND were added to Tyrode’s solution (control); Vf (0.2, 0.5, 1, and 2 mg/mL); 40 μg/mL Bjssu; pre-incubation for 30 min with Bjssu and 1 mg/mL Vf; and a Bjssu pretreated preparation (for 10 min) followed by 1 mg/mL Vf. Myographic recording was performed, and the contractile responses were recorded. The antimicrobial activity (minimum inhibitory concentration [MIC] and minimum bactericidal concentration [MBC]) was obtained for Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis, using gentamicin and vancomycin as positive controls. Results TLC analysis yielded several compounds from Vf, such as flavonoids (quercetin) and phenolic acids (chlorogenic acid). Bjssu completely blocked the contractile responses of PND preparations, while Vf preserved 97% (±10%) of the contractile responses when incubated with Bjssu. In the PND pretreated with Bjssu, Vf was able to inhibit the neuromuscular blockade progress. MIC and MBC of Vf ranged from 2.5 to 5.0 mg/mL for P. aeruginosa and S. aureus strains, while no antimicrobial activity was observed for E. coli and E. faecalis. Conclusions The hydroalcoholic extract from Vf leaves was able to neutralize and decrease the in vitro neuromuscular blockade caused by Bjssu. However, it did not show significant antimicrobial activity against the tested bacteria. PMID:24507387

Quality Control Testing for Tracking Endotoxin-Producing Gram-Negative Bacteria during the Preparation of Polyvalent Snake Antivenom Immunoglobulin.

PubMed

Sheraba, Norhan S; Diab, Mohamed R; Yassin, Aymen S; Amin, Magdy A; Zedan, Hamdallah H

2015-01-01

Snake bites represent a serious public health problem, particularly in rural areas worldwide. Antitoxic sera preparations are antibodies from immunized animals and are considered to be the only treatment option. The purification of antivenom antibodies should aim at obtaining products of consistent quality, safety, efficacy, and adherence to good manufacturing practice principles. Endotoxins are an integral component of the outer cell surface of Gram-negative bacteria. They are common contaminates of the raw materials and processing equipment used in the manufacturing of antivenoms. In this work, and as a part of quality control testing, we establish and examine an environmental monitoring program for identification of potential sources of endotoxin-producing Gram-negative bacteria throughout the whole steps of antivenom preparation. In addition, we follow all the steps of preparation starting from crude plasma till finished product using a validated sterility and endotoxin testing.Samples from air, surface, and personnel were collected and examined through various stages of manufacturing for the potential presence of Gram-negative bacteria. A validated sterility and endotoxin test was carried out in parallel at the different production steps. The results showed that air contributed to the majority of bacterial isolates detected (48.43%), followed by surfaces (37.5%) and then personnel (14%). The most common bacterial isolates detected were Achromobacter xylosoxidans, Ochrobactrum anthropi, and Pseudomonas aeruginosa, which together with Burkholderia cepacia were both also detected in cleaning water and certain equipment parts. A heavy bacterial growth with no fungal contamination was observed in all stages of antivenom manufacturing excluding the formulation stage. All samples were positive for endotoxin including the finished product.Implementation and continued evaluation of quality assurance and quality improvement programs in aseptic preparation is essential in ensuring the safety and quality of these products. Antitoxic sera preparations are the only treatment option for snake bites worldwide. They are prepared by immunizing animals, usually horses, with snake venom and collecting horse plasma, which is then subjected to several purification steps in order to finally prepare the purified immunoglobulins. Components of the bacterial cell wall known as endotoxins can constitute a potential hazardous contamination known as pyrogen in antisera, which can lead to fever and many other adverse reactions to the person subjected to it.In this work, we monitored the environment associated with the different steps of production and purification of snake antivenom prepared from immunized horses. We examined the air quality, surface, and personnel for possible sources of contamination, particularly the presence of Gram-negative bacteria, which is the major source of endotoxin presence. We also monitored all stages of preparation by sterility and endotoxin testing. Our results showed that air contributed to the majority of bacterial isolates. Sterility testing revealed the presence of bacterial contamination in all the intermediate steps, as only the final preparation after filtration was sterile. Endotoxin was present in all tested samples and the final product. Good manufacturing practice procedures are essential in any facility involved in antisera production. © PDA, Inc. 2015.

First recorded case of paramyxovirus infection introduced into a healthy snake collection in Croatia.

PubMed

Prpic, Jelena; Keros, Tomislav; Balija, Maja Lang; Forcic, Dubravko; Jemersic, Lorena

2017-04-08

In the present study, we describe the first paramyxovirus infection in a snake collection in Croatia caused by an introduction of new snakes that were not previously tested and didn't show any signs of disease. In less than a month after introduction into a healthy colony, new snakes began to show respiratory symptoms (i.e. mouth opening, wheezing, etc.) and died within a month and a half after antibiotic therapy was applied. The same symptoms and a high mortality rate were then observed in in-contact snakes from other collections belonging to different snake families. Two entries of new snakes in different time periods were recorded and recognized as possible sources of infection. We stress the need for veterinary health control and monitoring of snakes prior to transportation as well as implementing obligatory quarantine measures to minimize the risk of infection among newly established snake groups.

Sensitivity to bites by the bedbug, Cimex lectularius.

PubMed

Reinhardt, K; Kempke, D; Naylor, R A; Siva-Jothy, M T

2009-06-01

Bedbugs are a public health problem and can cause significant economic losses, but little is known about the effects of bites on humans. We reviewed case reports and published papers on bedbug bites to assess the empirical basis of the commonly cited figure that only approximately 80% of the population are sensitive to bedbug bites. We found the sensitivity estimate to be based on only one study carried out 80 years ago. However, this study did not account for the now well-established fact that only repeated exposure to external allergens leads to skin reactions. In our sample, 18 of 19 persons showed a skin reaction after bedbug exposure, but in most cases only after repeated controlled exposure. With repeated exposure, the latency between bite and skin reactions decreased from approximately 10 days to a few seconds. Our results are relevant for the hospitality industry, where apparently increasing infestation rates are likely to lead to an increase in the number of tourists and hotel employees exposed to bedbugs. Medical and public health professionals may expect to see an increase in the prevalence of people with bedbug bite sensitivity. The significance of the delayed reaction time of skin to bites may also have implications in litigation cases where people seek compensation.

Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department.

PubMed

Birdsey, Matthew; Edwards, Gail; Abetz, Jeremy; Jennings, Natasha; Mitra, Biswadev

2016-07-01

Emergency department presentations after mammalian bites may be associated with injection of bacteria into broken skin and may require prophylactic antibiotics to prevent subsequent infection. We aim to describe the epidemiology of patients presenting with a mammalian bite injury and antibiotic choice to an Australian adult tertiary centre. A retrospective cohort study was performed capturing all presentations after mammalian bite wounds between 01 Jan 2014 and 31 Dec 2014. An explicit chart review was conducted to determine management of each case. Cases were subgrouped into high- and low-risk groups as defined by the Australian Therapeutic Guidelines for animal bites. There were 160 cases of mammalian bite wounds included, with 143 (89.4%) patients grouped as high-risk and 17 (10.6%) patients identified as low-risk. High-risk features were delayed presentation > 8 hours (57 patients, 35.6%), bites to the head, hand or face (113 patients, 70.6%), and puncture wounds unable to be adequately debrided (74 patients, 46.3%). There was a significant association with delayed presentation of more than eight hours and clinically established infection [OR 36.2; 95% CI: 12.6-103.6; P < 0.001]. Prescriptions for antibiotics that adhered to current guidelines occurred in 99 (61.9%) cases. This study highlights variability in antibiotic prescription practice among clinicians and the need for ongoing education on antibiotic stewardship. Intervention strategies, including ongoing education, are indicated to improve adherence to antibiotic guidelines. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cutaneous and Subcutaneous Soft Tissue Tumours in Snakes: A Retrospective Study of 33 Cases.

PubMed

Dietz, J; Heckers, K O; Aupperle, H; Pees, M

2016-07-01

Cutaneous and subcutaneous soft tissue tumours have been rarely described in detail in snakes. Several malignant entities show strikingly similar histological patterns and therefore the term soft tissue sarcoma (STS) has become a standard histopathological diagnosis. The present study characterizes soft tissue tumours in 33 snakes. Samples included 29 surgically excised masses and four carcasses. Additionally, six animals were humanely destroyed and submitted for necropsy examination following tumour recurrence. Benign neoplasms (n = 8) were described as lipomas of varying differentiation. Recurrence was observed in two of five snakes in which the clinical course was recorded. Malignant neoplasms (n = 25) were diagnosed as STS and graded according to a three-point system previously applied to canine STS. Five (20%) of the primary tumours were classified as grade 1, eleven (44%) as grade 2 and nine (36%) as grade 3 sarcomas. Clinically, recurrence of STS was observed in 11 of 17 cases with available follow-up information. Pathologically, multiple cutaneous metastases were found in one grass snake (Natrix natrix), while visceral metastases were observed in one carpet python (Morelia spilota) and two corn snakes (Pantherophis guttatus). Metastatic risk appears to increase with histological grade. Surgical excision generally represents the current therapy of choice for STS. This study includes the first reports of conventional lipomas in a ribbon snake (Thamnophis radix), angiolipomas in a black-headed python (Aspidites melanocephalus) and a corn snake as well as of STS in a Jamaican boa (Epicrates subflavus), emerald tree boa (Corallus caninus), grass snake (N. natrix), African house snake (Lamprophis fuliginosus), California kingsnake (Lampropeltis getula californiae) and common garter snake (Thamnophis sirtalis). Copyright © 2016 Elsevier Ltd. All rights reserved.

Indigenous knowledge of medicinal plants used by Saperas community of Khetawas, Jhajjar District, Haryana, India

PubMed Central

2010-01-01

Background Plants have traditionally been used as a source of medicine in India by indigenous people of different ethnic groups inhabiting various terrains for the control of various ailments afflicting human and their domestic animals. The indigenous community of snake charmers belongs to the 'Nath' community in India have played important role of healers in treating snake bite victims. Snake charmers also sell herbal remedies for common ailments. In the present paper an attempt has been made to document on ethno botanical survey and traditional medicines used by snake charmers of village Khetawas located in district Jhajjar of Haryana, India as the little work has been made in the past to document the knowledge from this community. Methods Ethno botanical data and traditional uses of plants information was obtained by semi structured oral interviews from experienced rural folk, traditional herbal medicine practitioners of the 'Nath' community. A total of 42 selected inhabitants were interviewed, 41 were male and only one woman. The age of the healers was between 25 years and 75 years. The plant specimens were identified according to different references concerning the medicinal plants of Haryana and adjoining areas and further confirmation from Forest Research Institute, Dehradun. Results The present study revealed that the people of the snake charmer community used 57 medicinal plants species that belonged to 51 genera and 35 families for the treatment of various diseases. The study has brought to light that the main diseases treated by this community was snakebite in which 19 different types of medicinal plants belongs to 13 families were used. Significantly higher number of medicinal plants was claimed by men as compared to women. The highest numbers of medicinal plants for traditional uses utilized by this community were belonging to family Fabaceae. Conclusion This community carries a vast knowledge of medicinal plants but as snake charming is banned in India as part of efforts to protect India's steadily depleting wildlife, this knowledge is also rapidly disappearing in this community. Such type of ethno botanical studies will help in systematic documentation of ethno botanical knowledge and availing to the scientific world plant therapies used as antivenin by the Saperas community. PMID:20109179

Cheek-biting disorder: another stereotypic movement disorder?

PubMed

Sarkhel, Sujit; Praharaj, Samir Kumar; Akhtar, Sayeed

2011-12-01

Recurrent cheek biting, a form of self-injurious behavior is a rare entity which presents mostly to dentists and dermatologists. We report a case of recurrent severe cheek biting in an adult male leading to mucosal ulceration. The stereotypic pattern of cheek biting and associated behavior bears striking resemblance to other impulse control disorders. Copyright © 2011 Elsevier Ltd. All rights reserved.

Rat-bites of an epidemic proportion in Peshawar vale; a GIS based approach in risk assessment.

PubMed

Fatima, Syeda Hira; Zaidi, Farrah; Adnan, Muhammad; Ali, Asad; Jamal, Qaiser; Khisroon, Muhammad

2018-03-19

Contemporary studies demonstrate that rodent bites do not occur frequently. However, a huge number of cases were reported from Peshawar vale, Pakistan during 2016. Two species, the local black rat Rattus rattus (Linnaeus, 1758) and the invasive brown rat Rattus norvegicus (Berkenhout, 1769) might be the suspected cause. Several studies indicated the invasion of brown rats into Pakistan presumably via port city of Karachi. In this study, we modeled geospatial distribution of rodent bites for risk assessment in the region. Bite cases reported to tertiary care lady reading hospital were monitored from January 1 to August 31, 2016. Among 1747 cases, statistically informative data (n = 1295) was used for analyses. MaxEnt algorithm was employed for geospatial modeling, taking into account various environmental variables (temperature, precipitation, humidity, and elevation) and anthropogenic factors (human population density, distance from roads, distance from water channels, and land use/land cover). MaxEnt results revealed that urban slums (84.5%) are at highest risk followed by croplands (10.9%) and shrublands (2.7%). Anthropogenic factors affecting incidence of rodent bites included host density (contribution: 34.7), distance from water channels (3.2), land use/land cover (2.8), and distance from roads (2). Most of the cases occurred within a radius of 0.3 km from roads and 5 km from water channels. Rodent bite incidence is currently at its peak in Peshawar vale. Factors significantly affecting rodents' bite activity and their distribution and dispersal include urbanization, distance from roads, and water channels. Further studies are needed to determine the impact of invasion by brown rat on bite incidence.

Environmental health concerns of the Persian Gulf War.

PubMed Central

Young, R. C.; Rachal, R. E.; Huguley, J. W.

1992-01-01

Environmental health concerns in the Persian Gulf are peculiar to the geography of the region. Prevention of heat and solar injury deserves primary consideration, but cold injury also may occur in the desert. Immunizations are recommended against a number of diseases, while malarial chemoprophylaxis is necessary in Iraq and Kuwait. In addition to malaria, other parasitic diseases deserve consideration. Diarrheal diseases, diseases from the desert dust, and products of infected desert animals are of concern. Additional natural hazards are venomous bites from scorpions and desert snakes. Finally, threats of enemy action necessitated protection from nuclear biological and chemical weapons and LASER eye/skin injury. Unexploded ordinance will constitute a continuing hazard into the future. Images Figure 2 PMID:1495114

The Ecology and Environmental Impact of Marshland and Estuaries

DTIC Science & Technology

1992-12-15

species of water snakes, blue runners , ribbon snakes, black snakes, and bull snakes, as well as water moccassins, rattlesnakes, copperheads, and coral...be encountered there that should receive special consideration is the swallow-tailed kite . Kites in general seem to be seriously declining in parts of...the southern U.S., and a couple have a tenuous hold on their environment or, in the case of the swallow-tailed kite , have an undetermined status

Diagnosis of Queensland tick typhus and African tick bite fever by PCR of lesion swabs.

PubMed

Wang, Jin Mei; Hudson, Bernard J; Watts, Matthew R; Karagiannis, Tom; Fisher, Noel J; Anderson, Catherine; Roffey, Paul

2009-06-01

We report 3 cases of Queensland tick typhus (QTT) and 1 case of African tick bite fever in which the causative rickettsiae were detected by PCR of eschar and skin lesions in all cases. An oral mucosal lesion in 1 QTT case was also positive.

Tick bite and Lyme disease-related emergency department encounters in New Hampshire, 2010-2014.

PubMed

Daly, E R; Fredette, C; Mathewson, A A; Dufault, K; Swenson, D J; Chan, B P

2017-12-01

Lyme disease (LD) is a common tick-borne disease in New Hampshire (NH). While LD is a reportable condition and cases are counted for public health surveillance, many more people receive care for tick bites or diagnoses of LD than are reflected in surveillance data. NH's emergency department (ED) data system was queried for tick bite and LD-related encounters. Chief complaint text was queried for words related to LD or tick bites. International Classification of Diseases 9th Revision (ICD-9) codes were queried for the LD diagnosis code (088.81). Emergency department patient data were matched to reportable disease data to determine the proportion of ED patients reported to the health department as a suspected LD case. Data were analysed to calculate frequencies for key demographic and reporting characteristics. From 2010 to 2014, 13,615 tick bite or LD-related ED encounters were identified in NH, with most due to tick bites (76%). Of 3,256 patients with a LD-related ED encounter, 738 (23%) were reported to the health department as a suspected LD case. The geographic distribution of ED patients was similar to reported LD cases; however, the regions of the state that experienced higher rates of ED encounters were different than the regions that observed higher rates of reported LD cases. Seasonal distribution of ED encounters peaked earlier than reported LD cases with a second peak in the fall. While age and sex distribution was similar among ED patients and reported LD cases, the rates for children 5 years and younger and adults 65 years and older were greater for ED encounters. Patients frequently visit the ED to seek care for tick bites and suspected LD. Results of ED data analyses can be used to target education, in particular for ED providers and the public through timely distribution of evidence-based educational materials and training programmes. © 2017 Blackwell Verlag GmbH.

Coral snakes predict the evolution of mimicry across New World snakes.

PubMed

Davis Rabosky, Alison R; Cox, Christian L; Rabosky, Daniel L; Title, Pascal O; Holmes, Iris A; Feldman, Anat; McGuire, Jimmy A

2016-05-05

Batesian mimicry, in which harmless species (mimics) deter predators by deceitfully imitating the warning signals of noxious species (models), generates striking cases of phenotypic convergence that are classic examples of evolution by natural selection. However, mimicry of venomous coral snakes has remained controversial because of unresolved conflict between the predictions of mimicry theory and empirical patterns in the distribution and abundance of snakes. Here we integrate distributional, phenotypic and phylogenetic data across all New World snake species to demonstrate that shifts to mimetic coloration in nonvenomous snakes are highly correlated with coral snakes in both space and time, providing overwhelming support for Batesian mimicry. We also find that bidirectional transitions between mimetic and cryptic coloration are unexpectedly frequent over both long- and short-time scales, challenging traditional views of mimicry as a stable evolutionary 'end point' and suggesting that insect and snake mimicry may have different evolutionary dynamics.

Coral snakes predict the evolution of mimicry across New World snakes

PubMed Central

Davis Rabosky, Alison R.; Cox, Christian L.; Rabosky, Daniel L.; Title, Pascal O.; Holmes, Iris A.; Feldman, Anat; McGuire, Jimmy A.

2016-01-01

Batesian mimicry, in which harmless species (mimics) deter predators by deceitfully imitating the warning signals of noxious species (models), generates striking cases of phenotypic convergence that are classic examples of evolution by natural selection. However, mimicry of venomous coral snakes has remained controversial because of unresolved conflict between the predictions of mimicry theory and empirical patterns in the distribution and abundance of snakes. Here we integrate distributional, phenotypic and phylogenetic data across all New World snake species to demonstrate that shifts to mimetic coloration in nonvenomous snakes are highly correlated with coral snakes in both space and time, providing overwhelming support for Batesian mimicry. We also find that bidirectional transitions between mimetic and cryptic coloration are unexpectedly frequent over both long- and short-time scales, challenging traditional views of mimicry as a stable evolutionary ‘end point' and suggesting that insect and snake mimicry may have different evolutionary dynamics. PMID:27146100

Streptobacillus moniliformis Bacteremia in a Pet Shop Employee: Case Report and Literature Review.

PubMed

Suzuki, Kiyozumi; Hirai, Yuji; Morita, Fujiko; Nakamura, Ayako; Uehara, Yuki; Naito, Toshio

2017-01-01

A 39-year-old pet shop employee who sustained a bite from one of his store's rats developed fever and arthritis. Streptobacillus moniliformis was cultured from the patient's blood, confirming a diagnosis of rat-bite fever. Treatment with standard antibiotics was successful. Although rat-bite fever is commonly considered a zoonosis transmitted by wild or laboratory rats, our case emphasizes that it may be transmitted by pet animals as well.

Walterinnesia aegyptia venom combined with silica nanoparticles enhances the functioning of normal lymphocytes through PI3K/AKT, NFκB and ERK signaling.

PubMed

Badr, Gamal; Al-Sadoon, Mohamed K; El-Toni, Ahmed M; Daghestani, Maha

2012-02-15

The toxicity of snake venom varies over time in some species. The venom of newborn and small juvenile snakes appears to be more potent than adults of the same species, and a bite from a snake that has not fed recently, such as one that has just emerged from hibernation, is more dangerous than one that has recently fed due to the larger volume of venom injected. Therefore, the potency of a snake's venom is typically determined using the LD50 or IC50 tests. In the present study, we evaluated the anti-tumor potential of snake venom from Walterinnesia aegyptia (WEV) on the human breast carcinoma cell line MDA-MB-231, as well as its effect on the normal mice peripheral blood mononuclear cells (PBMCs). This venom was used alone (WEV) or in combination with silica nanoparticles (WEV+NP). The IC50 values of WEV alone and WEV+NP in the MDA-MB-231 cells were determined to be 50 ng/ml and 20 ng/ml, respectively. Interestingly, at these concentrations, the venom did not affect the viability of normal human PBMCs. To investigate the in vivo effects of this venom further, three groups of mice were used (15 mice in each group): Group I was the control, Group II was subcutaneously injected with WEV, and Group III was injected with WEV+NP. Using flow cytometry and western blot analysis, we found that the blood lymphocytes of WEV-injected mice exhibited a significant increase in actin polymerization and cytoskeletal rearrangement in response to CXCL12 through the activation of AKT, NF-κB and ERK. These lymphocytes also showed a significant increase in their proliferative capacity in response to mitogen stimulation compared with those isolated from the control mice (P < 0.05). More importantly, in the WEV+NP-treated mice, the biological functions of normal lymphocytes were significantly (P < 0.05) enhanced in comparison with those of WEV-treated mice. Our data reveal the unique biological effects of WEV, and we demonstrated that its combination with nanoparticles strongly enhanced these biological effects.

Clinico-epidemiology of arthropod stings and bites in primary hospitals of North Western province of Sri Lanka.

PubMed

Kularatne, Senanayake A M; Shahmy, Seyed; Rathnayake, Shantha S; Dawson, Andrew H

2018-03-06

Arthropod stinging and bites are common environmental hazards in Sri Lanka. However, their medical importance has not been fully evaluated yet. This study aims to study the burden, epidemiology, and outcome of stings and bites in primary hospitals in the Kurunegala district in North Western Province (NWP) of Sri Lanka. The study was conducted one year from 25th May 2013 to 25th May 2014. Details of all stings and bites admissions and their outcomes were retrospectively extracted from hospital records in all 44 primary hospitals in the district. There were 623 stings and bites with population incidence of 38/100,000 (95% CI 27-52). There were no deaths. Median age was 38 years (IQR: 19-53 years), and 351 (56%) were males. Most of stings and bites (75%) occurred in the daytime. Median time to hospital arrival was 55 minutes (IQR: 30 min to 2 h). The offending arthropods had been identified in 557 (89%) cases, of them, 357 (57%) were Hymenoptera (hornet and bees), 99 centipedes, 61 spiders and 40 scorpions. Local pain occurred in 346 (56%) cases - centipede 69 (70%), Scorpion 24 (60%), spider 36 (59%), Hymenoptera 187 (52%) and unidentified 30 (45%). Hymenoptera stings and spider bites occurred between 06 am to 12 noon, and scorpion stings and centipede bites mostly occurred between 06 pm to 12 midnight. Mild, moderate to severe anaphylaxis reactions occurred in 173 (28%) patients including 110 Hymenoptera stings - mild 39, moderate 62 and severe 9. From primary hospitals, 53(9%) cases had been transferred to tertiary care units for further management. Of them, 41 cases were Hymenoptera stings and 24 (58%) of them had mild, moderate to severe anaphylaxis. In the entire group, 27% severe cases received adrenaline. The primary hospitals in NW province of Sri Lanka manage large numbers of arthropod stings and bites. These include Hymenoptera (hornet and bee), centipedes, spiders, and scorpions. Pain, swellings and anaphylactic reactions were the most common adverse effects.

[Management of dog bite trauma of the external genital organs].

PubMed

Dubosq, Francis; Traxer, Olivier; Boublil, Véronique; Gattegno, Bernard; Thibault, Philippe

2004-04-01

Animal bites to the scrotum are rare, but potentially serious. In the light of a personal case, the authors discuss the management of these lesions. An animal bite comprises a triple infectious risk: bacterial, tetanus and rabies. Surgical exploration is indicated for assessment of the structures involved and debridement. The morbidity is related to the severity of the bite and the waiting time before consultation, and complications are rare. Orchidectomy is sometimes necessary, as in the case reported here, and the patient must be warned about this possibility. Antibiotic therapy is empirical: tetracycline and anti-anaerobe antibiotic. Rabies and tetanus prophylaxis must be performed according to vaccine guidelines.

Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: A prospective study.

PubMed

Mukhopadhyay, P; Mishra, R; Mukherjee, D; Mishra, R; Kar, M

2016-01-01

Snake bite is an occupational hazard in India and important preventable cause of acute kidney injury (AKI). This study was done to estimate the magnitude of snakebite-induced AKI (SAKI) who required renal replacement therapy, prognostic predictors, and final outcome, and to measure the oxidative and carbonyl stress (CS) level in SAKI patient who underwent hemodialysis (HD). All SAKI patients dialyzed between April 2010 and July 2011 in NRS Medical College were included. Demographical, clinical, and biochemical data were analyzed, and patients are followed to discharge or death. Oxidative and CS markers (advanced oxidation protein product [AOPP], advanced glycation end product, pentosidine, dityrosine, thioberbituric acid reactive substance, and methylglyoxal [MG]) were measured in 48 SAKI patient requiring HD. About 155 SAKI patients (M: F 2.2:1) received HD. Of them. The age was 36.2 (range 4-74) years. The most common site of the bite was lower limb (88.7%). Oliguria and bleeding manifestation were the common presentation. Hypotension was found in 52 (33.5%) cases, cellulitis and inflammation were found in about 63%. Mean creatinine was 4.56 ± 0.24 mg/dl. About 42 (27.1%) had disseminated intravascular coagulation (DIC). 36 (78.2%) had cellulites, 24 (52.2%) had hypotension or shock at initial presentation ( P < 0.05), bleeding manifestation was found in 37 (80.4%), and 22 (47.8%) had DIC ( P < 0.05). Forty-six (29.7%) patient died. DIC and hypotension/shock at initial presentation came out as an independent predictor of death. Among all markers measured for oxidative and CS ( n = 48) AOPP and MG came out as an independent predictor ( P < 0.05) of adverse outcome. Hypotension, DIC, AOPP, and MG were a poor prognostic marker in SAKI patients requiring dialysis.

Clinacanthus nutans: A review of the medicinal uses, pharmacology and phytochemistry.

PubMed

Alam, Ariful; Ferdosh, Sahena; Ghafoor, Kashif; Hakim, Abdul; Juraimi, Abdul Shukor; Khatib, Alfi; Sarker, Zaidul I

2016-04-01

Clinacanthus nutans Lindau is known as snake grass belonging to the Acanthaceae family. This plant has diverse and potential medicinal uses in traditional herbal medicine for treating skin rashes, insects and snake bites, lesions caused by herpes simplex virus, diabetes, and gout in Malaysia, Indonesia, Thailand and China. Phytochemical investigations documented the varied contents of bioactive compounds from this plant namely flavonoids, glycosides, glycoglycerolipids, cerebrosides and monoacylmonogalatosylglycerol. The pharmacological experiment proved that various types of extracts and pure compounds from this species exhibited a broad range of biological properties such as anti-inflammatory, antiviral, antioxidant, and anti-diabetic activities. The findings of toxicity study showed that extracts from this plant did not show any toxicity thus it can be used as strong therapeutic agents for specific diseased conditions. However, further experiments on chemical components and their mode of action showing biological activities are required to elucidate the complete phytochemical profile and assess to confirm their suitability for future drugs. This review summarizes the medicinal uses, phytochemistry and pharmacology of this plant in order to explore its therapeutic potential and gaps necessitating for prospected research work. Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

Gingival abscess due to an unusual nail-biting habit: a case report.

PubMed

Sousa, Denise; Pinto, Daniela; Araujo, Rebecca; Rego, Rodrigo Otavio; Moreira-Neto, Jose

2010-03-01

Nail-biting is one of the most frequent deleterious oral habits in children. It can result in systemic diseases or oral traumatic lesion. This report describes a case of gingival abscess in a child due to a fingernail-biting habit. A 5-year, 6-month-old female presented gingival swelling and fistula in the primary maxillary left central and right lateral incisors as an unusual sequelae to the periodontal tissues from fingernail-biting. A periodontal curette was used to remove the fragments and to curette the area. After the curettage, an exudate of blood and pus was drained. Then the area was irrigated with 0.12% chlorhexidine solution; applying finger pressure controlled the secretion. After one week, the patient returned with gingival swelling present in the same teeth. The same curettage procedure was performed. It was suggested that the deleterious habit was related to emotional tension and anxiety behaviors and the patient was referred for psychological treatment. When the patient returned one month later, she was still biting her fingernails, but she had stopped placing fragments into the gingival crevice. No more gingival inflammation or swelling was observed. his paper presents an unusual case report of a gingival abscess due to a fingernail-biting habit in a child, probably related to an emotional condition. The fingernail-biting habit can induce a periodontal traumatic injury yielding a more serious complication such as a gingival abscess.

Periocular dog bite injuries and responsible care.

PubMed

Burroughs, John R; Soparkar, Charles N S; Patrinely, James R; Williams, Patrick D; Holck, David E E

2002-11-01

To report patients who received dog bite injuries to the periocular area and the incidence of repeat attacks by the biting dog and its disposition. To discuss the demographics of bite attacks, occult injuries, steps to avoid medicolegal problems, and the appropriate options for animal disposition. Single-practice prospective case series of dog attacks on 18 victims. Patients were followed and questioned about any repeat attacks by the offending dog. Of 18 individuals who received dog bites to the perio-ocular area, only 2 were >12 years old. Of the 16 cases available for follow-up (4 months to 3 years; mean, 16 months), 7 of the dogs were euthanized and 1 was sent away from the family. Of the 8 remaining animals, 5 (63%) bit again. All the dogs bit family members or family friends. Although most dogs make wonderful pets, canine bites pose a significant public health concern, and some simple steps may be taken to protect against personal injury and legal fallout from repeat attacks.

Hemostatic interference of Indian king cobra (Ophiophagus hannah) Venom. Comparison with three other snake venoms of the subcontinent.

PubMed

Gowtham, Yashonandana J; Kumar, M S; Girish, K S; Kemparaju, K

2012-06-01

Unlike Naja naja, Bungarus caeruleus, Echis carinatus, and Daboia/Vipera russellii venoms, Ophiophagus hannah venom is medically ignored in the Indian subcontinent. Being the biggest poisonous snake, O. hannah has been presumed to inject several lethal doses of venom in a single bite. Lack of therapeutic antivenom to O. hannah bite in India makes any attempt to save the victim a difficult exercise. This study was initiated to compare O. hannah venom with the above said venoms for possible interference in hemostasis. Ophiophagus hannah venom was found to actively interfere in hemostatic stages such as fibrin clot formation, platelet activation/aggregation, and fibrin clot dissolution. It decreased partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin clotting time (TCT). These activities are similar to that shown by E. carinatus and D. russellii venoms, and thus O. hannah venom was found to exert procoagulant activity through the common pathway of blood coagulation, while N. naja venom increased aPTT and TCT but not PT, and hence it was found to exert anticoagulant activity through the intrinsic pathway. Venoms of O. hannah, E. carinatus, and D. russellii lack plasminogen activation property as they do not hydrolyze azocasein, while they all show plasmin-like activity by degrading the fibrin clot. Although N. naja venom did not degrade azocasein, unlike other venoms, it showed feeble plasmin-like activity on fibrin clot. Venom of E. carinatus induced clotting of human platelet rich plasma (PRP), while the other three venoms interfered in agonist-induced platelet aggregation in PRP. Venom of O. hannah least inhibited the ADP induced platelet aggregation as compared to D. russellii and N. naja venoms. All these three venoms showed complete inhibition of epinephrine-induced aggregation at varied doses. However, O. hannah venom was unique in inhibiting thrombin induced aggregation.

Production of high titre antibody response against Russell's viper venom in mice immunized with ethanolic extract of fruits of Piper longum L. (Piperaceae) and piperine.

PubMed

Shenoy, P A; Nipate, S S; Sonpetkar, J M; Salvi, N C; Waghmare, A B; Chaudhari, P D

2014-01-15

Piper longum L. fruits have been traditionally used against snakebites in north-eastern and southern region of India. The aim of the study was to assess the production of antibody response against Russell's viper venom in mice after prophylactic immunization with ethanolic extract of fruits of Piper longum L. and piperine. The mice sera were tested for the presence of antibodies against Russell's viper venom by in vitro lethality neutralization assay and in vivo lethality neutralization assay. Polyvalent anti-snake venom serum (antivenom) manufactured by Haffkine Bio-Pharmaceutical Corporation Ltd. was used as standard. Further confirmation of presence of antibodies against the venom in sera of mice immunized with PLE and piperine was done using indirect enzyme-linked immunosorbent assay (ELISA) and double immunodiffusion test. Treatment with PLE-treated mice serum and piperine-treated mice serum was found to inhibit the lethal action of venom both in the in vitro lethality neutralization assay and in vivo lethality neutralization assay. ELISA testing indicated that there were significantly high (p<0.01) levels of cross reactions between the PLE and piperine treated mice serum and the venom antigens. In double immunodiffusion test, a white band was observed between the two wells of antigen and antibodies for both the PLE-treated and piperine-treated mice serum. Thus it can be concluded that immunization with ethanolic extract of fruits of Piper longum and piperine produced a high titre antibody response against Russell's viper venom in mice. The antibodies against PLE and piperine could be useful in antivenom therapy of Russell's viper bites. PLE and piperine may also have a potential interest in view of the development of antivenom formulations used as antidote against snake bites. Copyright © 2013 Elsevier GmbH. All rights reserved.

Animal bite injuries to the face : A Case Report.

PubMed

Simao, Niverso Rodrigues; Borba, Alexandre Meireles; da Silva, Andre Luis Fernandes; Vieira, Evanice Menezes Marcal; Carvalhosa, Artur Aburad; Bandeca, Matheus Coelho; Borges, Alvaro Henrique

2013-08-01

Traumatic lacerations to the skin are problems frequently seen and treated by emergency centers around the world. Among all wounds, dog and cat bites are commonly seen. As in many mammals, different species of microorganisms are found in dog and cat mouths with a potential pathological effect to humans, as represented by rabies. The injuries have disfiguration effect with possible psychological repercussion to the patient. This article aimed presenting up to date considerations regarding the management of animal bite injuries to the face, exemplified by a case report that should be the interest of all professions that deal with facial tissues, as dentists do. How to cite this article: Simao NR, Borba AM, da Silva ALF, Vieira EMM, Carvalhosa AA, Bandeca MC, Borges AH. Animal bite injuries to the face: A Case Report. J Int Oral Health 2013; 5(4):68-72.

Orthodontic Treatment Timing and Modalities in Anterior Open Bite: Case Series Study

PubMed Central

Al Hamadi, Wisam; Saleh, Fayez; Kaddouha, Mohamad

2017-01-01

Objective: The purpose of this study was to present early and adult cases of anterior open bite that were treated efficiently using different treatment approaches and mechanics. Materials and Methods: Five patients of different age groups (from 7 to 27 years), suffering from a clear Anterior open bite deformity, were properly diagnosed and relevant treatment modality for each was selected. Results: Positive overbite was efficiently achieved for all patients. Conclusion: Patient compliance is a key factor in using removable habit breakers. However, fixed palatal crib gave the same results but in shorter time. Anterior open bite of skeletal components should be thoroughly evaluated before selecting camouflage or orthognathic surgery treatment modality. PMID:29299074

Phantom bite: a real or a phantom diagnosis? A case report.

PubMed

Sutter, Ben A

2017-01-01

This case report describes computer-guided occlusal therapy in a patient who met the unified diagnostic criteria for phantom bite. After a review of the patient's medical history, along with a diagnostic work-up that included cone beam computed tomography, temporomandibular joint vibration analysis, and digital occlusal analysis, problematic dental components were discovered (including prolonged disclusion time and imbalanced bite force). A digital occlusal analyzer evaluated the patient's occlusion and systematically guided the necessary changes. After reduction of the disclusion time and correction of the occlusal force imbalance, the patient reported significant improvement in comfort. The results suggest that phantom bite could be an abnormal occlusal condition and not a psychological or neurologic somatoform disorder.

A case of tick bite by a spontaneously retreated Ixodes nipponensis.

PubMed

Cho, B K; Nam, H W; Cho, S Y; Lee, W K

1995-09-01

A 58-year old housewife consulted us about 1 cm sized, dark-brownish, bean-like mass which was dropped spontaneously from indurated skin lesion on her abdomen. The mass was identified morphologically as an engorged female Ixodes nipponensis. Nine days earlier, she had an excursion collecting edible sprouts of wild grass. Spontaneous retreat has been unusual in clinical tick bites in Korea. Fourteen cases of tick bite described in the Korean literature were reviewed briefly in relation to Lyme borreliosis.

Streptobacillus moniliformis Bacteremia in a Pet Shop Employee: Case Report and Literature Review

PubMed Central

Hirai, Yuji; Morita, Fujiko; Nakamura, Ayako; Uehara, Yuki; Naito, Toshio

2017-01-01

Abstract A 39-year-old pet shop employee who sustained a bite from one of his store’s rats developed fever and arthritis. Streptobacillus moniliformis was cultured from the patient’s blood, confirming a diagnosis of rat-bite fever. Treatment with standard antibiotics was successful. Although rat-bite fever is commonly considered a zoonosis transmitted by wild or laboratory rats, our case emphasizes that it may be transmitted by pet animals as well. PMID:28730157

Food or threat? Wild capuchin monkeys (Sapajus libidinosus) as both predators and prey of snakes.

PubMed

Falótico, Tiago; Verderane, Michele P; Mendonça-Furtado, Olívia; Spagnoletti, Noemi; Ottoni, Eduardo B; Visalberghi, Elisabetta; Izar, Patrícia

2018-01-01

Snakes present a hazard to primates, both as active predators and by defensive envenomation. This risk might have been a selective pressure on the evolution of primate visual and cognitive systems, leading to several behavioral traits present in human and non-human primates, such as the ability to quickly learn to fear snakes. Primates seldom prey on snakes, and humans are one of the few primate species that do. We report here another case, the wild capuchin monkey (Sapajus libidinosus), which preys on snakes. We hypothesized that capuchin monkeys, due to their behavioral plasticity, and cognitive and visual skills, would be capable of discriminating dangerous and non-dangerous snakes and behave accordingly. We recorded the behavioral patterns exhibited toward snakes in two populations of S. libidinosus living 320 km apart in Piauí, Brazil. As expected, capuchins have a fear reaction to dangerous snakes (usually venomous or constricting snakes), presenting mobbing behavior toward them. In contrast, they hunt and consume non-dangerous snakes without presenting the fear response. Our findings support the tested hypothesis that S. libidinosus are capable of differentiating snakes by level of danger: on the one hand they protect themselves from dangerous snakes, on the other hand they take opportunities to prey on non-dangerous snakes. Since capuchins and humans are both predators and prey of snakes, further studies of this complex relationship may shed light on the evolution of these traits in the human lineage.

Prospective audit of 106 consecutive human bite injuries: the importance of history taking

PubMed Central

Wallace, C; Robertson, C

2005-01-01

Methods: Patients with cutaneous wounds who did not present with a history of human bite were asked a follow up question. Those who then gave a history of human bite were noted. Results: Certain groups of patients with human bites were significantly more likely to provide a factitious history and/or delay presentation. Conclusion: Follow up questioning dramatically increased the case-detection rate, prompting specific management. PMID:16299201

Rat-bite fever presenting with rash and septic arthritis.

PubMed

Kanechorn Na Ayuthaya, Rajyani; Niumpradit, Nucha

2005-11-01

Rat-bite fever is an uncommon disease known for its endemicity to occur worldwide. Although most patients tend to develop mild symptoms with improvement from conventional antibiotics, it can progress with severe complications with a mortality rate as high as 13% without proper treatment. The authors report a complicated case of rat bite-fever involving a 61-year old woman who presented with fever petechial rash, and septic arthritis following a rat bite. Initially, multiple antibiotics were administered but were not effective. As a consequence, invasive procedures such as arthrotomy and joint debridement were done and prolonged antibiotic was administered until clinical resolution. Since many cases do not have a history of rat bite and may present with fever, rashes, and arthritis it is essential to distinguish it from other diseases. Here, the authors will provide details on the etiology, clinical manifestations, diagnosis, and management to aid prompt detection and treatment of the disease.

A pattern of acute poisoning in children in urban Zimbabwe: ten years experience.

PubMed

Kasilo, O M; Nhachi, C F

1992-09-01

1. A retrospective analysis was performed to evaluate the epidemiology of poisoning in children based on admissions to six of Zimbabwe's main urban hospitals over a 10-year period from 1980 to 1989 inclusive. 2. A total of 2873 cases were children aged between 0-15 years. This constituted 47.8% of poisoning cases from all age groups (6018) recorded during the study period. 3. All of the children (0-15 years) had signs and symptoms of poisoning on admission and, depending on their severity, were admitted to a ward or to an intensive care unit. A total of 4.9% (141) died. Most of those who died were suicide cases among the 11-15 year age group and accidental poisonings among the 0-15 year old group. 4. The under 0-5 age group constituted the majority of cases (75.4%) in the 0-15 age group, and most were between 1 and 3 years old. The 6-10 and 11-15 age groups formed 12.6% and 12% of the cases, respectively. The sex distribution showed that 53.1% were male. 5. Most incidences were accidental (93.2%). Suicides and parasuicides accounted for 1.9% and there were only two homicides. 6. The commonest toxic agents were: household products (27.2%), traditional medicines (23.%), venoms from snake bites and insect stings (16%) and therapeutic agents (12.4%). Of the therapeutic agents the most frequently implicated were antipsychotics 18.9%, analgesics 16.8%, anti-infectives 11.7%, anticonvulsants (8.2%) and benzodiazepines (7.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Common Cutaneous Bacteria Isolated from Snakes Inhibit Growth of Ophidiomyces ophiodiicola.

PubMed

Hill, Aubree J; Leys, Jacob E; Bryan, Danny; Erdman, Fantasia M; Malone, Katherine S; Russell, Gabrielle N; Applegate, Roger D; Fenton, Heather; Niedringhaus, Kevin; Miller, Andrew N; Allender, Matthew C; Walker, Donald M

2018-03-01

There is increasing concern regarding potential impacts of snake fungal disease (SFD), caused by Ophidiomyces ophiodiicola (Oo), on free-ranging snake populations in the eastern USA. The snake cutaneous microbiome likely serves as the first line of defense against Oo and other pathogens; however, little is known about microbial associations in snakes. The objective of this study was to better define the composition and immune function of the snake cutaneous microbiome. Eight timber rattlesnakes (Crotalus horridus) and four black racers (Coluber constrictor) were captured in Arkansas and Tennessee, with some snakes exhibiting signs of SFD. Oo was detected through real-time qPCR in five snakes. Additional histopathological techniques confirmed a diagnosis of SFD in one racer, the species' first confirmed case of SFD in Tennessee. Fifty-eight bacterial and five fungal strains were isolated from skin swabs and identified with Sanger sequencing. Non-metric multidimensional scaling and PERMANOVA analyses indicated that the culturable microbiome does not differ between snake species. Fifteen bacterial strains isolated from rattlesnakes and a single strain isolated from a racer inhibited growth of Oo in vitro. Results shed light on the culturable cutaneous microbiome of snakes and probiotic members that may play a role in fighting an emergent disease.

A systematic review of risk of HIV transmission through biting or spitting: implications for policy.

PubMed

Cresswell, F V; Ellis, J; Hartley, J; Sabin, C A; Orkin, C; Churchill, D R

2018-04-23

The perceived threat of HIV transmission through spitting and biting is evidenced by the increasing use of "spit hoods" by Police Forces in the UK. In addition, a draft parliamentary bill has called for increased penalties for assaults on emergency workers, citing the risk of communicable disease transmission as one justification. We aimed to review literature relating to the risk of HIV transmission through biting or spitting. A systematic literature search was conducted using Medline, Embase and Northern Lights databases and conference websites using search terms relating to HIV, AIDS, bite, spit and saliva. Inclusion and exclusion criteria were applied to identified citations. We classified plausibility of HIV transmission as low, medium, high or confirmed based on pre-specified criteria. A total of 742 abstracts were reviewed, yielding 32 articles for full-text review and 13 case reports/series after inclusion and exclusion criteria had been applied. There were no reported cases of HIV transmission related to spitting and nine cases identified following a bite, in which the majority occurred between family (six of nine), in fights involving serious wounds (three of nine), or to untrained first-aiders placing fingers in the mouth of someone having a seizure (two of nine). Only four cases were classified as highly plausible or confirmed transmission. None related to emergency workers and none were in the UK. There is no risk of transmitting HIV through spitting, and the risk through biting is negligible. Post-exposure prophylaxis is not indicated after a bite in all but exceptional circumstances. Policies to protect emergency workers should be developed with this evidence in mind. © 2018 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

A Prospective Study among Patients Presenting at the General Practitioner with a Tick Bite or Erythema Migrans in the Netherlands

PubMed Central

Hofhuis, Agnetha; Herremans, Tineke; Notermans, Daan W.; Sprong, Hein; Fonville, Manoj; van der Giessen, Joke W. B.; van Pelt, Wilfrid

2013-01-01

Background We performed a nationwide prospective study on the transmission risk for Borrelia to humans, investigating symptoms and serology at enrolment and three months after tick bites, and after standard treatment for erythema migrans (EM). Aiming to quantify the infection risk at point of care by physicians, we explored risk factors such as tick testing for Borrelia and assessment of the duration of the tick's blood meal. Methods and Findings Questionnaires, blood samples and ticks from patients who consulted one of 307 general practitioners for tick bites (n = 327) or EM (n = 283) in 2007 and 2008, were collected at enrolment and three months later at follow-up. Borrelia burgdorferi sensu lato DNA was detected in 29.3% of 314 ticks, using PCR/reverse line blot and real-time PCR on the OspA gene. Seroconversion in C6 ELISA, IgM or IgG immunoblots for Borrelia-specific antibodies was observed in 3.2% of tick bite cases. Fourteen tick bite cases had evidence of early Borrelia infection, of which EM developed among seven cases. The risk of developing EM after tick bites was 2.6% (95%CI: 1.1%–5.0%), and the risk of either EM or seroconversion was 5.1% (95%CI: 2.9%–8.2%). Participants with Borrelia-positive ticks had a significantly higher risk of either EM or seroconversion (odds ratio 4.8, 95%CI: 1.1–20.4), and of seroconversion alone (odds ratio 11.1, 95%CI: 1.1–108.9). A third (34%) of the cases enrolled with EM did not recall preceding tick bites. Three EM cases (1%) reported persisting symptoms, three months after standard antibiotic treatment for EM. Conclusions One out of forty participants developed EM within three months after tick bites. The infection risk can be assessed by tick testing for Borrelia at point of care by physicians. However, further refining is needed considering sensitivity and specificity of tick tests, accuracy of tick attachment time and engorgement. PMID:23696884

Venomous Snake Bite in India - Why do 50,000 Indians Die Every Year?

PubMed

Menon, Jaideep C; Joseph, Joseph K; Whitaker, Romulus E

2017-08-01

Snakebite is an occupational hazard causing considerable morbidity and mortality worldwide, particularly so in tropical countries like India. An estimated 50,000 Indians die due to venomous snakebite every year, seventy percent of whom are males between the ages of 20 to 50 years. Along with the associated morbidity and mortality, snakebite leads to a significant financial burden on the victim, both by way of hospital bills and labour hours lost. Snakebite is also a cause for considerable psychological stress among survivors. Most snakebites are eminently treatable and curable. Given a concerted thrust from all concerned , this menace could surely be curtailed considerably over the next few years. © Journal of the Association of Physicians of India 2011.

Bartisch on theriac.

PubMed

Blanchard, D L

2001-09-01

George Bartisch is best known as the German ophthalmologist who wrote the mammoth textbook Ophthalmodouleia, printed in 1583. He wrote several other books, most of which were never published. One that he self-published is on Venice Theriac of Andromachus. Common theriac has a long history in medicine from just after Hippocrates. It initially was used for venomous snake bites but later was used for poisonings too. By Bartisch's time it was considered a nearly universal cure-all. In the book, a multitude of ophthalmic and general diseases are listed and then the dose of Theriac is given. Bartisch warned against the many inferior types of theriac available through unscrupulous traveling salespeople. He offered the superior Venice Theriac for sale, compounded by himself in Dresden, Germany, where he resided.

Animal bite injuries to the face : A Case Report

PubMed Central

Simao, Niverso Rodrigues; Borba, Alexandre Meireles; da Silva, Andre Luis Fernandes; Vieira, Evanice Menezes Marcal; Carvalhosa, Artur Aburad; Bandeca, Matheus Coelho; Borges, Alvaro Henrique

2013-01-01

Traumatic lacerations to the skin are problems frequently seen and treated by emergency centers around the world. Among all wounds, dog and cat bites are commonly seen. As in many mammals, different species of microorganisms are found in dog and cat mouths with a potential pathological effect to humans, as represented by rabies. The injuries have disfiguration effect with possible psychological repercussion to the patient. This article aimed presenting up to date considerations regarding the management of animal bite injuries to the face, exemplified by a case report that should be the interest of all professions that deal with facial tissues, as dentists do. How to cite this article: Simao NR, Borba AM, da Silva ALF, Vieira EMM, Carvalhosa AA, Bandeca MC, Borges AH. Animal bite injuries to the face: A Case Report. J Int Oral Health 2013; 5(4):68-72. PMID:24155623

Facial dog bite injuries in children: treatment and outcome assessment.

PubMed

Eppley, Barry L; Schleich, Arno Rene

2013-03-01

Dog bite injuries to a child's face are not an infrequent occurrence. They may require primary and revisional surgery. All result in permanent facial scars. This report describes the treatment and outcomes of dog bites of the face, scalp, and neck based on a case series of 107 children over a 10-year period.The average children's age was 5.9 years. In cases where the dog was identified (95%), it was known to the victim and their family. The events leading to the dog bite were categorized as provoked (77%) in the majority of the cases.The majority of wounds could be closed primarily without a significant risk of wound infection. Complex reconstructions were required in more severe cases. The majority of families (77%) opted for scar revision between 9 and 18 months after initial treatment to improve the aesthetic outcome.Lawsuit actions resulted in 39 of the cases making good documentation an essential part of treatment. Dogbite injuries to the face in children frequently require multiple scar revisions to obtain the best possible aesthetic outcome, and the family should be so counseled at the onset of treatment.

The case of Ohio v. Robinson. An 1870 bite mark case.

PubMed

Pierce, L J; Strickland, D J; Smith, E S

1990-06-01

In 1870, Ansil L. Robinson was charged with the murder of his mistress, Mary Lunsford, in Mansfield, Ohio, U.S.A. Evidence against Robinson included an attempt to match his teeth to bite marks on the victim's arm. Robinson was acquitted after a 3-week trial despite the evidence linking his teeth to the wounds. This trial represents an early and perhaps the first attempt to admit bite-mark evidence in a court of law in the United States. The acquittal resulted in the obscurity that prevented this case from coming to the awareness of the forensic dental and legal communities sooner.

Bite by a dog under provocation: is it free from risk?

PubMed

Dutta, J K

2002-05-01

There is a common belief that rabid dogs bite without provocation, hence a dog bite under provocation is free from the risk of rabies. This is not always true as is evident from the case report narrated below. Here in this article, a man of 38 years was bitten by a dog under provocation. He developed rabies 4 months after the bite and subsequently died. Autopsy revealed Negri bodies from the brain tissue.

Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis.

PubMed

Isbister, Geoffrey K; Brown, Simon G; MacDonald, Ellen; White, Julian; Currie, Bart J

2008-04-21

To investigate current use of Australian snake antivenoms and the frequency and severity of immediate-type hypersensitivity reactions. Nested prospective cohort study as part of the Australian Snakebite Project. Patients receiving snake antivenom in Australian hospitals between 1 January 2002 and 30 November 2007. The use of CSL Limited antivenom; frequency and severity of hypersensitivity reactions to antivenom; premedication and treatment of these reactions. Snake antivenom was administered to 195 patients, mostly for venom-induced consumption coagulopathy (145 patients, 74%), followed by non-specific systemic effects (12%), neurotoxicity (5%) and myotoxicity (4%). Antivenom was given to nine patients (5%) without evidence of envenoming or who were bitten by a species of snake for which antivenom is not required. The commonest antivenoms used were brown snake (46%), tiger snake (30%) and polyvalent (11%). The median dose was four vials (interquartile range, 2-5 vials), and 24 patients received two different types of antivenom. Immediate-type hypersensitivity reactions occurred in 48 patients (25%); 21 satisfied our definition of anaphylaxis, with 11 moderate and 10 severe cases, including nine in which patients were hypotensive. The remaining 27 reactions were mild (skin only). Adrenaline was used in 26 cases with good effect. The frequency of reactions to tiger snake (41%) and polyvalent (41%) antivenoms was higher than that to brown snake antivenom (10%). Hypersensitivity reactions occurred in 11 of 40 patients receiving any form of premedication (28%) and in 2 of 11 given adrenaline for premedication (18%) versus 20 of 86 not receiving premedication (23%). Antivenom was used appropriately, and most commonly for coagulopathy. Hypersensitivity reactions were common, but most were not severe. The discretionary use of premedication was not associated with any reduction in reactions.

Venomous snakebites in the United States: management review and update.

PubMed

Juckett, Gregory; Hancox, John G

2002-04-01

Venomous snakebites, although uncommon, are a potentially deadly emergency in the United States. Rattlesnakes cause most snakebites and related fatalities. Venomous snakes in the United States can be classified as having hemotoxic or neurotoxic venom. Patients with venomous snakebites present with signs and symptoms ranging from fang marks, with or without local pain and swelling, to life-threatening coagulopathy, renal failure, and shock. First-aid techniques such as arterial tourniquets, application of ice, and wound incisions are ineffective and can be harmful; however, suction with a venom extractor within the first five minutes after the bite may be useful. Conservative measures, such as immobilization and lymphatic constriction bands, are now advocated until emergency care can be administered. Patients with snakebites should undergo a comprehensive work-up to look for possible hematologic, neurologic, renal, and cardiovascular abnormalities. Equine-derived antivenin is considered the standard of care; however, a promising new treatment is sheep-derived antigen binding fragment ovine (CroFab), which is much less allergenic. Although there is no universal grading system for snakebites, a I through IV grading scale is clinically useful as a guide to antivenin administration. Surgical intervention with fasciotomy is now reserved for rare cases. Snakebite prevention should be taught to patients.

[Hypersensitivity to mosquito bite manifested as Skeeter síndrome].

PubMed

Pérez-Vanzzini, Rafael; González-Díaz, Sandra Nora; Arias-Cruz, Alfredo; Palma-Gómez, Samuel; Yong-Rodríguez, Adrián; Gutiérrez-Mujica, José Julio; García-Calderín, Diego; Ibarra, Jesús Arturo

2015-01-01

The reactions to mosquito bites are immunological reactions with involvement of IgE, IgG and T cells mediated hypersensitivity. These reactions are common and range from small local reactions, large local reactions to systemic allergic reactions. Skeeter syndrome is defined as a large local induced inflammatory reaction to mosquito bite and sometimes accompanied by systemic symptoms such as fever and vomiting. Diagnosis is based on clinical history and physical examination, supported by the identification of specific IgE by skin testing. Treatment includes prevention, antihistamines and steroids in some cases. Specific immunotherapy still requires further study. This paper reports two cases of patients with hypersensitivity reactions to mosquito bites, which were evaluated in our center presenting positive skin tests.

Poison exposures in young Israeli military personnel: a National Poison Center Data analysis.

PubMed

Lavon, Ophir; Bentur, Yedidia

2017-06-01

To characterize poison exposures in young Israeli military personnel as reported to the national poison center. Retrospective poison center chart review over a 14-year period. Cases included were Israeli soldiers aged 18-21 years, the compulsory military service age required by the Israeli law. 1770 records of poison exposures in young military personnel were identified. Most exposed individuals involved males (n = 1268, 71.6%). Main routes of exposure were ingestion (n = 854, 48.3%), inhalation (n = 328, 18.6%) and ocular (n = 211, 11.9%). Accidents or misuse (n = 712, 40.2%) were the most frequently reported circumstances, followed by suicide attempts (370, 20.9%), and bites and stings (161, 9.1%). More than half of the cases involved chemicals (n = 939, 53.1%); hydrocarbons, gases and corrosives were the main causative agents. Pharmaceuticals (mainly analgesics) were involved in 519 (29.3%) cases, venomous animals (mainly scorpions, centipedes, and snakes) in 79 (4.5%). Clinical manifestations were reported in 666 (37.6%) cases, mostly gastrointestinal, neurologic, and respiratory. The vast majority of cases (1634, 92.3%) were asymptomatic or mildly affected; no fatalities were recorded. In 831 (46.9%) cases the clinical toxicologist recommended referral to an emergency department; ambulatory observation was recommended in 563 (31.8%) cases, and hospitalization in 86 (4.9%). Our data show that poison exposures among young soldiers involve mainly males, accidents, misuse and suicides, oral route and chemicals; most exposures were asymptomatic or with mild severity. Repeated evaluations of poison center data pertaining to military personnel is advised for identifying trends in poison exposure and characteristics in this particular population.

Review of Eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010.

PubMed

Wood, A; Schauben, J; Thundiyil, J; Kunisaki, T; Sollee, D; Lewis-Younger, C; Bernstein, J; Weisman, R

2013-01-01

Envenomation by the Eastern coral snake is rare but may be associated with significant morbidity. While effective, acquisition of North American Coral Snake Antivenin (NACSAV) is difficult because production was discontinued for many years. The purpose of this study is to characterize coral snake exposures in Florida and determine the effects of varying treatment paradigms on patient outcomes. This study is an observational case series of cases received at Florida poison centers. Included cases were Eastern coral snake exposures occurring between January 1, 1998 and October 31, 2010. Excluded cases included those found to be unrelated or those not followed for at least 24 h post envenomation. Case comments were reviewed to obtain data. Comparisons were made between asymptomatic patients receiving empiric antivenom therapy (empiric group) and those asymptomatic patients who received antivenom upon developing signs of systemic envenomation (withhold group). Of the 553 cases identified, 387 were included in the final analysis. According to case comments, 56.3% of patients had no reported systemic symptoms. Most commonly, patients were reported to have pain (40.6%), paresthesias (28.4%), nausea (12.7%), and emesis (11.4%). NACSAV was administered to 252 patients (65%). Of those patients receiving NACSAV, 18.25% were reported to have had an adverse reaction. Patients in the withhold group (n = 106) had significantly fewer minor, moderate, and major outcomes than patients in the empiric group (n = 134, p < 0.01). While patients in the withhold group had favorable outcomes compared with those in the empiric group, this strategy cannot be applied to all patients presenting asymptomatic to healthcare facilities due to study limitations. Further studies are needed to determine what treatment strategy is most appropriate for asymptomatic patients presenting to healthcare facilities.

Acute Generalized Exanthematous Pustulosis Due to Insect Bites?

PubMed

Bhat, Yasmeen J; Hassan, Iffat; Sajad, Peerzada; Yaseen, Atiya; Wani, Rohi

2015-01-01

Acute generalized exanthematous pustulosis is a rare severe cutaneous adverse reaction pattern that is mostly caused by the intake of drugs and rarely associated with viral infections, food allergens or toxins. Here we present the report of three patients who got admitted in our hospital for generalized pustulosis and fever after insect bites. The diagnosis of acute generalized exanthematous pustulosis was made by EuroSCAR scoring. The drug etiology was excluded and spider bite was implicated as the etiological agent in these cases of AGEP which are the first such reported cases in India.

Three cases of successful microvascular ear replantation after bite avulsion injury.

PubMed

Schonauer, Fabrizio; Blair, James W; Moloney, Dominique M; Teo, T C; Pickford, Mark A

2004-01-01

We present three cases of sub-total amputation of the external ear caused by bite avulsion injury. The ears were all successfully replanted despite us being unable to perform a venous anastomosis in one case. These outcomes support attempted microsurgical replantation for total or sub-total amputations of the ear, as successful replantation is the most effective surgical option.

Australian elapid snake envenomation in cats: Clinical priorities and approach.

PubMed

Mcalees, Trudi J; Abraham, Linda A

2017-11-01

Practical relevance: No fewer than 140 species of terrestrial snakes reside in Australia, 92 of which possess venom glands. With the exception of the brown tree snake, the venom-producing snakes belong to the family Elapidae. The venom of a number of elapid species is more toxic than that of the Indian cobra and eastern diamondback rattle snake, which has earned Australia its reputation for being home to the world's most venomous snakes. Clinical challenges: The diagnosis of elapid snake envenomation is not always easy. Identification of Australian snakes is not straightforward and there are no pathognomonic clinical signs. In cats, diagnosis of envenomation is confounded by the fact that, in most cases, there is a delay in seeking veterinary attention, probably because snake encounters are not usually witnessed by owners, and also because of the tendency of cats to hide and seek seclusion when unwell. Although the administration of antivenom is associated with improved outcomes, the snake venom detection kit and antivenom are expensive and so their use may be precluded if there are financial constraints. Evidence base: In providing comprehensive guidance on the diagnosis and treatment of Australian elapid snake envenomation in cats, the authors of this review draw on the published veterinary, medical and toxicology literature, as well as their professional experience as specialists in medicine, and emergency medicine and critical care.

Keeping venomous snakes in the Netherlands: a harmless hobby or a public health threat?

PubMed

van Genderen, P J J; Slobbe, L; Koene, H; Mastenbroek, R D L; Overbosch, D

2013-10-01

To describe the incidence of venomous snakebites and the hospital treatment thereof (if any) amongst private individuals who keep venomous snakes as a hobby. Descriptive study. Private keepers of venomous snakes were invited via the social media Facebook, Hyves, Twitter, Google Plus, Linked In and two large discussion forums to fill in an online questionnaire on a purely voluntary and anonymous basis. In the period from 1 September 2012 to 31 December 2012, 86 questionnaires were completed by individuals who keep venomous snakes as a hobby. One-third of the venomous snake keepers stated that they had at some point been bitten by a venomous snake. Out of those, two-thirds needed hospital treatment and one-third of those bitten required at least one, sometimes more, doses of antiserum. The chances of being bitten increased the more venomous snakes a person kept. An inventory of the collections of venomous snakes being kept further revealed that no antiserum exists for 16 of the species, including for the most commonly held venomous snake, the coral cobra. Keeping venomous snakes as a hobby is not without danger. Although in the majority of snakebite cases no antiserum had to be administered, there is nevertheless a significant risk of morbidity and sequelae. Preventing snakebites in the first place remains the most important safety measure since there are no antiserums available for a substantial number of venomous snakes.

Determinants of health seeking behaviour following rabies exposure in Ethiopia.

PubMed

Beyene, T J; Mourits, M C M; Revie, C W; Hogeveen, H

2018-06-01

The objective of this study was to identify factors that determine medical treatment seeking behaviour following potential rabies exposure after being bitten by a suspected dog and the likelihood of compliance to receive sufficient doses of post-exposure prophylaxis after the visit to a health centre visit. A detailed survey based on case investigation was conducted on suspected rabid dog bite cases in three areas of Ethiopia. Two multivariable logistic regression models were created with a set of putative variables to explain treatment seeking and compliance outcomes. Based on the registered bite cases at each health centre and the set of unregistered bite cases derived by contact tracing, 655 bite victim cases were identified to have occurred between September 2013 and August 2014. Of these evaluated bite incidences, 465 cases were considered to have been caused by a potentially rabid dog. About 77% of these suspected rabid dog bite victims visited a health centre, while 57% received sufficient doses of PEP. The overall likelihood of seeking medical services following rabies exposure was higher for people bitten by dogs of unknown ownership, where the bite was severe, being bitten on the leg, spend of more than 100 USD per month and where the victim lived close to the nearest health centre, while the likelihood of receiving sufficient doses of PEP was sensitive to monthly spending and distance to health centre. However, the evaluated factors did only explain a part of the variation among the three districts. The district in which victims lived appeared to have a relevant influence on the likelihood of seeking medical treatment but did not improve the prediction on the likelihood of treatment compliance. Given the insights obtained from this study, improvements in the rural districts with regard to accessibility of post-exposure prophylaxis delivering health centres in shorter distance could improve health seeking behaviour. In addition, in rural districts, majority of exposed persons who seek medical treatment tend to comply with treatment regimen, indicating that the promotion of medical treatment through awareness creation campaigns could be beneficial. © 2018 The Authors. Zoonoses and Public Health Published by Blackwell Verlag GmbH.

Household exposure and animal-bite surveillance following human rabies detection in Southern Ghana.

PubMed

Afakye, Kofi; Kenu, Ernest; Nyarko, Kofi Mensah; Johnson, Sherry Ama Mawuko; Wongnaah, Florence; Bonsu, George Kwame

2016-01-01

Rabies remains a neglected tropical zoonotic disease with 100% case fatality rate and estimated 6,000 global mortality annually, and yet vaccine preventable. In Ghana, rabies outbreaks receive poor response. We investigated rabies in a 5-year old boy to find the source of infection, identify exposed persons for post-exposure prophylaxis and describe animal-bite surveillance in Manya-Krobo District of Ghana. We actively searched for cases and exposures by interviewing household members of the victim, schoolmates, and health professionals using WHO case definition, interview guide and checklist. We reviewed health and veterinary records and reports, and interviewed stakeholders. Descriptive data analyses were carried out and presented using tables and charts. Recorded responses were transcribed into thematic areas and analysed. Child had dog-bite at the wrist, and developed hyperactivity, hydrophobia and hyperventilation 2 months post bite. He was hospitalised and died from respiratory failure day 3 after admission. Thirty-three persons were exposed to rabies infectious material. Females were 66%, age-groups 5-15yrs and 30-59 yrs were 33.3% and 39.4% respectively. A third (11/33) were category II exposure by WHO classification and were recommended for post-exposure prophylaxis. Surveillance records showed ninety-two animal-bite cases were reported for past 12 months. Half were females, and 18-59yrs age-group was 43%. Surveillance data quality was poor. Rabies remains a public health burden inGhana with domestic dog as reservoir of the virus and females more vulnerable to secondary exposures. Health education on rabies should be intensified, and robust animal-bite surveillance system put in place.

Poisoning in Israel: annual report of the Israel Poison Information Center, 2012.

PubMed

Bentur, Yedidia; Lurie, Yael; Cahana, Alfred; Kovler, Nona; Bloom-Krasik, Anna; Gurevych, Bella; Klein-Schwartz, Wendy

2014-11-01

The Israel National Poison Information Center (IPIC), Rambam Health Care Campus, provides 24 hour telephone consultations in clinical toxicology as well as drug and teratogen information. It participates in research, teaching and regulatory activities, and also provides laboratory services. To report data on the epidemiology of poisonings and poison exposures in Israel. We made computerized queries and descriptive analyses of the medical records database of the IPIC during 2012. A total of 31,519 poison exposure cases were recorded, a 157.6% increase compared with 1995. Children < 6 years of age were involved in 43.1% of cases; 74.0% of calls were made by the public and 23.7% by physicians; 74.8% of exposures were unintentional and 9.1% intentional. Chemicals were involved in 35.8% of all cases (single and multiple substances), pharmaceuticals in 48.8%, bites and stings in 3.8%, and plants and mushrooms in 1.6%. Substances most frequently involved were analgesics, cleaning products and antimicrobials. Clinical severity was moderate/major in 3.4%. Substances most frequently involved in moderate/major exposures were corrosives, insecticides and snake venom. Four fatalities were recorded; all were intentional exposures in adults (corrosive, medications, energy drink). Poison exposures and poisonings have increased significantly and have contributed substantially to morbidity and mortality in Israel. The IPIC database is a valuable national resource for the collection and monitoring of poisoning exposure cases. It can be used as a real-time surveillance system for the benefit of public health. It is recommended that reporting to the IPIC become mandatory and its activities be adequately supported by national resources.

Is there more than one way to skin a newt? Convergent toxin resistance in snakes is not due to a common genetic mechanism.

PubMed

Feldman, C R; Durso, A M; Hanifin, C T; Pfrender, M E; Ducey, P K; Stokes, A N; Barnett, K E; Brodie, E D; Brodie, E D

2016-01-01

Convergent evolution of tetrodotoxin (TTX) resistance, at both the phenotypic and genetic levels, characterizes coevolutionary arms races between amphibians and their snake predators around the world, and reveals remarkable predictability in the process of adaptation. Here we examine the repeatability of the evolution of TTX resistance in an undescribed predator-prey relationship between TTX-bearing Eastern Newts (Notophthalmus viridescens) and Eastern Hog-nosed Snakes (Heterodon platirhinos). We found that that local newts contain levels of TTX dangerous enough to dissuade most predators, and that Eastern Hog-nosed Snakes within newt range are highly resistant to TTX. In fact, these populations of Eastern Hog-nosed Snakes are so resistant to TTX that the potential for current reciprocal selection might be limited. Unlike all other cases of TTX resistance in vertebrates, H. platirhinos lacks the adaptive amino acid substitutions in the skeletal muscle sodium channel that reduce TTX binding, suggesting that physiological resistance in Eastern Hog-nosed Snakes is conferred by an alternate genetic mechanism. Thus, phenotypic convergence in this case is not due to parallel molecular evolution, indicating that there may be more than one way for this adaptation to arise, even among closely related species.

Is there more than one way to skin a newt? Convergent toxin resistance in snakes is not due to a common genetic mechanism

PubMed Central

Feldman, C R; Durso, A M; Hanifin, C T; Pfrender, M E; Ducey, P K; Stokes, A N; Barnett, K E; Brodie III, E D; Brodie Jr, E D

2016-01-01

Convergent evolution of tetrodotoxin (TTX) resistance, at both the phenotypic and genetic levels, characterizes coevolutionary arms races between amphibians and their snake predators around the world, and reveals remarkable predictability in the process of adaptation. Here we examine the repeatability of the evolution of TTX resistance in an undescribed predator–prey relationship between TTX-bearing Eastern Newts (Notophthalmus viridescens) and Eastern Hog-nosed Snakes (Heterodon platirhinos). We found that that local newts contain levels of TTX dangerous enough to dissuade most predators, and that Eastern Hog-nosed Snakes within newt range are highly resistant to TTX. In fact, these populations of Eastern Hog-nosed Snakes are so resistant to TTX that the potential for current reciprocal selection might be limited. Unlike all other cases of TTX resistance in vertebrates, H. platirhinos lacks the adaptive amino acid substitutions in the skeletal muscle sodium channel that reduce TTX binding, suggesting that physiological resistance in Eastern Hog-nosed Snakes is conferred by an alternate genetic mechanism. Thus, phenotypic convergence in this case is not due to parallel molecular evolution, indicating that there may be more than one way for this adaptation to arise, even among closely related species. PMID:26374236

Crystallization and preliminary X-ray diffraction analysis of a Lys49-phospholipase A2 complexed with caffeic acid, a molecule with inhibitory properties against snake venoms

PubMed Central

Shimabuku, Patrícia S.; Fernandes, Carlos A. H.; Magro, Angelo J.; Costa, Tássia R.; Soares, Andreimar M.; Fontes, Marcos R. M.

2011-01-01

Phospholipases A2 (PLA2s) are one of the main components of bothropic venoms; in addition to their phospholipid hydrolysis action, they are involved in a wide spectrum of pharmacological activities, including neurotoxicity, myo­toxicity and cardiotoxicity. Caffeic acid is an inhibitor that is present in several plants and is employed for the treatment of ophidian envenomations in the folk medicine of many developing countries; as bothropic snake bites are not efficiently neutralized by conventional serum therapy, it may be useful as an antivenom. In this work, the cocrystallization and preliminary X-ray diffraction analysis of the Lys49-PLA2 piratoxin I from Bothrops pirajai venom in the presence of the inhibitor caffeic acid (CA) are reported. The crystals diffracted X-rays to 1.65 Å resolution and the structure was solved by molecular-replacement techniques. The electron-density map unambiguously indicated the presence of three CA molecules that interact with the C-terminus of the protein. This is the first time a ligand has been observed bound to this region and is in agreement with various experiments previously reported in the literature. PMID:21301098

Allopurinol Reduces the Lethality Associated with Acute Renal Failure Induced by Crotalus durissus terrificus Snake Venom: Comparison with Probenecid

PubMed Central

Frezzatti, Rodrigo; Silveira, Paulo Flavio

2011-01-01

Background Acute renal failure is one of the most serious complications of envenoming resulting from Crotalus durissus terrificus bites. This study evaluated the relevance of hyperuricemia and oxidative stress and the effects of allopurinol and probenecid in renal dysfunction caused by direct nephrotoxicity of C. d. terrificus venom. Methodology/Principal Findings Hematocrit, protein, renal function and redox status were assessed in mice. High ratio of oxidized/reduced glutathione and hyperuricemia induced by C. d. terrificus venom were ameliorated by both, allopurinol or probenecid, but only allopurinol significantly reduced the lethality caused by C. d. terrificus venom. The effectiveness of probenecid is compromised probably because it promoted hypercreatinemia and hypocreatinuria and worsed the urinary hypo-osmolality in envenomed mice. In turn, the highest effectiveness of allopurinol might be due to its ability to diminish the intracellular formation of uric acid. Conclusions/Significance Data provide consistent evidences linking uric acid with the acute renal failure induced by C. d. terrificus venom, as well as that this envenoming in mice constitutes an attractive animal model suitable for studying the hyperuricemia and that the allopurinol deserves to be clinically evaluated as an approach complementary to anti-snake venom serotherapy. PMID:21909449

Acute Generalized Exanthematous Pustulosis Due to Insect Bites?

PubMed Central

Bhat, Yasmeen J; Hassan, Iffat; Sajad, Peerzada; Yaseen, Atiya; Wani, Rohi

2015-01-01

Acute generalized exanthematous pustulosis is a rare severe cutaneous adverse reaction pattern that is mostly caused by the intake of drugs and rarely associated with viral infections, food allergens or toxins. Here we present the report of three patients who got admitted in our hospital for generalized pustulosis and fever after insect bites. The diagnosis of acute generalized exanthematous pustulosis was made by EuroSCAR scoring. The drug etiology was excluded and spider bite was implicated as the etiological agent in these cases of AGEP which are the first such reported cases in India. PMID:26288442

Surgical Orthodontic Treatment for Open Bite in Noonan Syndrome Patient: A Case Report.

PubMed

Kawakami, Masayoshi; Yamamoto, Kazuhiko; Shimomura, Tadahiro; Kirita, Tadaaki

2016-03-01

Noonan syndrome, characterized by short stature, facial anomalies, and congenital heart defects, may also be associated with hematopoietic disorders. Craniofacial anomalies in affected patients include hypertelorism and severe open bite associated with masticatory dysfunction. We treated a Noonan syndrome patient with a skeletal open bite. Surgical orthodontic treatment including two-jaw surgery established a good occlusal relationship after correction of severe anemia. Both upper and lower incisors were moved to upright positions, while clockwise rotation of the palatal plane and decreased mandibular plane angle were accomplished. Lower masticatory activity may affect posttreatment occlusion in such cases.

Rat bite fever, a fatal case of Streptobacillus moniliformis infection in a 14-month-old boy.

PubMed

Banerjee, Priya; Ali, Zabiullah; Fowler, David R

2011-03-01

Streptobacillus moniliformis is the primary cause of rat bite fever in North America. Children under 12 years of age are primarily infected, presenting with an acute syndrome of fever, rash, and polyarthritis. Common vectors include rats and mice. Transmission is predominantly from a bite or scratch, but contact with or ingestion of food contaminated with feces or saliva has also been reported. We report a fatal case of S. moniliformis infection in a 14-month-old-boy. At home, the child was exposed to filthy living conditions and the family had pet ferrets. Autopsy revealed a red-pink, mostly confluent rash and a circumscribed area suspicious for a possible bite mark. Cerebrospinal fluid cultures were positive for S. moniliformis. This case highlighted key features, such as the morbiliform rash, but lacked lymphadenopathy or joint manifestations. It is important to consider rat or rodent exposure as a source of infection. © 2011 American Academy of Forensic Sciences.

Temporal analyses of coral snakebite severity published in the American Association of Poison Control Centers' Annual Reports from 1983 through 2007.

PubMed

Walter, Frank G; Stolz, Uwe; Shirazi, Farshad; McNally, Jude

2010-01-01

The only U.S. Food and Drug Administration-approved coral snake antivenom was officially discontinued in 2007, causing ever-diminishing supplies. This study describes the severity of U.S. coral snakebites during the last 25 years to determine trends in annual rates of these bites' medical outcomes. This study retrospectively analyzed all human coral snakebites voluntarily reported by the public and/or health care professionals to poison centers that were subsequently published in the Annual Reports of the American Association of Poison Control Centers (AAPCC) from 1983 through 2007. Annual rates of medical outcomes from coral snakebites were calculated by dividing the annual number of people bitten by coral snakes who developed fatal, major, moderate, minor, or no effect outcomes by the total annual number of people bitten by coral snakes. Negative binomial regression was used to examine trends in annual rates. From 1983 through 2007, the incidence rate of coral snakebites producing no effects significantly decreased by 4.7% per year [incidence rate ratio (IRR) = 0.953; 95% confidence interval (CI) = 0.920-0.987]. From 1985 through 2007, the incidence rates of minor and major outcomes did not significantly change; however, moderate outcomes significantly increased by 3.4% per year (IRR = 1.034; 95% CI = 1.004-1.064). No fatalities were reported from 1983 through 2007. Annual rates of coral snakebites producing no effects significantly decreased and those producing moderate outcomes significantly increased in our analyses of data from the last 25 years of published AAPCC Annual Reports. This study has important limitations that must be considered when interpreting these conclusions.

[Herpetological data and management of ophidian envenomation at university hospitals in Abidjan, Côte d'Ivoire].

PubMed

Djohan, V; Menan, E I H; Yavo, W; Barro, P C K; Vanga, H; Dempah, J A; N'Dri, D K; Mignonsin, D; Akaffou, M H; Koné, K

2010-02-01

This study was carried in the intensive care units of Abidjan university hospitals and in the herpetology department of Pasteur Institute between January 2001 and April 2003. The purpose was to identify ophidian species that were dangerous for man and to document cases of snakebite in Abidjan. The study was carried out in two phases, i.e., collection and identification of snake species followed by review of case records involving snake envenomation at Cocody and Treichville university hospitals. A total of 5 snake families, 14 genera and 17 species including some that were dangerous for man were identified. All species except Naja nigricollis live in forest areas. Most snakebites led to simple clinical signs that regressed within 72 hours with only symptomatic treatment. However, a few cases required immunotherapy. Traditional methods of snakebite treatment were used for first line treatment in 50% of cases.

Breaking the Thumb Sucking Habit: When Compliance Is Essential

PubMed Central

Tanaka, Orlando; Oliveira, Wagner; Galarza, Melissa; Aoki, Vanessa; Bertaiolli, Bruno

2016-01-01

The anterior open bite (AOB) and posterior cross bite are the most frequent malocclusions associated with prolonged sucking habits. This clinical case illustrates and discusses the use of a Haas-type palatal expander for stopping a thumb sucking habit. The improvement in closing the open bite with discontinuation of the habit was observed. But with the return of the habit and lack of cooperation, the relapse of anterior open bite occurred. Therefore, different approaches are necessary. The need of a multidisciplinary approach, consent, and cooperation are keys to a good prognosis. PMID:26904311

The management of bite wounds in children--a retrospective analysis at a level I trauma centre.

PubMed

Jaindl, Manuela; Grünauer, Judith; Platzer, Patrick; Endler, Georg; Thallinger, Christiane; Leitgeb, Johannes; Kovar, Florian M

2012-12-01

Animal bite wounds are a significant problem, which have caused several preventable child deaths in clinical practice in the past. The majority of bite wounds is caused by dogs and cats, and also humans have to be considered to lead to those extreme complicated diagnosis in the paediatric patient population. Early estimation of infection risk, adequate antibiotic therapy and, if indicated, surgical treatment, are cornerstones of successful cures of bite wounds. However, antibiotic prophylaxis and wound management are discussed controversially in the current literature. In our study, we retrospectively investigated the bite source, infection risk and treatment options of paediatric bite wounds. A total of 1592 paediatric trauma patients were analysed over a period of 19 years in this retrospective study at a level I trauma centre, Department of Trauma Surgery, Medical University of Vienna, Austria. Data for this study were obtained from our electronic patient records and follow-up visits. In our database, all paediatric patients triaged to our major urban trauma centre have been entered retrospectively. During the 19-year study period, 1592 paediatric trauma patients met the inclusion criteria. The mean age was 7.7 years (range 0-18.9), 878 (55.2%) were males and 714 (44.8%) were females. In our study population, a total of 698 dog bites (43.8%), 694 human bites (43.6%), 138 other bites (8.7%) and 62 cat bites (3.9%) have been observed. A total of 171 wounds (10.7%) have been infected. Surgical intervention was done in 27 wounds (1.7%). Gender-related incidence in bite wounds for dog and cat could be detected. Second, our findings for originator of bite wounds reflect the findings in the published literature. Total infection rate reached 10.7%, primary antibiotic therapy was administered in 221 cases (13.9%) and secondary antibiotic therapy in 20 (1.3%) cases. Observed infection rate of punctured wounds and wounds greater than 3 cm was 3 times higher than for all other wounds. Our findings need to be proven in further prospective clinical trials. Copyright © 2012 Elsevier Ltd. All rights reserved.

Emerging fungal pathogen Ophidiomyces ophiodiicola in wild European snakes.

PubMed

Franklinos, Lydia H V; Lorch, Jeffrey M; Bohuski, Elizabeth; Rodriguez-Ramos Fernandez, Julia; Wright, Owen N; Fitzpatrick, Liam; Petrovan, Silviu; Durrant, Chris; Linton, Chris; Baláž, Vojtech; Cunningham, Andrew A; Lawson, Becki

2017-06-19

Snake fungal disease (SFD) is an emerging disease of conservation concern in eastern North America. Ophidiomyces ophiodiicola, the causative agent of SFD, has been isolated from over 30 species of wild snakes from six families in North America. Whilst O. ophiodiicola has been isolated from captive snakes outside North America, the pathogen has not been reported from wild snakes elsewhere. We screened 33 carcasses and 303 moulted skins from wild snakes collected from 2010-2016 in Great Britain and the Czech Republic for the presence of macroscopic skin lesions and O. ophiodiicola. The fungus was detected using real-time PCR in 26 (8.6%) specimens across the period of collection. Follow up culture and histopathologic analyses confirmed that both O. ophiodiicola and SFD occur in wild European snakes. Although skin lesions were mild in most cases, in some snakes they were severe and were considered likely to have contributed to mortality. Culture characterisations demonstrated that European isolates grew more slowly than those from the United States, and phylogenetic analyses indicated that isolates from European wild snakes reside in a clade distinct from the North American isolates examined. These genetic and phenotypic differences indicate that the European isolates represent novel strains of O. ophiodiicola. Further work is required to understand the individual and population level impact of this pathogen in Europe.

Injuries due to human and animal aggression in humans.

PubMed

Łabęcka, Marzena; Lorkiewicz-Muszyńska, Dorota E; Przystańska, Agnieszka; Kondrusiewicz, Krzysztof

2013-01-01

People breed animals, professionally take care of them, and work with them. To live with animals, however, it is necessary to know their behaviour and habits, as well as fears. Ignorance of this knowledge may lead to tragedy for the victim (a person), as well as for the beast (animal). Then, nobody cares whether the animal behaved itself or not in accordance with its nature. The aim of the presented study is to compare the rate of animal aggression in relation to cases of documented aggression towards humans. The victims were investigated according to the age, gender and types of injuries caused by animal bites. The protocols of autopsies (2,218) and medical-legal examinations (4,569) performed from 2004-2009 in the Department of Forensic Sciences in Poznań were analyzed. The selected data was studied using Microsoft Office Excel 2007 for Windows. Analysis revealed the presence of animal bite injuries in less than 1% of the deceased victims of aggression. The number of individuals who died as a result of animal bites varied from 1-4 a year, and in all cases these were postmortem injuries. Analysis of injuries among surviving victims of aggression showed animal bite injuries were present in 41 out of 4,569 victims, almost equally among males and females. Moreover, in 25 victims the bite injuries recognized as human were found. The majority of animal bites occurred in adults. The medium injuries were the most frequent in the animal bite victims. Animal aggression is a marginal problem considering all cases of aggression towards humans. In contrast to the aggression of humans towards other humans, this is a very rare cause of human death or even major injury.

Dystocia in a snake.

PubMed

Peters, A R; Coote, J

1977-05-14

Herpetology is a rapidly growing interest in this country, reptiles being kept both for research purposes and as pets. However, there is a lack of literature on reptilian medicine and surgery; the authors know of only one available text (Frye 1973). Furthermore, there are only two published case histories of dystocia in the snake (Huff 1976, Hime 1976) and thus this case was considered to be of particular interest.

A fatal bite from the burrowing asp Atractaspis corpulenta (Hallowell 1854).

PubMed

Tilbury, Colin R; Verster, Janette

2016-08-01

Bites from the various species of Atractaspis are a common occurrence in Africa but deaths are very unusual. Of the 19 described species, the clinical effects of the bite of only seven have been described, and in only three (Atractaspis irregularis, Atractaspis microlepidota and Atractaspis engaddensis) have fatalities been documented. A case of envenomation is described following a bite to a finger by Atractaspis corpulenta, which resulted in sudden death approximately two and a half hours later. The victim received antivenom and although anaphylaxis to this cannot be ruled out, we consider it to be unlikely to be the cause of death. A late autopsy was performed and the findings and their interpretation are discussed. The previous case fatalities, toxic fractions and clinical effects of Atractaspis venom are briefly reviewed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of risk and protective factors for work-related bite injuries to veterinary technicians certified in Minnesota.

PubMed

Nordgren, Leslie D; Gerberich, Susan G; Alexander, Bruce H; Church, Timothy R; Bender, Jeff B; Ryan, Andrew D

2014-08-15

To identify risk and protective factors for work-related bite injuries among veterinary technicians certified in Minnesota. Nested case-control study. 868 certified veterinary technicians (CVTs). A questionnaire was mailed to CVTs who previously participated in a survey regarding work-related injuries and did (cases; 301 surveys sent) or did not (controls; 567) report qualifying work-related animal bite injuries in the preceding 12 months. Descriptive statistics were summarized. Demographic and work-related variables for the month preceding the bite injury (for cases) or a randomly selected month (controls) were assessed with univariate analysis (489 CVTs) and multivariate analysis of a subset of 337 CVTs who worked in small or mixed mostly small animal facilities. Responses were received from 176 case and 313 control CVTs. For the subset of 337 CVTs, risk of bite injury was higher for those < 25 years of age (OR, 3.82; 95% confidence interval [CI], 1.84 to 7.94) than for those ≥ 35 years of age, for those who had worked < 5 years (OR, 3.24; 95% CI, 1.63 to 6.45) versus ≥ 10 years in any veterinary facility, and for those who handled ≥ 5 species/d (OR, 1.99; 95% CI, 1.06 to 3.74) versus < 3 species/d. Risk was lower for CVTs who handled < 10 versus ≥ 20 animals/d (OR, 0.23; 95% CI, 0.08 to 0.71). Several work-related factors were associated with the risk of work-related bite injury to CVTs. These findings may serve as a basis for development of intervention efforts and future research regarding work-related injuries among veterinary staff.

Household exposure and animal-bite surveillance following human rabies detection in Southern Ghana

PubMed Central

Afakye, Kofi; Kenu, Ernest; Nyarko, Kofi Mensah; Johnson, Sherry Ama Mawuko; Wongnaah, Florence; Bonsu, George Kwame

2016-01-01

Introduction Rabies remains a neglected tropical zoonotic disease with 100% case fatality rate and estimated 6,000 global mortality annually, and yet vaccine preventable. In Ghana, rabies outbreaks receive poor response. We investigated rabies in a 5-year old boy to find the source of infection, identify exposed persons for post-exposure prophylaxis and describe animal-bite surveillance in Manya-Krobo District of Ghana. Methods We actively searched for cases and exposures by interviewing household members of the victim, schoolmates, and health professionals using WHO case definition, interview guide and checklist. We reviewed health and veterinary records and reports, and interviewed stakeholders. Descriptive data analyses were carried out and presented using tables and charts. Recorded responses were transcribed into thematic areas and analysed. Results Child had dog-bite at the wrist, and developed hyperactivity, hydrophobia and hyperventilation 2 months post bite. He was hospitalised and died from respiratory failure day 3 after admission. Thirty-three persons were exposed to rabies infectious material. Females were 66%, age-groups 5-15yrs and 30-59 yrs were 33.3% and 39.4% respectively. A third (11/33) were category II exposure by WHO classification and were recommended for post-exposure prophylaxis. Surveillance records showed ninety-two animal-bite cases were reported for past 12 months. Half were females, and 18-59yrs age-group was 43%. Surveillance data quality was poor. Conclusion Rabies remains a public health burden inGhana with domestic dog as reservoir of the virus and females more vulnerable to secondary exposures. Health education on rabies should be intensified, and robust animal-bite surveillance system put in place. PMID:28149437

Sphero-echinocytosis of human red blood cells caused by snake, red-back spider, bee and blue-ringed octopus venoms and its inhibition by snake sera.

PubMed

Flachsenberger, W; Leigh, C M; Mirtschin, P J

1995-06-01

It was found that bee (Apis mellifera) venom, red-back spider (Latrodectus mactans) venom, blue-ringed octopus (Hapalochlaena maculosa) venom, ten different snake venoms, phospholipase A2 and four snake toxins caused sphero-echinocytosis of human red blood cells at 200 ng/ml. Most venoms and toxins lost the ability to deform human red blood cells when their components of less than mol. wt 10,000 were applied. In a number of cases the sphero-echinocytotic effect was also inhibited by blood sera of Notechis scutatus and Pseudonaja textilis.

Necrotizing fasciitis due to Streptococcus mitis caused by accidental human bite.

PubMed

Bastug, Aliye; Kislak, Sumeyye; Mutlu, Nevzat Mehmet; Akcaboy, Zeynep Nur; Koksal, Asude; Sertcelik, Ahmet; Ünlü, Ramazan Erkin; Akinci, Esragul; Bodur, Hurrem

2016-01-31

Human bite wounds are more prone to infection than animal bites, which may cause necrotizing soft tissue infections such as myositis, fasciitis. Both aerobic and anaerobic microorganisms may be responsible, including Streptococcus spp., Staphylococcus aureus, Peptostreptococcus spp. Necrotizing fasciitis is characterized by serious tissue destruction and systemic toxicity with high morbidity and mortality. We report a patient with Streptococcus mitis associated necrotizing fasciitis on the upper extremity resulting from an accidental human bite, which caused nearly fatal infection. Prophylactic antibiotic treatment should be given after a human bite to prevent infection. If the infection signs and symptoms develop, rapid diagnosis, appropriate antibiotic and surgical therapy should be administered immediately. Streptococcus mitis is a viridans streptococcus, usually known as a relatively benign oral streptococcus. To our knowledge, this is the first necrotizing fasciitis case due to Streptococcus mitis after human bite.

Identification of snake arenaviruses in live boas and pythons in a zoo in Germany.

PubMed

Aqrawi, T; Stöhr, A C; Knauf-Witzens, T; Krengel, A; Heckers, K O; Marschang, R E

2015-01-01

Recent studies have described the detection and characterisation of new, snake specific arenaviruses in boas and pythons with inclusion body disease (IBD). The objective of this study was to detect arenaviral RNA in live snakes and to determine if these were associated with IBD in all cases. Samples for arenavirus detection in live animals were compared. Detected viruses were compared in order to understand their genetic variability. Esophageal swabs and whole blood was collected from a total of 28 boas and pythons. Samples were tested for arenaviral RNA by RT-PCR. Blood smears from all animals were examined for the presence of inclusion bodies. Internal tissues from animals that died or were euthanized during the study were examined for inclusions and via RT-PCR for arenaviral RNA. All PCR products were sequenced and the genomic sequences phylogenetically analysed. Nine live animals were found to be arenavirus-positive. Two additional snakes tested positive following necropsy. Five new arenaviruses were detected and identified. The detected viruses were named "Boa Arenavirus Deutschland (Boa Av DE) numbers 1-4" and one virus detected in a python (Morelia viridis) was named "Python Av DE1". Results from sequence analyses revealed considerable similarities to a portion of the glycoprotein genes of recently identified boid snake arenaviruses. Both oral swabs and whole blood can be used for the detection of arenaviruses in snakes. In most cases, but not in all, the presence of arenaviral RNA correlated with the presence of inclusions in the tissues of infected animals. There was evidence that some animals may be able to clear arenavirus infection without development of IBD. This is the first detection of arenaviruses in live snakes. The detection of arenaviruses in live snakes is of importance for both disease detection and prevention and for use in quarantine situations. The findings in this study support the theory that arenaviruses are the cause of IBD, but indicate that in some cases it may be possible for animals to clear arenavirus infections without developing IBD.

A verified spider bite and a review of the literature confirm Indian ornamental tree spiders (Poecilotheria species) as underestimated theraphosids of medical importance.

PubMed

Fuchs, Joan; von Dechend, Margot; Mordasini, Raffaella; Ceschi, Alessandro; Nentwig, Wolfgang

2014-01-01

Literature on bird spider or tarantula bites (Theraphosidae) is rare. This is astonishing as they are coveted pets and interaction with their keepers (feeding, cleaning the terrarium or taking them out to hold) might increase the possibility for bites. Yet, this seems to be a rare event and might be why most theraphosids are considered to be harmless, even though the urticating hairs of many American species can cause disagreeable allergic reactions. We are describing a case of a verified bite by an Indian ornamental tree spider (Poecilotheria regalis), where the patient developed severe, long lasting muscle cramps several hours after the bite. We present a comprehensive review of the literature on bites of these beautiful spiders and conclude that a delayed onset of severe muscle cramps, lasting for days, is characteristic for Poecilotheria bites. We discuss Poecilotheria species as an exception from the general assumption that theraphosid bites are harmless to humans. Copyright © 2013 Elsevier Ltd. All rights reserved.

Snakebite Survivors Club: retrospective review of rattlesnake bites in Central California.

PubMed

Spano, Susanne; Macias, Fernando; Snowden, Brandy; Vohra, Rais

2013-07-01

We investigated clinical patterns of crotaline envenomation presenting to a tertiary-care academic hospital in Central California over a 10-year period. An IRB-approved, retrospective chart review was conducted on all patients diagnosed with snakebite from December 2000 to December 2010. Data abstracted: demographics, anatomic location of bite, comorbid conditions and intoxicants, length of stay, antivenom dose, laboratory results, and complications or procedures. There were 46 snakebite cases admitted over the study period. Five were "dry bites"; the remaining cases (41/46) received antivenom. There was a male predominance (83% male victims). Upper extremity bites were more common (32/41 upper vs 10/42 lower extremity). One victim sustained bilateral bites to the hands. Thirty-five patients (85%) were admitted, with an average length of stay 2.12 days. The longest hospitalization was 15 days. There were no fatalities. The average time from bite to ED presentation was 2 h 44 min. Bites occurred during every month except November, with the majority occurring during spring and summer months and peaking in June (12/42 cases). Most bites occurred in the hours between noon and 8 pm. The amount of antivenom given ranged from 2 to 35 vials (average, 9 vials). Interfacility transfers were common in our study population: thirteen (32%) patients were transferred into our emergency department for a higher level of care, and 3 (7%) were transferred out (two because of insurance requirements, and one for higher level of Pediatric ICU care). There were no surgical interventions in our study group. Intoxication did not appear to play a major role in this population as only 3 patients (7%) were found to be acutely intoxicated: one with cannabis and amphetamines, 1 with alcohol, and 1 with opioids. In Central California, crotaline envenomations occurred mainly in adult males. Dry bites, or bites not requiring antivenom administration, were uncommon, comprising only 10% of bites in this study population. Contrary to popular and clinical beliefs, substance abuse and/or alcohol intoxication did not appear to play a role in the majority of patients in this study. Care providers and snakebite specialists should be aware that snakebite patients are often transferred between facilities, a finding that may be useful in designing future first aid protocols and research. We hope these findings add concrete data and help correct some common misconceptions about snakebites in Central California. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Management of the yellow fever epidemic in 2010 in Séguéla (Côte d'Ivoire): value of multidisciplinary investigation].

PubMed

Konan, Yao Lucien; Coulibaly, Zanakoungo Ibrahima; Allali, Kouadio Bernard; Tétchi, Sopi Mathilde; Koné, Atioumounan Blaise; Coulibaly, Daouda; Ekra, Kouadio Daniel; Doannio, Julien Marie Christian; Oudéhouri-Koudou, Paul

2014-01-01

In August 2010, five positive cases of yellow fever were reported in the region of Séguéla, in the northwest of Côte d'Ivoire, affected by an armed conflict since 2002. In order to evaluate the extent of yellow fever virus circulation and the risk for local people, a multidisciplinary investigation was carried out by the Côte-d'Ivoire Ministry of Health and Public Hygiene. Theses investigations were conducted in the villages of confirmed cases and the outpatient and hospitalization centers attended by infected patients, two weeks after the reactive immunization campaign performed in order to stop the spread of the epidemic. The search for suspects identified 16 cases, including 4 cases and 2 deaths in hospital registers and 12 cases during community interviews, including 6 deaths. Stegomyiens indices were relatively low. Aedes aegypti was present among adult mosquitoes. In addition, three wild vectors, varying in number from one locality to another, were detected: Ae. africanus, Ae. luteocephalus and Ae. vittatus with average biting rates of 0.3; 0.1 and 0.05 bite/man/twilight, respectively, at Soba, Ae. africanus and Ae. vittatus with average biting rates of 0.25 and 0.3 bite/man/twilight, respectively, at Yaokro and Ae. luteocephalus with one bite/man/twilight at Kaborékro. Unfortunately, the vaccine response conducted before investigations did not stop progression of the epidemic which broke out three months later in the Worofla health area, close to the Magrékros encampment.

Clinical and epidemiological features of human rabies cases in the Philippines: a review from 1987 to 2006.

PubMed

Dimaano, Efren M; Scholand, Stephen J; Alera, Maria Theresa P; Belandres, Domingo B

2011-07-01

Rabies viral infection causes a fatal encephalomyelitis. In humans, classic features include hydrophobia, aerophobia, hypersalivation, agitation, and neurological symptoms. In the Philippines, canine rabies contributes to a significant burden of human disease. We retrospectively reviewed the medical records of 1839 patients admitted to San Lazaro Hospital, Manila, Philippines between 1987 and 2006, with a clinical diagnosis of rabies. We used the World Health Organization case definition for clinical rabies, which is defined by the presence of hydrophobia. Male patients outnumbered females by 2.2 to 1 and twice the number of adults were affected compared with children. Most patients were indigent. Dog bites occurred more than cat bites (97.1% vs. 2.9%) and most cases were caused by a single bite (86.2%), compared to multiple bites (8.7%). Bites to the face, head, and neck led to shorter incubation times, yet the incubation period varied, with most cases (42.7%) occurring in the bracket of 91-365 days post-exposure. Clinical symptoms included hydrophobia in all cases, as per our case definition, and aerophobia in 95.5%; only 9.4% had fever, 9.2% exhibited restlessness, and 6.7% exhibited hypersalivation. Localized neurological symptoms included pain (4.1%), numbness (2.6%), and itching (2.3%). None of the patients received appropriate post-exposure prophylaxis (PEP). This study examines the largest cohort of rabies patients reported to-date. Better understanding of clinical disease manifestations may help in salvage efforts to save patients with rabies. Knowledge of epidemiological factors will improve preventative efforts to reduce suffering from rabies. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Rat bite fever without fever.

PubMed

Stehle, P; Dubuis, O; So, A; Dudler, J

2003-09-01

Rat bite fever is a rarely reported acute febrile bacterial illness caused by Streptobacillus moniliformis or Spirillum minus following a rat bite. It is classically characterised by abrupt onset of fever with rigors, myalgias, headache, and the appearance of a generalised maculopapular petechial skin rash. Polyarthritis complicates the course of the disease in up to 50% of infected patients, and numerous hurdles can make the diagnosis particularly difficult in the absence of fever or rash, as in the present case. A high degree of awareness is necessary to make the correct diagnosis in such cases. Diagnosis has important prognostic implications as the disease is potentially lethal, but easily treatable.

[Risk and circumstances in which people are bitten by dogs in Cracow-- observations from the Consulting Clinic of Infectious Diseases].

PubMed

Garlicki, A; Caban, J; Krukowiecki, J

1996-01-01

Inquiries about incidence of bites people by dogs have been made in the Consulting Ward for prophylactics of rabies of Chair and Department of Infectious Diseases in Cracow. There are frequent cases of people bitten by dogs, which usually occur in the streets. Victims are usually young. In the most cases there are not connection between victim's behavior and incidence. Dogs however bite without an understandable reasons frequently when they are controlled by their owners. The owners of the dogs often are not aware of their responsibility to prevent their dogs from biting passers-by.

Black widow spider bite: a case study.

PubMed

Gaisford, Kristine; Kautz, Donald D

2011-01-01

This article is a case study of a patient cared for in the hours before her death. After the patient's death, we learned the patient died of a black widow spider bite. This article sheds light on the potential seriousness of this venom and allows for more rapid detection and treatment of those who are unfortunate enough to be bitten. The authors have documented the sequence of events for the patient, outlined the care the patient received, examined the pathophysiology of the body to a spider bite, and then made a passionate appeal for other nurses who work in critical care to do the same with patients in similar situations.

A study of snake-like locomotion through the analysis of a flexible robot model

PubMed Central

Cicconofri, Giancarlo; DeSimone, Antonio

2015-01-01

We examine the problem of snake-like locomotion by studying a system consisting of a planar inextensible elastic rod with adjustable spontaneous curvature, which provides an internal actuation mechanism that mimics muscular action in a snake. Using a Cosserat model, we derive the equations of motion in two special cases: one in which the rod can only move along a prescribed curve, and one in which the rod is constrained to slide longitudinally without slipping laterally, but the path is not fixed a priori (free-path case). The second setting is inspired by undulatory locomotion of snakes on flat surfaces. The presence of constraints leads in both cases to non-standard boundary conditions that allow us to close and solve the equations of motion. The kinematics and dynamics of the system can be recovered from a one-dimensional equation, without any restrictive assumption on the followed trajectory or the actuation. We derive explicit formulae highlighting the role of spontaneous curvature in providing the driving force (and the steering, in the free-path case) needed for locomotion. We also provide analytical solutions for a special class of serpentine motions, which enable us to discuss the connection between observed trajectories, internal actuation and forces exchanged with the environment. PMID:26807040

Clinical Features of Idiopathic Parotid Pain Triggered by the First Bite in Japanese Patients with Type 2 Diabetes: A Case Study of Nine Patients.

PubMed

Chiba, Masatoshi; Hirotani, Hiroaki; Takahashi, Tetsu

2018-01-01

First bite syndrome, characterized by pain in the parotid region after the first bite of each meal, predominantly develops in patients who have had head and neck surgery. Idiopathic parotid pain (IPP) that mimics first bite syndrome may present in patients without a history of surgery or evidence of an underlying tumor, but its clinical features are unclear. This study characterized the clinical characteristics of IPP in patients with diabetes. A retrospective case review involving the clinical findings and pain characteristics of nine patients with IPP and diabetes who presented to our department between 2013 and 2016. All the patients were men diagnosed with type 2 diabetes (median age, 43 years). IPP developed unilaterally in seven patients and bilaterally in two. The median intensity of the first bite pain was 8 on a numerical rating scale of 0-10. The trigger factor was gustatory stimuli, and the trigger area was the posterior section of the tongue. Postprandial pain occurred within 1-10 min after meals in six patients. IPP may be considered a separate disorder, in which the pain characteristics are similar to those of first bite syndrome but the clinical features and pathophysiology are different.

Clinical Features of Idiopathic Parotid Pain Triggered by the First Bite in Japanese Patients with Type 2 Diabetes: A Case Study of Nine Patients

PubMed Central

Hirotani, Hiroaki; Takahashi, Tetsu

2018-01-01

Objective First bite syndrome, characterized by pain in the parotid region after the first bite of each meal, predominantly develops in patients who have had head and neck surgery. Idiopathic parotid pain (IPP) that mimics first bite syndrome may present in patients without a history of surgery or evidence of an underlying tumor, but its clinical features are unclear. This study characterized the clinical characteristics of IPP in patients with diabetes. Study Design A retrospective case review involving the clinical findings and pain characteristics of nine patients with IPP and diabetes who presented to our department between 2013 and 2016. Results All the patients were men diagnosed with type 2 diabetes (median age, 43 years). IPP developed unilaterally in seven patients and bilaterally in two. The median intensity of the first bite pain was 8 on a numerical rating scale of 0–10. The trigger factor was gustatory stimuli, and the trigger area was the posterior section of the tongue. Postprandial pain occurred within 1–10 min after meals in six patients. Conclusions IPP may be considered a separate disorder, in which the pain characteristics are similar to those of first bite syndrome but the clinical features and pathophysiology are different. PMID:29796314

Use of forensic analysis to better understand shark attack behaviour.

PubMed

Ritter, E; Levine, M

2004-12-01

Shark attacks have primarily been analyzed from wound patterns, with little knowledge of a shark's approach, behaviour and intention leading to such wounds. For the first time, during a shark-human interaction project in South Africa, a white shark, Carcharodon carcharias, was filmed biting a vertically positioned person at the water surface, and exhibiting distinct approach patterns leading to the bite. This bite was compared to ten white shark attacks that occurred (i) in the same geographical area of South Africa, and (ii) where the same body parts were bitten. Close similarity of some of these wound patterns to the bite imprint of the videotaped case indicate that the observed behaviour of the white shark may represent a common pattern of approaching and biting humans.

A preliminary study of EAT and BITE scores for one school year in Bermuda: increased early anorexic measures related to socio-economic factors.

PubMed

Marlowe, Karl

2005-03-01

Bermuda is a unique heterogeneous ethnic population in which it is possible to study the interaction of ethnicity, culture, gender and economic factors that influence abnormal eating attitudes. A cross-sectional survey of 836 adolescents, one total school year in Bermuda. The BITE and EAT self-report questionnaires were administered in a classroom setting. The analysis was for caseness and for total scores. Caseness represents possible developing anorexic or bulimic eating disorder pathology for this non-adult population. 7.3% fulfilled EAT caseness, 0.24% fulfilled BITE caseness. There was no gender or ethnic difference for caseness. Multivariate analysis for EAT caseness found Odds Ratios of 2.89 (95% CI 1.37, 6.11) for Manual maternal job status. Despite the limitation of a questionnaire analysis, lower socioeconomic status increases the risk of possible eating disorder pathology in this adolescent population. Developing anorexic eating attitudes were more prevalent compared to bulimic attitudes for schoolchildren in this unique cultural setting.

[Canine and human rabies in Conakry: epidemiology and preventive aspects].

PubMed

Youla, A S; Traore, F A; Sako, F B; Feda, R M; Emeric, M A

2014-02-01

In Guinea, stray dogs are present in large numbers in public places and around landfills. The objectives of this study were to determine the frequency of human exposure to rabies risk, the cases of human and canine rabies and to describe the epidemiological profile of the cases. This retrospective and descriptive study was conducted in health and veterinarian facilities within the city of Conakry. All records of patients admitted in these facilities because of animal bites and veterinary records for aggression by domestic animals from 2002 to 2012, so, during an 11-year period, were collected. During the study period, 7 994 people were concerned by domestic animal bites. Males were the most affected with 60.4% of all cases. Students represented the higher class with 36.0%, followed by workers (18%). The majority of injuries were to the lower limbs (54.4%). The dog has been implicated in the attacks in 98.8% of cases. Among the 2 916 biting dogs which were placed under observation, 14 developed clinical rabies. Among those assaulted, 11 cases of rabies were reported. From 7 994 victims of domestic animal bites, 2 634 received post-exposure prophylaxis and the dropout rate was 51%. Rabies is a real risk in Conakry. Provisions in terms of public health strategy must be taken to minimize it.

A localizing circumferential compression device increases survival after coral snake envenomation to the torso of an animal model.

PubMed

Hack, Jason B; Deguzman, Jocelyn M; Brewer, Kori L; Meggs, William J; O'Rourke, Dorcas

2011-07-01

Pressure immobilization bandages have been shown to delay onset of systemic toxicity after Eastern coral snake (Micrurus fulvius) envenomation to the distal extremity. To assess the efficacy of a novel compression device in delaying onset of systemic toxicity after truncal envenomations with Eastern coral snake (Micrurus fulvius) venom in a porcine model. With University approval, nine juvenile pigs (11 kg to 22 kg) were sedated, anesthetized, and intubated but not paralyzed to ensure continuous spontaneous respirations in a university animal laboratory. Each animal was injected subcutaneously with 10 mg of M. fulvius venom in a pre-selected area of the trunk. After 1 min, six animals had the application of a novel, localizing circumferential compression (LoCC) device applied to the bite site (treatment group) and three animals had no treatment (control group). The device was composed of a rigid polymer clay form molded into a hollow fusiform shape with an internal dimension of 8 × 5 × 3 cm and an elastic belt wrapped around the animal securing the device in place. Vital signs were recorded at 30-min intervals. End points included a respiratory rate below 3 breaths/min, oxygen saturation < 80%, or survival to 8 h. Survival to 8 h was analyzed using Fisher's exact test, with p < 0.05 indicating significance. Survival analysis was performed using the Mantel-Cox test to assess time to death with outcomes represented in a Kaplan-Meier Cumulative survival plot. Five of the six pigs in the treatment group survived 8 h (293-480 min). None of the control pigs survived to 8 h (Fisher's exact p = 0.04), with mean time of respiratory failure 322 min (272-382 min). Survival analysis showed a significant delay in time to event in the treatment group compared to the control group (p = 0.04). The LoCC device used in this study delayed the onset of systemic toxicity and significantly increased survival time after artificial truncal envenomation by Eastern coral snake venom. Copyright © 2011 Elsevier Inc. All rights reserved.

Condylar position analysis with a new electronic condylar position measuring instrument E-CPM: influence of different examiners and a working bite on reproducibility.

PubMed

Vahle-Hinz, K; Rybczynski, A; Jakstat, H; Ahlers, M O

2009-01-01

Condylar position analysis facilitates a quantitative comparison of the condylar position with and without a bite record, different records and changed influencing factors. Handling by the examiner when positioning the model is a significant factor with regard to the accuracy of the examination. Measurement accuracy could be improved when positioning the models by using special working bites, hence the objective of the experiments described in this study consisted in examining the extent to which the measuring results are influenced by different examiners and by using working bites. In the first trial, one examiner performed ten measurements without and with an interposed working bite for five model pairs in each case. In the second trial, nine examiners (three specialized dentists, three dental assistants, three students) performed ten measurements in each case without and with an interposed working bite. The three-dimensional position was read digitally with the E-CPM (Gamma Dental, Klosterneuburg/Vienna, Austria), recorded by means of spreadsheet software (Microsoft Excel) and diagnostic software (CMDfact, CMD3D module, dentaConcept, Hamburg), and evaluated with graphing software (Sigma Plot, Systat Software, USA). In the first trial, it was shown that the reproducibility of mounting was improved markedly (p <0.01) by using bite records in the form of working bites. In the second trial, it was shown that the mean error increased significantly (p <0.01) when several examiners performed the measurements compared with the results of one examiner alone. No significantly different results occurred (p < 0.01) in the comparison of the different groups of examiners with different educational and training backgrounds. This applied for the mounting methods without and with working bite. On the other hand, the reproducibility of mounting improved distinctly (p<0.01) in every group of examiners when working bites were used. Reproducibility of condylar position analysis was improved significantly by mounting the models with special working bites. This applied for operators of different professional background (dentists, dental assistants and dental students), while there were no significant differences between results of the three groups.

Emerging fungal pathogen Ophidiomyces ophiodiicola in wild European snakes

USGS Publications Warehouse

Franklinos, Lydia H. V.; Lorch, Jeffrey M.; Bohuski, Elizabeth A.; Rodriguez-Ramos Fernandez, Julia; Wright, Owen; Fitzpatrick, Liam; Petrovan, Silviu; Durrant, Chris; Linton, Chris; Baláž, Vojtech; Cunningham, Andrew A; Lawson, Becki

2017-01-01

Snake fungal disease (SFD) is an emerging disease of conservation concern in eastern North America. Ophidiomyces ophiodiicola, the causative agent of SFD, has been isolated from over 30 species of wild snakes from six families in North America. Whilst O. ophiodiicola has been isolated from captive snakes outside North America, the pathogen has not been reported from wild snakes elsewhere. We screened 33 carcasses and 303 moulted skins from wild snakes collected from 2010–2016 in Great Britain and the Czech Republic for the presence of macroscopic skin lesions and O. ophiodiicola. The fungus was detected using real-time PCR in 26 (8.6%) specimens across the period of collection. Follow up culture and histopathologic analyses confirmed that both O. ophiodiicola and SFD occur in wild European snakes. Although skin lesions were mild in most cases, in some snakes they were severe and were considered likely to have contributed to mortality. Culture characterisations demonstrated that European isolates grew more slowly than those from the United States, and phylogenetic analyses indicated that isolates from European wild snakes reside in a clade distinct from the North American isolates examined. These genetic and phenotypic differences indicate that the European isolates represent novel strains of O. ophiodiicola. Further work is required to understand the individual and population level impact of this pathogen in Europe.

Epidemiological characteristics, hospital course and outcome of snakebite victims in West Texas.

PubMed

Abbey, James M; Jaffar, Nabil A; Abugrara, Hazem L; Nazim, Muhammad; Smalligan, Roger D; Khasawneh, Faisal A

2015-01-01

Numerous snakebites are reported every spring and summer in the United States especially in the Southwestern part of the country. This is usually associated with significant morbidity but fatalities are rare. Most victims are male and the majority of bites are on the extremities. A search for all cases coded with a discharge diagnosis of snakebite injury revealed 90 patients admitted to Northwest Texas Hospital, the trauma center in Amarillo, Texas, between January 2002 and December 2012. These charts were retrospectively reviewed and data extracted including patient demographics, severity of snakebite, treatment given, and ultimate outcome. Ninety patients were admitted to the hospital due to snakebite. It was a rattlesnake in 83 cases. The mean age of the victims was 29.7 years and 74 of them were male. Fifty-one bites were on the upper extremities, thirty-eight bites were on the lower extremities and one bite was on the abdominal wall. About 95% of the lower extremity bites were moderate or severe compared to 74.5% of the upper extremity bites, Cramer's coefficient 0.3, p=0.02. Thirty-one patients had complications and twenty patients required surgical intervention. Eighty-eight patients received a median of 10 vials of antivenin that was well tolerated. Median hospital length of stay was 3 days. None of the patients died. Rattlesnake bites cause significant morbidity although mortality is rare. Early administration of antivenin and appropriate supportive measures and monitoring for complications with surgical intervention when needed leads to improved patient outcomes.

First bite syndrome: our experience of laser tympanic plexus ablation.

PubMed

Amin, N; Pelser, A; Weighill, J

2014-02-01

First bite syndrome is a condition characterised by severe facial pain brought on by the first bite of each meal. This can severely affect the patient's ability to eat. We present a 70-year-old woman for whom we performed a laser ablation of the left ear tympanic plexus, as treatment of first bite syndrome. A permeatal approach was used to raise a tympanomeatal flap. The tympanic plexus was identified on the promontory and a 4 mm2 area of the plexus was ablated using CO2 laser. The flap was repositioned and a dressing was placed with topical antibiotics. At two-month follow up, there was full resolution of the patient's symptoms. First bite syndrome carries a high morbidity; treatment options are variable, and often unsuccessful. We describe the first documented case of laser tympanic plexus ablation, with a very effective initial response. This procedure represents a useful therapeutic option for first bite syndrome.

Ulceroglandular tularemia in a toddler in Germany after a mosquito bite.

PubMed

Hanke, Christof A; Otten, Joerg-Elard; Berner, Reinhard; Serr, Annerose; Splettstoesser, Wolf; von Schnakenburg, Christian

2009-08-01

Although tularemia is a long-known disease, its significance had diminished over the last decades in Middle Europe. However, over the past years, there is new evidence suggesting that tularemia has re-emerged in Germany. In 2007, the highest number of human cases for almost 50 years has been notified. Beside typical vectors, new ways of transmission seem to gain significance. So far, mosquito bite-transmitted tularemia has only been known from Scandinavia but not from Middle Europe. We report the first case of a 1-year-old toddler from Southwestern Germany with mosquito bite-associated ulceroglandular tularaemia. The new and interesting features of this case are the young age of the patient and the unusual transmission route. The available data suggesting changes in the epidemiology for tularemia in Germany are reviewed. This is an interesting case of infantile tularemia with a very unusual transmission route, highlighting ongoing changes in the epidemiology of tularemia in Germany.

Management of severe anterior open-bite in an adult patient using miniscrews as skeletal anchorage.

PubMed

Rachala, Madhukar Reddy; Harikrishnan, Pandurangan

2010-01-01

Anterior open bite is often caused by a downward rotation of the mandible and/or by excessive eruption of the posterior teeth. In such cases, it is difficult to establish absolute anchorage for molar intrusion by traditional orthodontic mechanics. This is a case report of successful treatment of a severe anterior open bite using miniscrew anchorage. A female patient of 20 yrs presented with symmetrical frontal facial appearance, increased anterior facial height, convex profile and incompetent lips. Dentally, she had lost both mandibular first molars due to caries and both maxillary first molars were extruded. She had class II canine relationship, 5 mm overjet, 5 mm anterior open bite, 3 mm mandibular midline diastema and a spacing of 2 mm in the maxillary arch. The treatment objectives were to correct the anterior open bite and establish ideal overjet and overbite and to restore the mandibular first molars with fixed prosthesis. Titanium miniscrews (1.3 mm diameter and 9 mm length) were implanted bilaterally in the maxillary arch between the second premolar and the first molar, and an intrusion force was applied with NiTi closed coil springs for 8 months. After molar intrusion, the same screws were used for en masse retraction of the entire dentition (third molars were extracted) for 4 months. The results showed that, after an active treatment of 20 months, the maxillary molars were intruded about 4 mm each and good occlusion was achieved. In conclusion, the miniscrews were very useful in the non-surgical management of adult anterior open bite cases.

Chemosensory age discrimination in the snake Boa constrictor (Serpentes: Boidae).

PubMed

Gabirot, Marianne; Picerno, Pablo; Valencia, Jorge; Lopez, Pilar; Martin, José

2012-12-01

Many snakes are able to use their chemosensory system to detect scent of conspecifics, which is important in many social contexts. Age discrimination based on chemical cues may be especially important to ensure access to sexually mature potential partners. In this study, we used 24 individual Boa constrictor snakes (12 adults mature and 12 non-mature individuals) that had been captured in different areas of Ecuador, and were maintained in captivity at the Vivarium of Quito. We used tongue-flick experiments to examine whether these snakes were able to discriminate between scents from mature and non-mature individuals. Results showed that B. constrictor snakes used chemical cues to recognize conspecifics and that the scent of individuals of different ages elicited chemosensory responses of different magnitudes. The scents from adult conspecifics elicited the quickest and highest chemosensory responses (i.e., short latency times and high tongue-flick rates), although we did not find differential responses to scent of males and females. The magnitude of the responses was lower to scent of sub adult individuals, and then even lower to scent of juvenile snakes, but in all cases the scent of snakes was discriminated from a blank control. We discuss the potential chemical mechanisms that may allow age recognition and its implications for social and sexual behavior of this snake species.

Rapid and repeated origin of insular gigantism and dwarfism in Australian tiger snakes.

PubMed

Keogh, J Scott; Scott, Ian A W; Hayes, Christine

2005-01-01

It is a well-known phenomenon that islands can support populations of gigantic or dwarf forms of mainland conspecifics, but the variety of explanatory hypotheses for this phenomenon have been difficult to disentangle. The highly venomous Australian tiger snakes (genus Notechis) represent a well-known and extreme example of insular body size variation. They are of special interest because there are multiple populations of dwarfs and giants and the age of the islands and thus the age of the tiger snake populations are known from detailed sea level studies. Most are 5000-7000 years old and all are less than 10,000 years old. Here we discriminate between two competing hypotheses with a molecular phylogeography dataset comprising approximately 4800 bp of mtDNA and demonstrate that populations of island dwarfs and giants have evolved five times independently. In each case the closest relatives of the giant or dwarf populations are mainland tiger snakes, and in four of the five cases, the closest relatives are also the most geographically proximate mainland tiger snakes. Moreover, these body size shifts have evolved extremely rapidly and this is reflected in the genetic divergence between island body size variants and mainland snakes. Within south eastern Australia, where populations of island giants, populations of island dwarfs, and mainland tiger snakes all occur, the maximum genetic divergence is only 0.38%. Dwarf tiger snakes are restricted to prey items that are much smaller than the prey items of mainland tiger snakes and giant tiger snakes are restricted to seasonally available prey items that are up three times larger than the prey items of mainland tiger snakes. We support the hypotheses that these body size shifts are due to strong selection imposed by the size of available prey items, rather than shared evolutionary history, and our results are consistent with the notion that adaptive plasticity also has played an important role in body size shifts. We suggest that plasticity displayed early on in the occupation of these new islands provided the flexibility necessary as the island's available prey items became more depauperate, but once the size range of available prey items was reduced, strong natural selection followed by genetic assimilation worked to optimize snake body size. The rate of body size divergence in haldanes is similar for dwarfs (h(g) = 0.0010) and giants (h(g) = 0.0020-0.0025) and is in line with other studies of rapid evolution. Our data provide strong evidence for rapid and repeated morphological divergence in the wild due to similar selective pressures acting in different directions.

Animal venom studies: Current benefits and future developments

PubMed Central

Utkin, Yuri N

2015-01-01

Poisonous organisms are represented in many taxa, including kingdom Animalia. During evolution, animals have developed special organs for production and injection of venoms. Animal venoms are complex mixtures, compositions of which depend on species producing venom. The most known and studied poisonous terrestrial animals are snakes, scorpions and spiders. Among marine animals, these are jellyfishes, anemones and cone snails. The toxic substances in the venom of these animals are mainly of protein and peptide origin. Recent studies have indicated that the single venom may contain up to several hundred different components producing diverse physiological effects. Bites or stings by certain poisonous species result in severe envenomations leading in some cases to death. This raises the problem of bite treatment. The most effective treatment so far is the application of antivenoms. To enhance the effectiveness of such treatments, the knowledge of venom composition is needed. On the other hand, venoms contain substances with unique biological properties, which can be used both in basic science and in clinical applications. The best example of toxin application in basic science is α-bungarotoxin the discovery of which made a big impact on the studies of nicotinic acetylcholine receptor. Today compositions of venom from many species have already been examined. Based on these data, one can conclude that venoms contain a large number of individual components belonging to a limited number of structural types. Often minor changes in the amino acid sequence give rise to new biological properties. Change in the living conditions of poisonous animals lead to alterations in the composition of venoms resulting in appearance of new toxins. At the same time introduction of new methods of proteomics and genomics lead to discoveries of new compounds, which may serve as research tools or as templates for the development of novel drugs. The application of these sensitive and comprehensive methods allows studying either of venoms available in tiny amounts or of low abundant components in already known venoms. PMID:26009701

Acute kidney injury following rhabdomyolysis and sepsis after non-poisonous desert monitor bite.

PubMed

Gupta, Poonam; Verma, Pradeep Kumar

2017-10-01

The desert monitor, Varanus griseus , is a species of desert monitor lizard found in North-Western India. They are believed to be non-poisonous. We report a case of Indian desert monitor bite leading to acute renal failure following rhabdomyolysis and severe sepsis. Prompt diagnosis and treatment resulted in the favourable outcome. This is author's intent to highlight the complication that may occur after Indian desert monitor bite.

Treatment of spider bites by high voltage direct current.

PubMed

Osborn, C D

1991-06-01

Between September 7, 1988, and January 15, 1991, 147 cases of confirmed (19) and suspected spider bites have been treated by high voltage direct current (HVDC) shocks. Venom damage to tissue was arrested at the time of treatment. Pain and systemic symptoms usually improved within 15 minutes. Lesion excision or grafts have not been necessary in any of the 127 cases with completed followup.

Epidemiological and clinical features of human rabies cases in Bali 2008-2010

PubMed Central

2012-01-01

Background Previously thought to be rabies free, Bali experienced an outbreak of animal and human rabies cases in November 2008. We describe the epidemiological and clinical data of human rabies cases occurring in the first two years of the outbreak. Methods We analysed the patient records of all rabies cases from the Sanglah General Hospital in Denpasar, and district hospitals in Buleleng and Tabanan. A conventional reverse transcriptase polymerase chain reaction was developed to detect the rabies virus genome in saliva, corneal swabs, and ante- and post-mortem cerebrospinal fluid (CSF). Results There were 104 human rabies cases in Bali during November 2008-November 2010. Patients' mean age was 36.6 years (range 3-84 years; SD 20.7), most were male (56.7%), and originated from rural districts. Almost all (92%) cases had a history of dog bite. Only 5.8% had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. No patients received rabies immunoglobulin (RIG). The estimated time from dog bite to the onset of signs and symptoms was 110.4 days (range 12-720 days; SD 118.2). The mean length of medical care until death was 21.8 hours (range 1-220 hours; SD 32.6). Less than 50% of patients had prodromal symptoms. The most frequent prodromal symptom was pain or paraesthesia at the bite site (37.6%). The two most common central nervous system infection signs were agitation (89.2%) and confusion (83.3%). Signs of autonomic nervous system dysfunction included hydrophobia (93.1%), hypersalivation (88.2%), and dyspnea (74.4%). On admission, 22 of 102 patients (21.6%) showed paralytic manifestations, while the rest (78.4%) showed furious rabies manifestations. The case-fatality rate was 100%. The rabies virus genome was detected in 50 of 101 patients (49.5%) with the highest detection rate from post-mortem CSF samples. Conclusions Rabies is a major public health problem in Bali. Human fatalities occur because of a lack of knowledge regarding rabies risk, the poor management of dog bites, and the limited availability of RIG. Increasing public awareness of dog bite management, increasing the availability of ARV and RIG, and implementing an island-wide dog vaccination campaign will help prevent human rabies cases. PMID:22471410

Epidemiological and clinical features of human rabies cases in Bali 2008-2010.

PubMed

Susilawathi, Ni M; Darwinata, Agus E; Dwija, Ida B N P; Budayanti, Nyoman S; Wirasandhi, Gusti A K; Subrata, Ketut; Susilarini, Ni K; Sudewi, Raka A A; Wignall, Frank S; Mahardika, Gusti N K

2012-04-02

Previously thought to be rabies free, Bali experienced an outbreak of animal and human rabies cases in November 2008. We describe the epidemiological and clinical data of human rabies cases occurring in the first two years of the outbreak. We analysed the patient records of all rabies cases from the Sanglah General Hospital in Denpasar, and district hospitals in Buleleng and Tabanan. A conventional reverse transcriptase polymerase chain reaction was developed to detect the rabies virus genome in saliva, corneal swabs, and ante- and post-mortem cerebrospinal fluid (CSF). There were 104 human rabies cases in Bali during November 2008-November 2010. Patients' mean age was 36.6 years (range 3-84 years; SD 20.7), most were male (56.7%), and originated from rural districts. Almost all (92%) cases had a history of dog bite. Only 5.8% had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. No patients received rabies immunoglobulin (RIG). The estimated time from dog bite to the onset of signs and symptoms was 110.4 days (range 12-720 days; SD 118.2). The mean length of medical care until death was 21.8 hours (range 1-220 hours; SD 32.6). Less than 50% of patients had prodromal symptoms. The most frequent prodromal symptom was pain or paraesthesia at the bite site (37.6%). The two most common central nervous system infection signs were agitation (89.2%) and confusion (83.3%). Signs of autonomic nervous system dysfunction included hydrophobia (93.1%), hypersalivation (88.2%), and dyspnea (74.4%). On admission, 22 of 102 patients (21.6%) showed paralytic manifestations, while the rest (78.4%) showed furious rabies manifestations. The case-fatality rate was 100%. The rabies virus genome was detected in 50 of 101 patients (49.5%) with the highest detection rate from post-mortem CSF samples. Rabies is a major public health problem in Bali. Human fatalities occur because of a lack of knowledge regarding rabies risk, the poor management of dog bites, and the limited availability of RIG. Increasing public awareness of dog bite management, increasing the availability of ARV and RIG, and implementing an island-wide dog vaccination campaign will help prevent human rabies cases.

Effects of season, sex and body size on the feeding ecology of turtle-headed sea snakes ( Emydocephalus annulatus) on IndoPacific inshore coral reefs

NASA Astrophysics Data System (ADS)

Goiran, C.; Dubey, S.; Shine, R.

2013-06-01

In terrestrial snakes, many cases of intraspecific shifts in dietary habits as a function of predator sex and body size are driven by gape limitation and hence are most common in species that feed on relatively large prey and exhibit a wide body-size range. Our data on sea snakes reveal an alternative mechanism for intraspecific niche partitioning, based on sex-specific seasonal anorexia induced by reproductive activities. Turtle-headed sea snakes ( Emydocephalus annulatus) on coral reefs in the New Caledonian Lagoon feed entirely on the eggs of demersal-spawning fishes. DNA sequence data (cytochrome b gene) on eggs that we palpated from stomachs of 37 snakes showed that despite this ontogenetic stage specialization, the prey comes from a taxonomically diverse array of species including damselfish (41 % of samples, at least 5 species), blennies (41 %, 4 species) and gobies (19 %, 5 species). The composition of snake diets shifted seasonally (with damselfish dominating in winter but not summer), presumably reflecting seasonality of fish reproduction. That seasonal shift affects male and female snakes differently, because reproduction is incompatible with foraging. Adult female sea snakes ceased feeding when they became heavily distended with developing embryos in late summer, and males ceased feeding while they were mate searching in winter. The sex divergence in foraging habits may be amplified by sexual size dimorphism; females grow larger than males, and larger snakes (of both sexes) feed more on damselfish (which often lay their eggs in exposed sites) than on blennies and gobies (whose eggs are hidden within narrow crevices). Specific features of reproductive biology of coral reef fish (seasonality and nest type) have generated intraspecific niche partitioning in these sea snakes, by mechanisms different from those that apply to terrestrial snakes.

Historical contingency and animal diets: the origins of egg eating in snakes.

PubMed

de Queiroz, Alan; Rodriguez-Robles, Javier A

2006-05-01

Evolutionary changes in animal diets must often begin through the inclusion of a novel food type as a minor component of the diet. An aspect of this initial change that has rarely been studied is the relationship between the existing diet and the use of specific novel foods. We used comparative analyses to test the hypothesis that, in snakes, feeding on squamate (lizard and snake) eggs or bird eggs--items that represent evolutionarily derived and, in most cases, minor components of the diet--is associated with feeding on squamates or birds, respectively. Phylogenetic concentrated-changes tests indicate a significant tendency for predation on eggs to arise in snake lineages characterized by feeding on the corresponding animals. These results also generally hold for analyses including only snake species that are likely to encounter eggs and are large enough to ingest them. The inferred histories of specialized egg eaters also support the hypothesis. Because snakes often use chemical cues to recognize prey, the observed phylogenetic patterns might be explained by chemical similarities between eggs and adult animals. Our results suggest broad effects of predispositions on snake diets and thus illustrate how historical contingencies can shape the ecology of organisms.

Snakebites as cause of deaths in the Western Brazilian Amazon: Why and who dies? Deaths from snakebites in the Amazon.

PubMed

da Silva Souza, Anderson; de Almeida Gonçalves Sachett, Jacqueline; Alcântara, João Arthur; Freire, Monique; Alecrim, Maria das Graças Costa; Lacerda, Marcus; de Lima Ferreira, Luiz Carlos; Fan, Hui Wen; de Souza Sampaio, Vanderson; Monteiro, Wuelton Marcelo

2018-04-01

Snake envenoming represents a major burden for public health worldwide. In the Amazon, the official number of cases and deaths detected is probably underestimated because of the difficulty riverine and indigenous populations have reaching health centers in order to receive medical assistance. Thus, integrated analysis of health information systems must be used in order to improve adequate health policies. The aim of this work is to describe a series of deaths and identify risk factors for lethality from snakebites in the state of Amazonas, Brazil. All deaths from snakebites reported to the Brazilian Notifiable Diseases Surveillance System (SINAN) and to the Mortality Information System (SIM; ICD10-10th revision, X.29), from 2007 to 2015, were included. Variables were assessed by blocks with distal (ecological variables), intermediate (demographics) and proximal (clinical variables) components to identify predictors of case fatality. A total of 127 deaths from snakebites were recorded, with 58 pairs found through linkage of the SINAN and SIM databases (45.7%), 37 (29.1%) deaths found only in SINAN and 32 (25.2%) found only in the SIM. Deaths occurred mostly in males (95 cases; 74.8%) living in rural areas (78.6%). The most affected age group was the ≥61 years old (36 cases; 28.4%). Snakebites were presumably due to Bothrops snakes in 68.5% of the cases and Lachesis in 29.5% based on clinico-epidemiological diagnosis. A proportion of 26.2% of the cases received treatment over 24 h after the bite ocurred. On admission, cases were mostly classified as severe (65.6%). Overall, 28 patients (22.0%). Deceased without any medical assistance Antivenom was given to 53.5%. In the multivariate analysis, a distance from Manaus >300 km [OR = 3.40 (95%CI = 1.99-5.79); (p < 0.001)]; age ≥61 years [OR = 4.31 (95%CI = 1.22-15.21); (p = 0.023)] and Indigenous status [OR = 5.47 (95%CI = 2.37-12.66); (p < 0.001)] were independently associated with case fatality from snakebites. Severe snakebites [OR = 16.24 (95%CI = 4.37-60.39); (p < 0.001)] and a lack of antivenom administration [OR = 4.21 (95%CI = 1.30-13.19); (p = 0.014)] were also independently associated with case fatality. Respiratory failure/dyspnea, systemic bleeding, sepsis and shock were recorded only among fatal cases. In conclusion, i) death from snakebites was underreported in the mortality surveillance system; ii) older age groups living in remote municipalities and indigenous peoples were the population groups most prone to death; iii) lack or underdosage of antivenom resulted in higher case fatality and iv) systemic bleeding, circulatory shock, sepsis and acute respiratory failure were strongly associated to fatal outcome. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cannulation in patients with large periampullary diverticulum using SpyBite miniforceps.

PubMed

Balkrishanan, Mahadevan; Jain, Mayank; Snk, Chenduran; Cg, Sridhar; Ramakrishnan, Ravi; Venkataraman, Jayanthi

2018-03-01

Cannulation is difficult in patients with periampullary diverticulum (PAD). The described success rate varies from 61% to 95.4%. Four cases with PAD in which, despite repeated attempts, we were unable to locate the papilla and cannulate. To overcome this difficulty, we used SpyBite forceps (Boston Scientific) to pull out the papillary orifice and then perform the cannulation using a sphincterotome introduced through the same working channel. This method reduced the time required for cannulation. In all four of our cases, we had 100% success in cannulation. Use of SpyBite miniforceps in difficult cannulations in patients with PAD is useful and has an excellent success rate.

[Comparison of bite marks and teeth features using 2D and 3D methods].

PubMed

Lorkiewicz-Muszyńska, Dorota; Glapiński, Mariusz; Zaba, Czesław; Łabecka, Marzena

2011-01-01

The nature of bite marks is complex. They are found at the scene of crime on different materials and surfaces - not only on human body and corpse, but also on food products and material objects. Human bites on skin are sometimes difficult to interpret and to analyze because of the specific character of skin--elastic and distortable--and because different areas of human body have different surfaces and curvatures. A bite mark left at the scene of crime can be a highly helpful way to lead investigators to criminals. The study was performed to establish: 1) whether bite marks exhibit variations in the accuracy of impressions on different materials, 2) whether it is possible to use the 3D method in the process of identifying an individual based on the comparison of bite marks revealed at the scene, and 3D scans of dental casts, 3) whether application of the 3D method allows for elimination of secondary photographic distortion of bite marks. The authors carried out experiments on simulated cases. Five volunteers bit various materials with different surfaces. Experimental bite marks were collected with emphasis on differentiations of materials. Subsequently, dental impressions were taken from five volunteers in order to prepare five sets of dental casts (the maxilla and mandible. The biting edges of teeth were impressed in wax to create an imprint. The samples of dental casts, corresponding wax bite impressions and bite marks from different materials were scanned with 2D and 3D scanners and photographs were taken. All of these were examined in detail and then compared using different methods (2D and 3D). 1) Bite marks exhibit variations in accuracy of impression on different materials. The most legible reproduction of bite marks was seen on cheese. 2) In comparison of bite marks, the 3D method and 3D scans of dental casts are highly accurate. 3) The 3D method helps to eliminate secondary photographic distortion of bite marks.

Skeletal Class III and anterior open bite treatment with different retention protocols: a report of three cases.

PubMed

Farret, Milton Meri Benitez; Farret, Marcel Marchiori; Farret, Alessandro Marchiori

2012-09-01

The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome.

Venom Proteomics of Indonesian King Cobra, Ophiophagus hannah: Integrating Top-Down and Bottom-Up Approaches.

PubMed

Petras, Daniel; Heiss, Paul; Süssmuth, Roderich D; Calvete, Juan J

2015-06-05

We report on the first application of top-down mass spectrometry in snake venomics. De novo sequence tags generated by, and ProSight Lite supported analysis of, combined collisional based dissotiations (CID and HCD) recorded in a hybrid LTQ Orbitrap instrument in data-dependent mode identified a number of proteins from different toxin families, namely, 11 three-finger toxins (7-7.9 kDa), a Kunitz-type inhibitor (6.3 kDa), ohanin (11.9 kDa), a novel phospholipase A2 molecule (13.8 kDa), and the cysteine-rich secretory protein (CRISP) ophanin (25 kDa) from Indonesian king cobra venom. Complementary bottom-up MS/MS analyses contributed to the completion of a locus-resolved venom phenotypic map for Ophiophagus hannah, the world's longest venomous snake and a species of medical concern across its wide distribution range in forests from India to Southeast Asia. Its venom composition, comprising 32-35 proteins/peptides from 10 protein families, is dominated by α-neurotoxins and convincingly explains the main neurotoxic effects of human envenoming caused by king cobra bite. The integration of efficient chromatographic separation of the venom's components and locus-resolved toxin identification through top-down and bottom-up MS/MS-based species-specific database searching and de novo sequencing holds promise that the future will be bright for the field of venom research.

Defensins and the convergent evolution of platypus and reptile venom genes.

PubMed

Whittington, Camilla M; Papenfuss, Anthony T; Bansal, Paramjit; Torres, Allan M; Wong, Emily S W; Deakin, Janine E; Graves, Tina; Alsop, Amber; Schatzkamer, Kyriena; Kremitzki, Colin; Ponting, Chris P; Temple-Smith, Peter; Warren, Wesley C; Kuchel, Philip W; Belov, Katherine

2008-06-01

When the platypus (Ornithorhynchus anatinus) was first discovered, it was thought to be a taxidermist's hoax, as it has a blend of mammalian and reptilian features. It is a most remarkable mammal, not only because it lays eggs but also because it is venomous. Rather than delivering venom through a bite, as do snakes and shrews, male platypuses have venomous spurs on each hind leg. The platypus genome sequence provides a unique opportunity to unravel the evolutionary history of many of these interesting features. While searching the platypus genome for the sequences of antimicrobial defensin genes, we identified three Ornithorhynchus venom defensin-like peptide (OvDLP) genes, which produce the major components of platypus venom. We show that gene duplication and subsequent functional diversification of beta-defensins gave rise to these platypus OvDLPs. The OvDLP genes are located adjacent to the beta-defensins and share similar gene organization and peptide structures. Intriguingly, some species of snakes and lizards also produce venoms containing similar molecules called crotamines and crotamine-like peptides. This led us to trace the evolutionary origins of other components of platypus and reptile venom. Here we show that several venom components have evolved separately in the platypus and reptiles. Convergent evolution has repeatedly selected genes coding for proteins containing specific structural motifs as templates for venom molecules.

Defensins and the convergent evolution of platypus and reptile venom genes

PubMed Central

Whittington, Camilla M.; Papenfuss, Anthony T.; Bansal, Paramjit; Torres, Allan M.; Wong, Emily S.W.; Deakin, Janine E.; Graves, Tina; Alsop, Amber; Schatzkamer, Kyriena; Kremitzki, Colin; Ponting, Chris P.; Temple-Smith, Peter; Warren, Wesley C.; Kuchel, Philip W.; Belov, Katherine

2008-01-01

When the platypus (Ornithorhynchus anatinus) was first discovered, it was thought to be a taxidermist’s hoax, as it has a blend of mammalian and reptilian features. It is a most remarkable mammal, not only because it lays eggs but also because it is venomous. Rather than delivering venom through a bite, as do snakes and shrews, male platypuses have venomous spurs on each hind leg. The platypus genome sequence provides a unique opportunity to unravel the evolutionary history of many of these interesting features. While searching the platypus genome for the sequences of antimicrobial defensin genes, we identified three Ornithorhynchus venom defensin-like peptide (OvDLP) genes, which produce the major components of platypus venom. We show that gene duplication and subsequent functional diversification of beta-defensins gave rise to these platypus OvDLPs. The OvDLP genes are located adjacent to the beta-defensins and share similar gene organization and peptide structures. Intriguingly, some species of snakes and lizards also produce venoms containing similar molecules called crotamines and crotamine-like peptides. This led us to trace the evolutionary origins of other components of platypus and reptile venom. Here we show that several venom components have evolved separately in the platypus and reptiles. Convergent evolution has repeatedly selected genes coding for proteins containing specific structural motifs as templates for venom molecules. PMID:18463304

Extreme skeletal open bite correction with vertical elastics.

PubMed

Cruz-Escalante, Marco Antonio; Aliaga-Del Castillo, Aron; Soldevilla, Luciano; Janson, Guilherme; Yatabe, Marilia; Zuazola, Ricardo Voss

2017-11-01

Severe skeletal open bites may be ideally treated with a combined surgical-orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.

Bite mark documentation and analysis: the forensic 3D/CAD supported photogrammetry approach.

PubMed

Thali, M J; Braun, M; Markwalder, Th H; Brueschweiler, W; Zollinger, U; Malik, Naseem J; Yen, K; Dirnhofer, R

2003-08-12

Bite mark identification is based on the individuality of a dentition, which is used to match a bite mark to a suspected perpetrator. This matching is based on a tooth-by-tooth and arch-to-arch comparison utilising parameters of size, shape and alignment. The most common method used to analyse bite mark are carried out in 2D space. That means that the 3D information is preserved only two dimensionally with distortions. This paper presents a new 3D documentation, analysis and visualisation approach based on forensic 3D/CAD supported photogrammetry (FPHG) and the use of a 3D surface scanner. Our photogrammetric approach and the used visualisation method is, to the best to our knowledge, the first 3D approach for bite mark analysis in an actual case. The documentation has no distortion artifacts as can be found with standard photography. All the data are documented with a metric 3D measurement, orientation and subsequent analysis in 3D space. Beside the metrical analysis between bite mark and cast, it is possible using our method to utilise the topographical 3D feature of each individual tooth. This means that the 3D features of the biting surfaces and edges of each teeth are respected which is--as shown in our case--very important especially in the front teeth which have the first contact to the skin. Based upon the 3D detailed representation of the cast with the 3D topographic characteristics of the teeth, the interaction with the 3D documented skin can be visualised and analysed on the computer screen.

Open bite as a risk factor for orthodontic root resorption.

PubMed

Motokawa, Masahide; Terao, Akiko; Kaku, Masato; Kawata, Toshitsugu; Gonzales, Carmen; Darendeliler, M Ali; Tanne, Kazuo

2013-12-01

The purpose of the present study was to clarify the prevalence and degree of root resorption induced by orthodontic treatment in patients with and without open bite. One hundred and eleven patients treated with multibracket appliances were retrospectively selected from the patients and divided into non-open bite (NOB) and open bite (OB) groups. The severity of root resorption and the root shape were classified into five groups on periapical radiographs before and after treatment. Moreover, only in the OB group, all teeth were sub-divided into functional and hypofunctional ones that are occluding and non-occluding. As the results of multiple linear regression analysis of patient characteristics and clinical variables with the number of overall root resorption, the independent variables that were found to contribute significantly to root resorption were bite and abnormal root shape. The prevalences of root resorption evaluated in the number of patients were significantly higher in OB group than in NOB group, and those in the number of teeth were significantly higher in OB group than in NOB group, in particular anterior and premolar teeth. The prevalence of resorbed teeth with abnormal root shapes was also significantly higher in OB group than in NOB group. On the other hand, in OB group, the prevalences of root resorption and teeth with abnormal root shape were significantly greater in hypofunctional teeth than in normal functional teeth. There are more teeth with root resorption and abnormal root shape in open bite cases than in normal bite cases, and more teeth with abnormal root shapes and root resorption in hypofunctional teeth than in functional teeth.

Disseminated Salmonella arizona infection associated with rattlesnake meat ingestion.

PubMed

Bhatt, B D; Zuckerman, M J; Foland, J A; Polly, S M; Marwah, R K

1989-04-01

Salmonella arizona is an uncommon enteric pathogen. We report a case of a woman with systemic lupus erythematosus, receiving prednisone therapy, who developed fatal disseminated S. arizona infection after ingesting raw dried rattlesnake meat as a form of treatment for her illness. S. arizona was isolated from stool, blood, peritoneal fluid, and cerebrospinal fluid. The importance of being aware of the Mexican-American folk remedy involving the ingestion of rattlesnake meat in the forms of dried snake, snake powder, or snake powder capsules, and the risk of acquiring S. arizona enteric infections is discussed.

Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon

PubMed Central

Sampaio, Vanderson Souza; Gomes, André Alexandre; Silva, Iran Mendonça; Sachett, Jacqueline; Ferreira, Luiz Carlos Lima; Oliveira, Sâmella; Sabidò, Meritxell; Chalkidis, Hipócrates; Barbosa Guerra, Maria Graças Vale; Salinas, Jorge Luis; Wen, Fan Hui; Lacerda, Marcus Vinícius Guimarães; Monteiro, Wuelton Marcelo

2016-01-01

Background A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation. Methodology/Principal Findings We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%). Bites mostly occurred in rural areas (59.5%). The most affected age group was between 16 and 45 years old (50.9%). A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR) = 0.40 (95%CI = 0.30–0.71; p<0.001)] and living in a municipality with a mean health system performance index (MHSPI >median [OR = 0.64 (95%CI = 0.39–0.75; p<0.001)] were independently associated with decreased risk of severity. Work related accidents [OR = 2.09 (95%CI = 1.49–2.94; p<0.001)], Indigenous status [OR = 2.15 (95%CI = 1.19–3.86; p = 0.011)] and living in a municipality located >300 km away from the state capital Manaus [OR = 1.90 (95%CI = 1.28–2.40; p<0.001)] were independently associated with a risk of severity. Living in a municipality located >300 km away from the state capital Manaus [OR = 1.53 (95%CI = 1.15–2.02; p = 0.003)] and living in a municipality with a MHSPI 300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage. PMID:27227455

Snakebite and Its Socio-Economic Impact on the Rural Population of Tamil Nadu, India

PubMed Central

Vaiyapuri, Sakthivel; Vaiyapuri, Rajendran; Ashokan, Rajesh; Ramasamy, Karthikeyan; Nattamaisundar, Kameshwaran; Jeyaraj, Anburaj; Chandran, Viswanathan; Gajjeraman, Prabu; Baksh, M. Fazil; Gibbins, Jonathan M.; Hutchinson, E. Gail

2013-01-01

Background Snakebite represents a significant health issue worldwide, affecting several million people each year with as many as 95,000 deaths. India is considered to be the country most affected, but much remains unknown about snakebite incidence in this country, its socio-economic impact and how snakebite management could be improved. Methods/Principal Findings We conducted a study within rural villages in Tamil Nadu, India, which combines a household survey (28,494 people) of snakebite incidence with a more detailed survey of victims in order to understand the health and socio-economic effects of the bite, the treatments obtained and their views about future improvements. Our survey suggests that snakebite incidence is higher than previously reported. 3.9% of those surveyed had suffered from snakebite and the number of deaths corresponds to 0.45% of the population. The socio-economic impact of this is very considerable in terms of the treatment costs and the long-term effects on the health and ability of survivors to work. To reduce this, the victims recommended improvements to the accessibility and affordability of antivenom treatment. Conclusions Snakebite has a considerable and disproportionate impact on rural populations, particularly in South Asia. This study provides an incentive for researchers and the public to work together to reduce the incidence and improve the outcomes for snake bite victims and their families. PMID:24278244

Bite Injuries to the Hand - Review of the Literature

PubMed Central

Raval, Pradyumna; Khan, Wasim; Haddad, Behrooz; Mahapatra, Anant Narayan

2014-01-01

Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, do also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports. PMID:25097675

Severe acute pulmonary haemorrhage and haemoptysis in ten dogs following eastern brown snake (Pseudonaja textilis) envenomation: Clinical signs, treatment and outcomes.

PubMed

Leong, Oriana S; Padula, Andrew M; Leister, Ellie

2018-05-29

This report describes a series of ten cases of fulminant pulmonary haemorrhage in dogs following envenomation by the eastern brown snake (Pseudonaja textilis) in south eastern Queensland, Australia. All cases were presented for veterinary treatment during 2011-2018 at a specialist veterinary emergency centre. Each case received prompt antivenom treatment and supportive care. Pulmonary haemorrhage was diagnosed based on clinical examination; overt haemoptysis; thoracic radiographic demonstration of a diffuse alveolar pattern; and, the presence of venom induced consumptive coagulopathy. The median elapsed time from hospital admission to onset of haemoptysis was 2 h (range 0-18 h). In 80% (8/10) of cases endotracheal intubation was required, whilst 20% (2/10) were successfully treated with mask oxygen supplementation alone, and 40% (4/10) received mechanical ventilation; but only 25% (1/4) of these survived to hospital discharge. Fresh frozen canine plasma was administered to 70% (7/10) of cases and 43% (3/7) of these survived. Of the total number of cases presented for treatment, 30% (3/10) survived to hospital discharge, 60% (6/10) were euthanised due to poor prognosis and 10% (1/10) died from cardiac arrest. Initial serum brown snake venom antigen levels were retrospectively measured from frozen serum samples by venom specific sandwich ELISA in two dogs at 154 ng/mL (survived) and 3607 ng/mL (euthanised); no free venom was detected post-antivenom. Dogs that survived were discharged from hospital without apparent complications. Pulmonary haemorrhage is an uncommon event following envenomation by P. textilis in dogs and has not been described in similarly envenomed humans. This case series highlights the potential for fulminant and fatal pulmonary haemorrhage in dogs following eastern brown snake envenomation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Reconstruction with different free flaps in oro-facial cancer patients.

PubMed

Bhathena, H M; Savant, D N; Kavarana, N M; Parikh, D M; Sanghvi, V D

1996-01-01

In 75 patients following ablative surgery of head and neck cancer, reconstruction was attempted with free tissue transfer techniques under magnification. It was possible to do free tissue transfers in 69 cases. In 6 cases it was not possible to harvest free flaps successfully and alternative reconstructive procedure was carried out due to unavoidable circumstances and various reasons: 1. unsuitable venous drainage, as in Anterior Rib Osteomyocutaneous Composite Flap, AROCF (2 cases), 2. injury to vessels during flap harvest, as in parascapular flap (1 case), 3. residual disease unable to excise (2 cases) and 4. unsuitable proposition (1 case), due to emergency curfew imposed suddenly. These 6 cases were not included in the study. Free tissue transfer was successful in 64 cases (92.7%) and there was a total failure in 5 cases where delayed secondary salvage surgery was performed. Out of 69 cases, in 65 cases reconstructions were carried out immediately, primarily as one-stage operative procedure. Their functional, cosmetic results and complications during the operative and post-operative period are analyzed and discussed. Inter-maxillary fixation was never used to maintain the bite alignment. All cases were given a bite guide prosthesis in the early post-operative period, to improve the bite alignment when it was necessary.

Indigenous cultural contexts for STEM experiences: snow snakes' impact on students and the community

NASA Astrophysics Data System (ADS)

Miller, Brant G.; Roehrig, Gillian

2018-03-01

Opportunities for American Indian youth to meaningfully engage in school-based science, technology, engineering, and mathematics (STEM) experiences have historically been inadequate. As a consequence, American Indian students perform lower on standardized assessments of science education than their peers. In this article we describe the emergence of meaning for students—as well as their community—resulting from Indigenous culturally-based STEM curriculum that used an American Indian tradition as a focal context. Specifically, the game of snow snakes ( Gooneginebig in Ojibwe) afforded an opportunity for STEM and culturally-based resources to work in unison. A case study research design was used with the bounded case represented by the community associated with the snow snake project. The research question guiding this study was: What forms of culturally relevant meaning do students and the community form as a result of the snow snake game? Results indicate evidence of increased student and community engagement through culturally-based STEM experiences in the form of active participation and the rejuvenation of a traditional game. Implications are discussed for using culturally-based contexts for STEM learning.

Snow snakes and science agency: Empowering American Indian students through a culturally-based science, technology, engineering, and mathematics (STEM) curriculum

NASA Astrophysics Data System (ADS)

Miller, Brant Gregory

Mainstream curricula have struggled to provide American Indian students with meaningful learning experiences. This research project studied a novel approach to engaging students with science, technology, engineering, and mathematics (STEM) content through a culturally-based context. The traditional American Indian game of Snow Snakes (shushumeg in Ojibwe) presented a highly engaging context for delivering STEM content. Through the engaging context of snow snakes, the designed STEM curriculum explicitly applied mathematics (scaling and data), and science (force and motion) to an engineering prototype iteration that used available materials and tools (technology) for success. It was hypothesized that by engaging students through the carefully integrated STEM curriculum, driven by the culturally based context of snow snakes, students would exhibit an increase in science agency and achievement. The overarching research question explored for this study was: How does a culturally-based and integrated STEM curriculum impact student's science agency? Associated sub-questions were: (1) What does science agency look like for 6th grade students? (2) What key experiences are involved in the development of science agency through a culturally-based STEM curriculum context? And (3) What are the impacts on the community associated with the implementation of a culturally-based STEM curriculum? A case study research design was implemented for this research. Yin (2003) defines a case study as investigating a phenomenon (e.g. science agency) which occurs within authentic contexts (e.g. snow snakes, Adventure Learning, and Eagle Soaring School) especially when the boundaries between phenomenon and context are unclear. For this case study Eagle Soaring School acted as the bounded case with students from the 6th grade class representing the embedded units. Science agency was the theoretical framework for data analysis. Major findings were categorized as science and STEM learning, agency, and community impact. Concerning agency, students displayed science agency through: connecting snow snake experiences to outside contexts; students emerging as leaders; and students commanding a facility with science. This research lays the foundation for future inquiry into the development of science agency in students using culturally-based contexts.

Anterior open bite treated with myofunctional therapy and palatal crib.

PubMed

Asiry, Moshabab A

2015-03-01

This case report demonstrates the treatment effects of palatal crib combined with the myofunctional therapy in a child with anterior open bite (AOB) due to thumb sucking and habitual anterior and low tongue position. The patient, an 11-year-old boy, had an anterior open bite and flared and spaced upper and lower incisors. Palatal cribs in conjunction with myofunctional therapy were used to discourage sucking habit and to adapt normal tongue position. Successful correction of the AOB with adequate overjet and overbite were achieved with total treatment time of 7 months. The importance of myofunctional therapy in adopting normal tongue position and in maintaining the stability of open bite correction is emphasized.

Long-term outcome in a patient with a dentoskeletal open-bite malocclusion treated without extraction.

PubMed

Celli, Daniel; Gasperoni, Enrico; Deli, Roberto

2007-01-01

This case report describes the treatment of a patient with a Class II malocclusion with an anterior open bite. The patient, a girl 16 years of age, had a significant anteroposterior discrepancy and a high-angle tendency. Her face was convex, with competent lips. Intraorally she had an anterior open bite of 3 mm, space in the mandibular arch, and an overjet of 2 mm. High-pull headgear, anterior intermaxillary elastics, and appropriate wire bending were used to close the bite and to correct the anteroposterior dental relationship. Modification of a tongue thrust habit helped to correct this significant malocclusion and provided stability at 11 years posttreatment.

Same dog bite and different outcome in two cases - case report.

PubMed

Rd, Gadekar; Vk, Domple; If, Inamdar; Nr, Aswar; Mk, Doibale

2014-06-01

There is still no cure for rabies and survival from clinical rabies is extremely rare. It is a preventable disease if the post exposure prophylaxis is initiated in time and administered as per WHO guidelines including administration of rabies immunoglobulin. The role of passive rabies immunization products is to provide the immediate availability of neutralizing antibodies at the site of the exposure before it is physiologically possible for the patient to begin producing his or her own antibodies after vaccination. In this case report, the same dog has bitten to a boy and to an adult. Local wound treatment and use of human rabies immunoglobulin as well as gluteal region as a site of bite were the probable reasons for survival of the boy. On the other hand no local wound treatment, no use of rabies immunoglobulin and finger as a site of bite are the probable reasons for death of an adult due to rabies.

Prophylaxis of Human Hydrophobia in South Korea

PubMed Central

2014-01-01

Domestic human hydrophobia has not been reported since the one case of 2004 in South Korea, but still a few animal rabies occur persistently since the reemerging stage of rabies from 1993. The government has made efforts to control animal rabies in many aspects, but whether prophylactic strategy for human hydrophobia is performed adequately is in question. The rate of proper post-exposure prophylaxis for animal bite case in 'high-risk region' of rabies is very low with 20% between 2011 and 2013. The National Animal Bite Patient Surveillance targeting 'high-risk region' is missing out animal bite cases who visit directly to hospitals in 'suspect-risk region' of rabies. Little data seems to exist for pre-exposure prophylaxis of domestic hydrophobia. Danger of reoccurrence of human hydrophobia always remain in South Korea. The medical personnel needs to have greater interest on the matter and the government strengthen the management system. PMID:25298903

Snake Venom As An Effective Tool Against Colorectal Cancer.

PubMed

Uzair, Bushra; Atlas, Nagina; Malik, Sidra Batool; Jamil, Nazia; Salaam, Temitope Ojuolape; Rehman, Mujaddad Ur; Khan, Barkat Ali

2018-06-13

Cancer is considered one of the most predominant causes of morbidity and mortality all over the world and colorectal cancer is the most common fatal cancers, triggering the second cancer related death. Despite progress in understanding carcinogenesis and development in chemotherapeutics, there is an essential need to search for improved treatment. More than the half a century, cytotoxic and cytostatic agents have been examined as a potential treatment of cancer, among these agents; remarkable progresses have been reported by the use of the snake venom. Snake venoms are secreting materials of lethal snakes are store in venomous glands. Venoms are composite combinations of various protein, peptides, enzymes, toxins and non proteinaceous secretions. Snake venom possesses immense valuable mixtures of proteins and enzymes. Venoms have potential to combat with the cancerous cells and produce positive effect. Besides the toxicological effects of venoms, several proteins of snake venom e.g. disintegrins, phospholipases A2, metalloproteinases, and L-amino acid oxidases and peptides e.g. bradykinin potentiators, natriuretic, and analgesic peptides have shown potential as pharmaceutical agents, including areas of diagnosis and cancer treatment. In this review we have discussed recent remarkable research that has involved the dynamic snake venoms compounds, having anticancer bustle especially in case of colorectal cancer. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Tularaemia in southwest Germany: Three cases of tick-borne transmission.

PubMed

Boone, I; Hassler, D; Nguyen, T; Splettstoesser, W D; Wagner-Wiening, C; Pfaff, G

2015-07-01

Tularaemia, caused by Francisella tularensis, is an endemic zoonosis frequently occurring in southwest Germany. Since 2005 there is an increase in the number of reported cases of tularaemia in Germany. We report on two cases of ulceroglandular tularaemia and one case of glandular tularaemia that occurred in the summer of 2012 and 2013 in two counties in the Federal State of Baden-Wuerttemberg. Bacteria were transmitted through tick bites, which to date has only rarely been reported in Germany. Inadequate treatment of the patients and an aggravation of clinical symptoms were caused by a delay between disease onset and the detection of the pathogen. Although contact to or consumption of infected hares are the most often reported transmission routes of tularaemia in Germany, tick-bites should also be taken into account. Health professionals should include Francisella tularensis in the differential diagnosis of patients with fever and/or ulcerative lymphadenopathy following a tick bite. Copyright © 2015 Elsevier GmbH. All rights reserved.

Additional observations and notes on the natural history of the prairie rattlesnake (Crotalus viridis) in Colorado.

PubMed

Fitzgerald, Kevin T; Shipley, Bryon K; Newquist, Kristin L; Vera, Rebecca; Flood, Aryn A

2013-11-01

On account of their unique anatomy, physiology, natural history, ecology, and behavior, rattlesnakes make ideal subjects for a variety of different scientific disciplines. The prairie rattlesnake (Crotalus viridis) in Colorado was selected for investigation of its relationship to colonies of black-tailed prairie dogs (Cynomys ludovicianus) with regard to spatial ecology. A total of 31 snakes were anesthetized and had radiotransmitters surgically implanted. In addition, at the time of their capture, all snakes underwent the following: (1) they had bacterial culture taken from their mouths for potential isolation of pathogenic bacteria; (2) similarly, they had cloacal bacterial cultures taken to assess potentially harmful bacteria passed in the feces; and (3) they had blood samples drawn to investigate the presence of any zoonotic agents in the serum of the snakes. The results of the study and their implications are discussed here. Traditionally, a low incidence of bacterial wound infection has been reported following snakebite. Nevertheless, the oral cavity of snakes has long been known to house a wide variety of bacterial flora. In our study, 10 different bacterial species were isolated from the mouths of the rattlesnakes, 6 of which are capable of being zoonotic pathogens and inducing human disease. More studies are necessary to see why more rattlesnake bites do not become infected despite the presence of such pathogenic bacteria. The results of fecal bacteria isolated revealed 13 bacterial species, 12 of which can cause disease in humans. Of the snakes whose samples were cultured, 26% were positive for the presence of the pathogen Salmonella arizonae, one of the causative agents of reptile-related salmonellosis in humans. It has long been reported that captive reptiles have a much higher incidence than wild, free-ranging species. This study shows the incidence of Salmonella in a wild, free-ranging population of rattlesnakes. In addition, Stenotrophomonas maltophilia was isolated. This bacterium is associated with wound and soft tissue infections that can lead to sepsis, endocarditis, meningitis, and peritonitis. In addition, this bacterium has been increasingly implicated as an opportunistic pathogen to humans during pregnancies, hospitalizations, malignancies and chemotherapy, chronic respiratory diseases, and presurgical endotracheal intubation. Furthermore, S. maltophilia has an intense resistance to broad-spectrum antibiotics, the results of our study showed the bacterium was resistant to multiple antibiotics. Our results indicate that anyone working with snake feces, dead skin, or their carcasses must follow reasonable hygiene protocols. Rattlesnakes tested for West Nile antibodies had positive results but these were invalidated owing to possible cross-reactivity with other unknown viruses, interference with snake serum proteins, and the fact that the test was not calibrated for rattlesnake serum. Still, the interesting implication remains, should we be regularly testing these animals as sentinels against potentially zoonotic diseases. The results of this study clearly show the value of veterinarians in a multidisciplinary study of this sort and the particular skill set they can offer. Veterinarians must get involved in conservation studies if the biodiversity of the planet is to be preserved. © 2013 Published by Elsevier Inc.

Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014–2015

PubMed Central

Undurraga, Eduardo A.; Meltzer, Martin I.; Tran, Cuc H.; Atkins, Charisma Y.; Etheart, Melissa D.; Millien, Max F.; Adrien, Paul; Wallace, Ryan M.

2017-01-01

Haiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area (N = 2,289) in 2014–2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568–$80,290) than the no-bite-case-management (NBCM) scenario ($15,988–$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891–$4,735, NBCM: $5,980–$8,453; 2015, HARSP: $3,534–$7,171, NBCM: $7,298–$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination. PMID:28719253

Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014-2015.

PubMed

Undurraga, Eduardo A; Meltzer, Martin I; Tran, Cuc H; Atkins, Charisma Y; Etheart, Melissa D; Millien, Max F; Adrien, Paul; Wallace, Ryan M

2017-06-01

AbstractHaiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area ( N = 2,289) in 2014-2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568-$80,290) than the no-bite-case-management (NBCM) scenario ($15,988-$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891-$4,735, NBCM: $5,980-$8,453; 2015, HARSP: $3,534-$7,171, NBCM: $7,298-$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination.

Convicted by a bite mark, Ted Bundy (1946-1989).

PubMed

Riaud, Xavier

2014-01-01

The identification of a murderer and the eventual conviction was largely due to forensic dentistry and in particular the use of bite marks on the victim compared with casts of the teeth of the accused. The Bundy case has become notorious in American legal circles.

Triploid Colubrid Snake Provides Insight into the Mechanism of Sex Determination in Advanced Snakes.

PubMed

Rovatsos, Michail; Augstenová, Barbora; Altmanová, Marie; Sloboda, Michal; Kodym, Petr; Kratochvíl, Lukáš

2018-06-19

The advanced snakes (Caenophidia), the important amniote lineage encompassing more than 3,000 living species, possess highly conserved female heterogamety across all families. However, we still lack any knowledge on the gene(s) and the molecular mechanism controlling sex determination. Triploid individuals spontaneously appear in populations of diploid species and can provide an important insight into the evolution of sex determination. Here, we report a case of spontaneous triploidy in a male of the twin-spotted ratsnake (Elaphe bimaculata) with ZZW sex chromosomes. We speculate that as both ZZ and ZZW individuals develop male gonads, the ratio between the number of Z chromosomes and autosomes, and not the presence of the W chromosome in the genome, drives sex determination in the advanced snakes. © 2018 S. Karger AG, Basel.

A qualitative investigation of the perceptions of female dog-bite victims and implications for the prevention of dog bites.

PubMed

Westgarth, Carri; Watkins, Francine

2015-01-01

Preventing dog bites is an increasingly important public health and political issue with implications for both human and animal health and welfare. Expert opinion is that most bites are preventable. Intervention materials have been designed to educate people on how to assess the body language of dogs, evaluate risk, and take appropriate action. The effectiveness of this approach is rarely evaluated and the incidence of dog bites is thought to be increasing. Is the traditional approach to dog bite prevention working as well as it should? In this novel, small scale qualitative study, the perceptions of victims regarding their dog bite experience were explored in-depth. The study recruited 8 female participants who had been bitten by a dog in the past 5 years. In-depth, one-to-one interviews were conducted, transcribed, and analyzed using thematic analysis. The findings indicate that dog bites may not be as easily preventable as previously presumed, and that education about dog body language may not prevent some types of dog bites. The reasons participants were bitten were multifaceted and complex. In some cases, there was no interaction with the dog before the bite so there was no opportunity to assess the situation and modify behavior around the dog accordingly. Identifying who was to blame, and had responsibility for preventing the bite, was straightforward for the participants in hindsight. Those bitten blamed themselves and/or the dog owner, but not the dog. Most participants already felt they had a theoretical knowledge that would allow them to recognize dog aggression before the dog bite, yet participants, especially those who worked regularly with dogs, routinely believed, "it would not happen to me." We also identified an attitude that bites were "just one of those things," which could also be a barrier prevention initiatives. Rather than being special to the human-canine relationship, the attitudes discovered mirror those found in other areas of injury prevention. A new approach to dog-bite prevention may now be required, drawing on other injury prevention strategies including awareness-raising and minimizing the damage caused by a bite when it happens.

Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?

PubMed

Ireland, Graham; Brown, Simon G A; Buckley, Nicholas A; Stormer, Jeff; Currie, Bart J; White, Julian; Spain, David; Isbister, Geoffrey K

2010-09-06

To determine which laboratory tests are first associated with severe envenoming after a snakebite, when (ie, how long after the bite) the test results become abnormal, and whether this can determine a safe observation period after suspected snakebite. Prospective cohort study of 478 patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project from January 2002 to April 2009, who had at least three sets of laboratory test results and at least 12 hours of observation in hospital after the bite. Severe envenoming was defined as venom-induced consumption coagulopathy (VICC), myotoxicity, neurotoxicity or thrombotic microangiopathy. International normalised ratio (INR), activated partial thromboplastin time (aPTT), creatine kinase (CK) level, and neurological examination. There were 240 patients with severe envenoming, 75 with minor envenoming and 163 non-envenomed patients. Of 206 patients with VICC, 178 had an INR > 1.2 (abnormal) on admission, and the remaining 28 had an INR > 1.2 within 12 hours of the bite. Of 33 patients with myotoxicity, a combination of CK > 250 U/L and an abnormal aPTT identified all but two cases by 12 hours; one of these two was identified within 12 hours by leukocytosis. Nine cases of isolated neurotoxicity had a median time of onset after the bite of 4 hours (range, 35 min - 12 h). The combination of serial INR, aPTT and CK tests and repeated neurological examination identified 213 of 222 severe envenoming cases (96%) by 6 hours and 238 of 240 (99%) by 12 hours. Laboratory parameters (INR, aPTT and CK) and neurological reassessments identified nearly all severe envenoming cases within 12 hours of the bite, even in this conservative analysis that assumed normal test results if the test was not done.

Skeletal anchorage for intrusion of bimaxillary molars in a patient with skeletal open bite and temporomandibular disorders

PubMed Central

Iwasa, Akihiko; Horiuchi, Shinya; Kinouchi, Nao; Izawa, Takashi; Hiasa, Masahiro; Kawai, Nobuhiko; Yasue, Akihiro; Hassan, Ali H.; Tanaka, Eiji

2017-01-01

The treatment of severe skeletal anterior open bite is extremely difficult in adults, and orthognathic surgery is generally selected for its treatment. We report the case of an 18-year-old adult patient with skeletal anterior open bite and temporomandibular disorders who was successfully treated using temporary anchorage devices. She had an open bite of −2.0 mm and an increased facial height. Miniplates were implanted in both the maxilla and mandible, and molar intrusion resulted in counterclockwise rotation of the mandible over a period of 12 months. After active treatment, her upper and lower first molars were intruded by approximately 2 mm and her overbite became +2.5 mm. Her retrognathic profile improved with counterclockwise rotation of the mandible. Orthodontic treatment aided with skeletal anchorage is beneficial for intrusion of bimaxillary molars in patients with anterior open bite. PMID:29119097

Reconstruction of massive facial avulsive injury, secondary to animal bite.

PubMed

Motamed, Sadrollah; Niazi, Feizollah; Moosavizadeh, Seyed Mehdi; Gholizade Pasha, Abdolhamid; Motamed, Ali

2014-02-01

Management of facial soft tissue trauma requires complex reconstruction surgery. Animal bite on face is a common cause of facial tissue trauma with severe destruction. Evaluation of unit involvement is the first effort, followed by designation of reconstruction. In this case, we performed multiple reconstruction options.

Lowland copperhead (Austrelaps superbus) envenomation causing severe neuromuscular paralysis in a dog.

PubMed

Wright, L V; Indrawirawan, Y H

2017-06-01

A case of lowland copperhead snake (Austrelaps superbus) envenomation in a dog is described. The dog developed severe and prolonged neuromuscular paralysis, including ventilatory failure. The dog was treated successfully with antivenom, intravenous fluids and mechanical ventilation. The toxic components of lowland copperhead snake venom are reviewed. © 2017 Australian Veterinary Association.

A placebo controlled clinical trial investigating the efficacy of a homeopathic after-bite gel in reducing mosquito bite induced erythema.

PubMed

Hill, N; Stam, C; Tuinder, S; van Haselen, R A

1995-01-01

A randomised, placebo controlled clinical trial was conducted to examine the efficacy of a homeopathic after-bite gel in the symptomatic relief of mosquito bites. Sixty eight healthy volunteers were bitten under laboratory conditions by Aedes aegypti mosquitoes at three spots, on the ventral aspect of the forearm. One bite was treated with the homeopathic after-bite gel, another bite with a placebo gel which was identical in appearance and smell to the homeopathic after-bite gel, and the third bite remained untreated. Immediately after the bites and 1, 3, 6, 26 and 31 hours post-bite, the length and width of the erythema were measured with a calliper, and photographs were taken of the bite sites from which the size of the erythema was subsequently determined. This was followed by assessment of the extent of itching with a verbal analogue scale, and finally treatment took place. For each spot the total erythema was calculated as the area under the plotted curve of the erythema at different time points (mm2*h) and the total sum of the itch scores was determined. For the bites treated with the homeopathic after-bite gel the median total erythema was 10.500 mm2*h. For the spots treated with the placebo gel and the untreated spots the median total erythema was 12.900 mm2*h and 13.300 mm2*h, respectively. The difference between the spots treated with the homeopathic after-bite gel and the untreated spots came close to significance (two-tailed P = 0.06), which was not the case for the difference between the spots treated with the homeopathic after-bite gel and the spots treated with placebo gel (P = 0.13). After pooling the data of a very similar previous pilot study and the present study (ntotal = 83), the homeopathic after-bite gel was significantly superior to no treatment (two-tailed P = 0.003) as well as to placebo gel (two-tailed P = 0.03). Comparing itching after the three treatments, no significant differences could be demonstrated. The extent of itching was positively correlated with the area of the erythema (r = 0.63). Treatment of mosquito bites with the homeopathic after-bite gel will reduce the erythema compared to no treatment. Comparison with the placebo gel suggests it is the plant extracts which are the active components of this gel.

Abundance, biting behaviour and parous rate of anopheline mosquito species in relation to malaria incidence in gold-mining areas of southern Venezuela.

PubMed

Moreno, J E; Rubio-Palis, Y; Páez, E; Pérez, E; Sánchez, V

2007-12-01

A longitudinal entomological and epidemiological study was conducted in five localities of southern Venezuela between January 1999 and April 2000 to determine the abundance, biting behaviour and parity of anopheline mosquitoes (Diptera: Culicidae) in relation to climate variables and malaria incidence. A total of 3685 female anopheline mosquitoes, representing six species, were collected. The most abundant species were Anopheles marajoara Galvão & Damasceno (60.7%) and Anopheles darlingi Root (35.1%), which together represented 95.8% of the total anophelines collected. Abundance and species distribution varied by locality. Malaria prevalence varied from 12.5 to 21.4 cases per 1000 population. Transmission occurred throughout the year; the annual parasite index (API) for the study period was 813.0 cases per 1000 population, with a range of 71.6-2492 per 1000 population, depending on locality. Plasmodium vivax (Grassi & Feletti) (Coccidia: Plasmodiidae) accounted for 78.6% of cases, Plasmodium falciparum (Welch) for 21.4% and mixed infections (Pv+Pf) for < 0.1%. Anopheles marajoara and An. darlingi were more abundant during the rainy season (April-September). There was no significant correlation (P > 0.05) between mosquito abundance and rainfall. Correlations between malaria incidence by parasite species and mosquito abundance were not significant (P > 0.05). Monthly parous rates were similar for An. marajoara and An. darlingi throughout the year, with two peaks that coincided with the dry-rainy transition period and the period of less rain. Peaks in the incidence of malaria cases were observed 1 month after major peaks in biting rates of parous anophelines. Anopheles darlingi engages in biting activity throughout the night, with two minor peaks at 23.00-00.00 hours and 03.00-04.00 hours. Anopheles marajoara has a different pattern, with a biting peak at 19.00-21.00 hours and 76.6% of biting occurring before midnight. Although both vectors bite indoors and outdoors, they showed a highly significant (P < 0.01) degree of exophagic behaviour. The present study constitutes the first effort to characterize the bionomics of anophelines in malaria endemic foci in different ecological situations in relation to malaria transmission in southern Venezuela and to provide relevant information to be considered when planning and implementing vector control programmes.

Sepsis by Pasteurella multocida in an Elderly Immunocompetent Patient after a Cat Bite.

PubMed

Caserza, Lara; Piatti, Gabriella; Bonaventura, Aldo; Liberale, Luca; Carbone, Federico; Dallegri, Franco; Ottonello, Luciano; Gustinetti, Giulia; Del Bono, Valerio; Montecucco, Fabrizio

2017-01-01

Pasteurella multocida colonizes animal scratches and bites. This bacterium was described to cause sepsis or endocarditis mainly in immunocompromised patients. We report the case of a 92-year-old woman presenting at the Emergency Department with coma and fever a week after the bite of her cat. The cat bite was misdiagnosed at admission partly due to an underestimation of this event by the patient's relatives. An inflamed area localized at perimalleolar skin of the right leg was detected. Laboratory biomarkers of inflammation were elevated. The cerebral computed tomography (CT) scan with angiographic sequences showed a complete occlusion of right intracranial vertebral artery. Total body CT scan and abdominal echocardiography were negative for foci of infection. Three consecutive blood cultures were positive for Pasteurella multocida . A diagnosis of sepsis by Pasteurella multocida was made, and the patient recovered after a specific antimicrobial treatment. In order to confirm the animal transmission, the cat saliva was cultured and found positive for Pasteurella multocida with a similar antibiotic sensitivity to that isolated from the patient. In conclusion, the case of a patient with coma and fever after a cat bite was presented. The transmission of pathogens from pets has to be carefully considered as an important route of infection in immunocompetent patients.

Anterior open bite treatment with magnets.

PubMed

Kiliaridis, S; Egermark, I; Thilander, B

1990-11-01

The aim of this study was to examine the effects of repelling magnets on the treatment of anterior open bite and compare them with the effects of acrylic posterior bite-blocks. Twenty patients, aged 9-16 years with skeletal anterior open bite, were randomly divided into two groups. In one group the patients wore posterior repelling magnet splints and in the other they wore acrylic posterior bite-blocks of the same thickness as the magnet splints. The patients were instructed to use their appliance as much as possible (the minimum accepted being 18 hours daily) during a 6-month period. Dental casts, intra-oral photos, and lateral cephalograms were taken before and after treatment, and the patients were also examined regularly to identify the development of any craniomandibular disorders. In the first group, the dental and skeletal vertical relation responded quickly to the magnet treatment. The open bite was generally closed in just under 4 months, especially in patients in early mixed dentition. Spacing in the labial segments decreased in some cases, while slight crowding was induced in others. Transverse problems, i.e. unilateral cross-bite, sometimes followed by scissor-bite on the opposite side, was observed in those patients who were in the early mixed dentition and had used the magnets intensively. The patients who wore acrylic posterior bite-blocks also showed improvement in the dental and skeletal vertical relationships, especially during the first months. This was followed by a 'plateau' period. No transverse problems were found in these patients.

Genetic Characterization of Turkish Snake Melon (Cucumis melo L. subsp. melo flexuosus Group) Accessions Revealed by SSR Markers.

PubMed

Solmaz, Ilknur; Kacar, Yildiz Aka; Simsek, Ozhan; Sari, Nebahat

2016-08-01

Snake melon is an important cucurbit crop especially in the Southeastern and the Mediterranean region of Turkey. It is consumed as fresh or pickled. The production is mainly done with the local landraces in the country. Turkey is one of the secondary diversification centers of melon and possesses valuable genetic resources which have different morphological characteristics in case of snake melon. Genetic diversity of snake melon genotypes collected from different regions of Turkey and reference genotypes obtained from World Melon Gene Bank in Avignon-France was examined using 13 simple sequence repeat (SSR) markers. A total of 69 alleles were detected, with an average of 5.31 alleles per locus. The polymorphism information content of SSR markers ranged from 0.19 to 0.57 (average 0.38). Based on cluster analysis, two major groups were defined. The first major group included only one accession (61), while the rest of all accessions grouped in the second major group and separated into different sub-clusters. Based on SSR markers, cluster analysis indicated that considerably high genetic variability exists among the examined accessions; however, Turkish snake melon accessions were grouped together with the reference snake melon accessions.

Philornis sp. bot fly larvae in free living scarlet macaw nestlings and a new technique for their extraction.

PubMed

Olah, George; Vigo, Gabriela; Ortiz, Lizzie; Rozsa, Lajos; Brightsmith, Donald J

2013-09-01

Bot fly larvae (Philornis genus) are obligate subcutaneous blood-feeding parasites of Neotropical birds including psittacines. We analyze twelve years of data on scarlet macaw (Ara macao) nestlings in natural and artificial nests in the lowland forests of southeastern Peru and report prevalence and intensity of Philornis parasitism. Bot fly prevalence was 28.9% while mean intensity was 5.0 larvae per infected chick. Prevalence in natural nests (11%, N=90 nestlings) was lower than in wooden nest-boxes (39%, N=57) and PVC boxes (39%, N=109). We describe a new technique of removing Philornis larvae using a reverse syringe design snake bite extractor. We compare this new technique to two other methods for removing bots from macaw chicks and find the new method the most suitable. Copyright © 2013 Elsevier B.V. All rights reserved.

Resembling a viper: implications of mimicry for conservation of the endangered smooth snake.

PubMed

Valkonen, Janne K; Mappes, Johanna

2014-12-01

The phenomenon of Batesian mimicry, where a palatable animal gains protection against predation by resembling an unpalatable model, has been a core interest of evolutionary biologists for 150 years. An extensive range of studies has focused on revealing mechanistic aspects of mimicry (shared education and generalization of predators) and the evolutionary dynamics of mimicry systems (co-operation vs. conflict) and revealed that protective mimicry is widespread and is important for individual fitness. However, according to our knowledge, there are no case studies where mimicry theories have been applied to conservation of mimetic species. Theoretically, mimicry affects, for example, frequency dependency of predator avoidance learning and human induced mortality. We examined the case of the protected, endangered, nonvenomous smooth snake (Coronella austriaca) that mimics the nonprotected venomous adder (Vipera berus), both of which occur in the Åland archipelago, Finland. To quantify the added predation risk on smooth snakes caused by the rarity of vipers, we calculated risk estimates from experimental data. Resemblance of vipers enhances survival of smooth snakes against bird predation because many predators avoid touching venomous vipers. Mimetic resemblance is however disadvantageous against human predators, who kill venomous vipers and accidentally kill endangered, protected smooth snakes. We found that the effective population size of the adders in Åland is very low relative to its smooth snake mimic (28.93 and 41.35, respectively).Because Batesian mimicry is advantageous for the mimic only if model species exist in sufficiently high numbers, it is likely that the conservation program for smooth snakes will fail if adders continue to be destroyed. Understanding the population consequences of mimetic species may be crucial to the success of endangered species conservation. We suggest that when a Batesian mimic requires protection, conservation planners should not ignore the model species (or co-mimic in Mullerian mimicry rings) even if it is not itself endangered. © 2014 Society for Conservation Biology.

Understanding Biological Roles of Venoms Among the Caenophidia: The Importance of Rear-Fanged Snakes.

PubMed

Mackessy, Stephen P; Saviola, Anthony J

2016-11-01

Snake venoms represent an adaptive trophic response to the challenges confronting a limbless predator for overcoming combative prey, and this chemical means of subduing prey shows several dominant phenotypes. Many front-fanged snakes, particularly vipers, feed on various vertebrate and invertebrate prey species, and some of their venom components (e.g., metalloproteinases, cobratoxin) appear to have been selected for "broad-brush" incapacitation of different prey taxa. Using proteomic and genomic techniques, the compositional diversity of front-fanged snakes is becoming well characterized; however, this is not the case for most rear-fanged colubroid snakes. Because these species consume a high diversity of prey, and because venoms are primarily a trophic adaptation, important clues for understanding specific selective pressures favoring venom component composition will be found among rear-fanged snake venoms. Rear-fanged snakes typically (but not always) produce venoms with lower complexity than front-fanged snakes, and there are even fewer dominant (and, arguably, biologically most relevant) venom protein families. We have demonstrated taxon-specific toxic effects, where lizards and birds show high susceptibility while mammals are largely unaffected, for both Old World and New World rear-fanged snakes, strongly indicating a causal link between toxin evolution and prey preference. New data are presented on myotoxin a, showing that the extremely rapid paralysis induced by this rattlesnake toxin is specific for rodents, and that myotoxin a is ineffectual against lizards. Relatively few rear-fanged snake venoms have been characterized, and basic natural history data are largely lacking, but directed sampling of specialized species indicates that novel compounds are likely among these specialists, particularly among those species feeding on invertebrate prey such as scorpions and centipedes. Because many of the more than 2200 species of colubroid snakes are rear-fanged, and many possess a Duvernoy's venom gland, understanding the nature of their venoms is foundational to understanding venom evolution in advanced snakes. © The Author 2016. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

Rat-bite fever in children: case report and review.

PubMed

Ojukwu, Ifeoma C; Christy, Cynthia

2002-01-01

We report 2 cases of rat-bite fever (RBF), a multisystem zoonosis, in children and review the literature. RBF is caused by I of 2 Gram-negative organisms: Streptobacillus moniliformis or, less commonly, Spirillum minus. Both of our cases developed in school-aged girls with a history of rat exposure who presented with a multisystem illness consisting of fever, petechial and purpuric rash, arthralgia and polyarthritis. Both responded promptly to antibiotic treatment. An additional 10 cases from a MEDLINE review (1960-2000) are reviewed. RBF must be included in the differential diagnosis of febrile patients with rashes and a history of exposure to rats.

The examination and identification of bite marks in foods using 3D scanning and 3D comparison methods.

PubMed

Naether, Silvio; Buck, Ursula; Campana, Lorenzo; Breitbeck, Robert; Thali, Michael

2012-01-01

Bite mark analysis offers the opportunity to identify the biter based on the individual characteristics of the dentitions. Normally, the main focus is on analysing bite mark injuries on human bodies, but also, bite marks in food may play an important role in the forensic investigation of a crime. This study presents a comparison of simulated bite marks in different kinds of food with the dentitions of the presumed biter. Bite marks were produced by six adults in slices of buttered bread, apples, different kinds of Swiss chocolate and Swiss cheese. The time-lapse influence of the bite mark in food, under room temperature conditions, was also examined. For the documentation of the bite marks and the dentitions of the biters, 3D optical surface scanning technology was used. The comparison was performed using two different software packages: the ATOS modelling and analysing software and the 3D studio max animation software. The ATOS software enables an automatic computation of the deviation between the two meshes. In the present study, the bite marks and the dentitions were compared, as well as the meshes of each bite mark which were recorded in the different stages of time lapse. In the 3D studio max software, the act of biting was animated to compare the dentitions with the bite mark. The examined food recorded the individual characteristics of the dentitions very well. In all cases, the biter could be identified, and the dentitions of the other presumed biters could be excluded. The influence of the time lapse on the food depends on the kind of food and is shown on the diagrams. However, the identification of the biter could still be performed after a period of time, based on the recorded individual characteristics of the dentitions.

Sabah snake grass extract pre-processing: Preliminary studies in drying and fermentation

NASA Astrophysics Data System (ADS)

Solibun, A.; Sivakumar, K.

2016-06-01

Clinacanthus nutans (Burm. F.) Lindau which also known as ‘Sabah Snake Grass’ among Malaysians have been studied in terms of its medicinal and chemical properties in Asian countries which is used to treat various diseases from cancer to viral-related diseases such as varicella-zoster virus lesions. Traditionally, this plant has been used by the locals to treat insect and snake bites, skin rashes, diabetes and dysentery. In Malaysia, the fresh leaves of this plant are usually boiled with water and consumed as herbal tea. The objectives of this study are to determine the key process parameters for Sabah Snake Grass fermentation which affect the chemical and biological constituent concentrations within the tea, extraction kinetics of fermented and unfermented tea and the optimal process parameters for the fermentation of this tea. Experimental methods such as drying, fermenting and extraction of C.nutans leaves were conducted before subjecting them to analysis of antioxidant capacity. Conventional oven- dried (40, 45 and 50°C) and fermented (6, 12 and 18 hours) whole C.nutans leaves were subjected to tea infusion extraction (water temperature was 80°C, duration was 90 minutes) and the sample liquid was extracted for every 5th, 10th, 15th, 25th, 40th, 60th and 90th minute. Analysis for antioxidant capacity and total phenolic content (TPC) were conducted by using 2, 2-diphenyl-1-pycryl-hydrazyl (DPPH) and Folin-Ciocaltheu reagent, respectively. The 40°C dried leaves sample produced the highest phenolic content at 0.1344 absorbance value in 15 minutes of extraction while 50°C dried leaves sample produced 0.1298 absorbance value in 10 minutes of extraction. The highest antioxidant content was produced by 50°C dried leaves sample with absorbance value of 1.6299 in 5 minutes of extraction. For 40°C dried leaves sample, the highest antioxidant content could be observed in 25 minutes of extraction with the absorbance value of 1.1456. The largest diameter of disc that could be observed at 18 hours of fermentation sample had a pile size of 3 cm that had expanded to 5.9 cm of diameter which indicated the microbe's growth.

What doesn't kill you might make you stronger: functional basis for variation in body armour.

PubMed

Broeckhoven, Chris; Diedericks, Genevieve; Mouton, P le Fras N

2015-09-01

1. Predation has been proposed to be a selective agent in the evolution of morphological antipredator strategies in prey. Among vertebrates, one of the morphological traits that evolved multiple times is body armour, including carapaces, thickened keratinized scales and plates of dermal bone. 2. It has been generally assumed that body armour provides protection against a predatory attack; yet, few explicit tests of the hypothesis exist. Cordylidae, a relatively small family of southern African lizards, show considerable variation in the degree of body armour. Hence, this family provides an opportunity to test the hypothesis that body armour serves as protection against predators. 3. Experiments were conducted to test whether the bite forces of four species of mammalian predators were high enough to penetrate the skins of Karusasaurus polyzonus, Namazonurus peersi, Cordylus cordylus and Cordylus macropholis, as well as those of Ouroborus cataphractus individuals originating from three localities that differed in their predator diversity. Furthermore, histological techniques were used to test whether variation in skin toughness was associated with concomitant changes in the degree of epidermal (i.e. β-keratin) and dermal (i.e. osteoderm) armour. 4. The skin toughness values for four out of five cordylid lizards tested in this study were well below the bite forces of the mammalian predators. In contrast, the thick osteoderms in the dermis of O. cataphractus can withstand bites from several mongoose species. However, the significant variation in body armour that is present between the three populations of O. cataphractus does not seem to be related to predator diversity. 5. It is concluded that body armour can serve as protection against predation in O. cataphractus, but that alternative selection pressures, such as thermoregulation or predation by snakes, presumably underlie variation in defensive morphology in the other cordylid lizards. © 2015 The Authors. Journal of Animal Ecology © 2015 British Ecological Society.

Selective mutism due to a dog bite trauma in a 4-year-old girl: a case report

PubMed Central

2009-01-01

Introduction A child experiencing an event of threatening or catastrophic nature may experience considerable post-traumatic psychological distress. Dog bites present an important public health problem and are a frequent cause of physical trauma in children. Physicians who manage paediatric trauma may not be vigilant of the high risk of psychological stress in children exposed to a physical injury. Case presentation A 4-year-old white girl of Greek origin, with a dog-bite related trauma was admitted to the University Hospital of Crete, Greece, for surgical repair and intravenous antibiotic therapy due to extensive lesions. Exposure to the traumatic event triggered the onset of an unusual psychological response, selective mutism and acute post-traumatic stress disorder. Conclusion There is limited literature discussing the psychological effect of dog bites in children. Parents and physicians involved in pediatric physical trauma need to be more familiar with post-traumatic behavioral reactions. Awareness of the potential development of such reactions may result in early detection and effective management of children at risk. PMID:19946578

Phosphorus losses from an irrigated watershed in the Northwestern U.S.: Case study of the Upper Snake Rock Watershed

USDA-ARS?s Scientific Manuscript database

Watersheds utilizing surface water for irrigation often return a portion of the water to a water body. This irrigation return flow often includes sediment and nutrients that reduce the quality of the receiving water body. Research in the 82,000 ha Upper Snake Rock (USR) watershed from 2005 to 2008 s...

An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital

PubMed Central

Shayesteh, Ali; Xu, Min Li

2017-01-01

Background: Incidence of dog bites continues to rise among the pediatric population and serves as a public health threat for the well-being of children. Plastic surgeons are at the forefront of initial management and eventual outcome of these devastating injuries. This study set out to determine the nature of dog bite injuries treated over a 3-year period at a large level 1 pediatric trauma center. Methods: A retrospective review of emergency room records of all pediatric patients (age, 0–18 years old) who sustained dog bites between January 2012 and December 2014 were gathered. All details about age of patient, location and severity of dog bites, type of dog breed, antibiotics given, and emergency versus operative treatment were recorded and analyzed. Results: One hundred eight patients aged 5 months to 18 years old were treated in the emergency department after suffering dog bite injuries during the study period. The highest incidence of dog bites occurred in preschool children. The mean age for patients who required operative repair was lower than the mean age for patients who underwent primary closure in the emergency department. The location of injury was most commonly isolated to the head/neck region. Of the 56 cases that had an identified dog breed, pit bulls accounted for 48.2% of the dog bites, and 47.8% of pit bull bites required intervention in the operating room. Conclusion: Children with large dog bite injuries require more immediate care in a level 1 pediatric trauma hospitals in order to optimize their hospitalization course and eventual outcome. PMID:29184724

TaqMan real-time polymerase chain reaction for detection of Ophidiomyces ophiodiicola, the fungus associated with snake fungal disease.

PubMed

Bohuski, Elizabeth; Lorch, Jeffrey M; Griffin, Kathryn M; Blehert, David S

2015-04-15

Fungal skin infections associated with Ophidiomyces ophiodiicola, a member of the Chrysosporium anamorph of Nannizziopsis vriesii (CANV) complex, have been linked to an increasing number of cases of snake fungal disease (SFD) in captive snakes around the world and in wild snake populations in eastern North America. The emergence of SFD in both captive and wild situations has led to an increased need for tools to better diagnose and study the disease. We developed two TaqMan real-time polymerase chain reaction (PCR) assays to rapidly detect O. ophiodiicola in clinical samples. One assay targets the internal transcribed spacer region (ITS) of the fungal genome while the other targets the more variable intergenic spacer region (IGS). The PCR assays were qualified using skin samples collected from 50 snakes for which O. ophiodiicola had been previously detected by culture, 20 snakes with gross skin lesions suggestive of SFD but which were culture-negative for O. ophiodiicola, and 16 snakes with no clinical signs of infection. Both assays performed equivalently and proved to be more sensitive than traditional culture methods, detecting O. ophiodiicola in 98% of the culture-positive samples and in 40% of the culture-negative snakes that had clinical signs of SFD. In addition, the assays did not cross-react with a panel of 28 fungal species that are closely related to O. ophiodiicola or that commonly occur on the skin of snakes. The assays did, however, indicate that some asymptomatic snakes (~6%) may harbor low levels of the fungus, and that PCR should be paired with histology when a definitive diagnosis is required. These assays represent the first published methods to detect O. ophiodiicola by real-time PCR. The ITS assay has great utility for assisting with SFD diagnoses whereas the IGS assay offers a valuable tool for research-based applications.

Molecular cloning, expression and characterization of albolamin: a type P-IIa snake venom metalloproteinase from green pit viper (Cryptelytrops albolabris).

PubMed

Jangprasert, Panchalee; Rojnuckarin, Ponlapat

2014-03-01

Snake venom metalloproteinases (SVMPs) can damage vessel wall, degrade clotting factors, inhibit integrins and block platelet functions. Studying them not only gives us deeper insights in pathogenesis of snakebites, but also potentially yields novel therapeutic agents. Here, we discovered a clone of an RGD-containing SVMP from the green pit viper (Cryptelytrops albolabris) venom gland cDNA library. Sequence analysis revealed that it belonged to the P-IIa subclass of SVMP comprising signal peptide, prodomain, metalloproteinase and disintegrin. Compared with other P-II SVMPs, it contained 2 additional conserved cysteines that were predicted to prevent the release of disintegrin from the metalloproteinase domain in the mature protein. The N-terminal histidine-tagged construct of metalloproteinase and disintegrin domains of albolamin was inserted into the pPICZαA vector and expressed in Pichia pastoris. The recombinant protein molecular weight was approximately 35 kDa on Western blot probed with anti-polyhistidine antibody. The recombinant albolamin could digest human type IV collagen starting within 15 min after incubation. In addition, it dose-dependently inhibited collagen-induced platelet aggregation with the IC50 of 1.8 μM. However, there was no effect on ADP-induced platelet aggregation. Therefore, the inhibition mechanism is probably through blocking collagen receptor(s). Albolamin activities probably contributed to pathology of green pit viper bites. Its disintegrin domain deserves further studies for the potential to be a useful agent affecting platelet functions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cross-reactivity and neutralization of Indian King cobra (Ophiophagus hannah) venom by polyvalent and monovalent antivenoms.

PubMed

Gowtham, Yashonandana J; Mahadeswaraswamy, Y H; Girish, K S; K, Kemparaju

2014-07-01

The venom of the largest venomous snake, the king cobra (Ophiophagus hannah), is still out of league for the production of therapeutic polyvalent antivenom nor it is characterized immunologically in the Indian subcontinent. In the present study, the king cobra venom is comparatively studied for the cross-reactivity/reactivity and toxicity neutralization by the locally available equine therapeutic polyvalent BSV and VB antivenoms, and monovalent antivenom (OH-IgG) prepared in rabbit. None of the two therapeutic antivenoms procured from two different firms showed any signs of cross-reactivity in terms of antigen-antibody precipitin lines in immunodouble diffusion assay; however, a weak and an insignificant cross-reactivity pattern was observed in ELISA and Western blot studies. Further, both BSV and VB antivenoms failed to neutralize proteolytic, hyaluronidase and phospholipase activities as well as toxic properties such as edema, myotoxicity and lethality of the venom. As expected, OH-IgG showed strong reactivity in immunodouble diffusion, ELISA and in Western blot analysis and also neutralized both enzyme activities as well as the toxic properties of the venom. Thus, the study provides insight into the likely measures that are to be taken in cases of accidental king cobra bites for which the Indian subcontinent is still not prepared for. Copyright © 2014 Elsevier B.V. All rights reserved.

Same Dog Bite and Different Outcome in Two Cases – Case Report

PubMed Central

VK, Domple; IF, Inamdar; NR, Aswar; MK, Doibale

2014-01-01

There is still no cure for rabies and survival from clinical rabies is extremely rare. It is a preventable disease if the post exposure prophylaxis is initiated in time and administered as per WHO guidelines including administration of rabies immunoglobulin. The role of passive rabies immunization products is to provide the immediate availability of neutralizing antibodies at the site of the exposure before it is physiologically possible for the patient to begin producing his or her own antibodies after vaccination. In this case report, the same dog has bitten to a boy and to an adult. Local wound treatment and use of human rabies immunoglobulin as well as gluteal region as a site of bite were the probable reasons for survival of the boy. On the other hand no local wound treatment, no use of rabies immunoglobulin and finger as a site of bite are the probable reasons for death of an adult due to rabies. PMID:25121007

Human case of bubonic plague resulting from the bite of a wild Gunnison's prairie dog during translocation from a plague-endemic area.

PubMed

Melman, S D; Ettestad, P E; VinHatton, E S; Ragsdale, J M; Takacs, N; Onischuk, L M; Leonard, P M; Master, S S; Lucero, V S; Kingry, L C; Petersen, J M

2018-02-01

Plague is a zoonotic disease (transmitted mainly by fleas and maintained in nature by rodents) that causes severe acute illness in humans. We present a human plague case who became infected by the bite of a wild Gunnison's prairie dog, and a good practical example of the One Health approach that resulted in a rapid public health response. The exposure occurred while the animal was being transported for relocation to a wildlife refuge after being trapped in a plague enzootic area. This is the first report of a human plague case resulting from the bite of a Gunnison's prairie dog. Additionally, we present an observation of a longer incubation period for plague in captive prairie dogs, leading to a recommendation for a longer quarantine period for prairie dogs during translocation efforts. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

[Emergencies of the external genital area].

PubMed

Kaminsky, A; Sperling, H

2016-04-01

In addition to epididymitis and testicular torsion, emergencies of the external genital are rare. Rapid diagnosis and therapy are essential so that immediate therapy can be provided, which is important for survival (Fournier gangrene) of the patient or for the preservation of erectile function (priapism and penile fracture). A detailed patient history and clinical examination are generally sufficient for correct diagnosis. Under certain circumstances, it might be useful to perform ultrasound, computed tomography scan or magnetic resonance imaging or retrograde urethrography. A urine analysis is obligatory. In case of penetrating injuries and genital trauma in females, additional imaging should be performed because these are often associated with concomitant injuries of the rectum, vagina, or bladder. Special cases are gunshot wounds, in which caliber and type of weapon play an important role for the degree of damage, and animal or human bites. For animal bites, the risk for rabies infection and in case of a human bite the risk for transmission of HIV and hepatitis should be taken into consideration and post-exposure prophylaxis should possibly be offered.

Funnel-web spider bite: a systematic review of recorded clinical cases.

PubMed

Isbister, Geoffrey K; Gray, Michael R; Balit, Corrine R; Raven, Robert J; Stokes, Barrie J; Porges, Kate; Tankel, Alan S; Turner, Elizabeth; White, Julian; Fisher, Malcolm McD

2005-04-18

To investigate species-specific envenoming rates and spectrum of severity of funnel-web spider bites, and the efficacy and adverse effects of funnel-web spider antivenom. Cases were identified from a prospective study of spider bite presenting to four major hospitals and three state poisons information centres (1999-2003); museum records of spider specimens since 1926; NSW Poisons Information Centre database; MEDLINE and EMBASE search; clinical toxinology textbooks; the media; and the manufacturer's reports of antivenom use. Patient age and sex, geographical location, month, expert identification of the spider, clinical effects and management; envenoming was classified as severe, mild-moderate or minor/local effects. 198 potential funnel-web spider bites were identified: 138 were definite (spider expertly identified to species or genus), and 77 produced severe envenoming. All species-identified severe cases were attributed to one of six species restricted to NSW and southern Queensland. Rates of severe envenoming were: Hadronyche cerberea (75%), H. formidabilis (63%), Atrax robustus (17%), Hadronyche sp. 14 (17%), H. infensa (14%) and H. versuta (11%). Antivenom was used in 75 patients, including 22 children (median dose, 3 ampoules; range, 1-17), with a complete response in 97% of expertly identified cases. Three adverse reactions were reported, all in adults: two early allergic reactions (one mild and one with severe systemic effects requiring adrenaline), and one case of serum sickness. Severe funnel-web spider envenoming is confined to NSW and southern Queensland; tree-dwelling funnel webs (H. cerberea and H. formidabilis) have the highest envenoming rates. Funnel-web spider antivenom appears effective and safe; severe allergic reactions are uncommon.

Open bite: diagnosis, treatment and stability.

PubMed

Matsumoto, Mírian Aiko Nakane; Romano, Fábio Lourenço; Ferreira, José Tarcísio Lima; Valério, Rodrigo Alexandre

2012-01-01

Open bite has fascinated Orthodontics due to the difficulties regarding its treatment and maintenance of results. This anomaly has distinct characteristics that, in addition to the complexity of multiple etiological factors, have aesthetic and functional consequences. Within this etiological context, several types of mechanics have been used in open bite treatment, such as palatal crib, orthopedic forces, occlusal adjustment, orthodontic camouflage with or without extraction, orthodontic intervention using mini-implants or mini-plates, and even orthognathic surgery. An accurate diagnosis and etiological determination are always the best guides to establish the objectives and the ideal treatment plan for such a malocclusion. This report describes two cases of open bite. At the end of the treatment, both patients had their canines and molars in Class I occlusion, normal overjet and overbite, and stability during the posttreatment period.

Coadjuvant treatment with surgery and pirfenidone in severe facial trauma due to dog bite.

PubMed

Cantú-Cantú, María Zulema; Lyra-González, Iván; Armendáriz-Borunda, Juan

2013-03-01

This case report assesses the effectiveness of surgery plus pirfenidone (PFD) as a concomitant therapy in the management of facial trauma after severe dog bite. A 16-month-old female patient who suffered a severe attack by a big-sized dog (Rottweiler) in the midface area was managed with surgery/PFD combination and followed up for 20 months to evaluate the efficacy to control, prevent, and improve injury sequels. Surgery/PFD combination offered a good complementary therapy downregulating inflammatory activity, improving blood supply, and activating cytokine modulation and collagen synthesis/biosynthesis (scar control). No side effects were reported in this case report. Surgery/PFD management for severe facial dog bites represents a safe and effective therapeutic option to protect and improve a patient's quality of life, minimizing long-time sequels.

Scissor bite in a young patient treated with an orthodontic-orthopedic device. A case report.

PubMed

Favero, V; Sbricoli, L; Favero, L

2013-06-01

Scissor bite is a rare malocclusion that often leads to minor facial asymmetry. An orthodontic and orthopaedic correction is advisable in young patients to prevent subsequent temporomandibular diseases requesting maxillofacial intervention. In this case report a 8-year-old girl in mixed dentition with unilateral left scissor bite was treated with a modified Rapid Palatal Expander. To modify an overexpanded maxilla (width 39 mm measured between both upper first molars) the device was used to close rather than to expand, without need of patient compliance. Orthodontic correction was then completed with traditional bracketing. Results were tangible (width 36 mm) and remained stable even for at least 2 years after retention. This original device has proved to be useful in this kind of situations and can be easily applied to young patient to correct such malocclusions.

An unexpected presentation of a traumatic wound on the lower lip: a case report

PubMed Central

2014-01-01

Introduction Traumatic lip injuries present major challenges in terms of reconstructive options and the outcome of surgical management. The aetiology of lip injuries includes human bite as interpersonal violence. Bite wounds are always considered to be complex injuries contaminated with unique polymicrobial inoculum. A classification of facial bite injuries has been included and the surgical management of these lesions has also been discussed. We report a rare bite injury on the lower lip that resembled an ulcerative process. Case presentation A 30-year-old African man presented with a severe tissue defect on his lower lip to a Dental and Oral Department in Tanzania. He explained that 12 days ago he had been involved in a fight and someone had bitten his lower lip. An orofacial examination confirmed a serious loss of lip tissue that resembled a chronic ulcerative process. Accurate assessment of the lesion was made by a thorough evaluation of some parameters such as size, depth, presence of granulation tissue, fibrin coverage, wound edges, exudates and/or necrosis. A surgical debridement under local anaesthesia was carried out. Afterwards a layered suture was performed. Eventually the healing was complete and satisfactory. Conclusions A severe bite avulsive wound on the lower lip, despite the elapsed time before treatment, may have an excellent prognosis after a simple surgical procedure. PMID:25196423

Human rabies: a descriptive observation of 21 children in Kinshasa, the Democratic Republic of Congo.

PubMed

Muyila, Delphin I; Aloni, Michel N; Lose-Ekanga, Marie Josée; Nzita, Jules M; Kalala-Mbikay, Alexandre; Bongo, Henri L; Esako, Mathilde N; Malonga-Biapi, Jean Pierre; Mputu-Dibwe, BenoÎt; Aloni, Muriel L; Ekila, Mathilde B

2014-10-01

Human rabies has recently emerged as a significant public health threat in Kinshasa, Democratic Republic of Congo (DRC). However, there is little epidemiological information on human rabies especially in children. We performed at Pediatrics Department of General Reference hospital of Kinshasa between December 2008 and July 2009, a retrospective study to assess the incidence and to describe their clinical aspects and outcome. A total of 21 cases were observed, rather three cases per month. There were 12 boys (57·1%) and 9 girls (42·9%). Biting animal was found to be dog in all cases (100%). The dog was not immunized in all of cases. On admission, all patients (100%) showed furious rabies manifestations. Only two (9·5%) had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. Two (9·5%) patients received rabies immunoglobulin (RIG). The case-fatality rate was 100%. The disease emerges as a new major public health problem because of a lack of knowledge regarding rabies risk, the poor management of dog bites. Preventative vaccination for rabies should be recommended in the population of Kinshasa, area at high risk to contract rabies, particularly in children.

Rattlesnake envenomation in 12 New World camelids.

PubMed

Dykgraaf, Susanne; Pusterla, Nicola; Van Hoogmoed, Linda M

2006-01-01

Rattlesnake envenomation of New World camelids is a seasonal problem with often dramatic clinical signs. The purpose of this study was to identify the clinical signs, laboratory results, treatment methods, and outcome for rattlesnake envenomation in New World camelids. Medical records from 1988 to 2004 were searched for New World camelids presented for rattlesnake bite or clinical signs suspected to be related to recent envenomation. Twelve records were identified. From these records a retrospective study was performed. Nine camelids presented for acute disease (2/9 arrived dead), whereas 3 presented for subacute onset of disease. Swelling of the lips, head and neck, tachypnea, dyspnea, tachycardia, and lethargy were the most common presenting signs. Snake bites were most commonly located to the muzzle (10/12). Common complete blood count (CBC) and serum biochemical abnormalities were neutrophilia, lymphopenia, increased muscle enzyme activity, hypoalbuminemia, hyperglycemia, hypokalemia, and thrombocytopenia. Treatment included combinations of intravenous fluid therapy, antimicrobials, anti-inflammatory drugs, tetanus prophylaxis, tracheostomy, supplemental oxygen, antivenom, total parenteral nutrition, and nursing care. Five of the 10 animals with acute onset of clinical signs survived, and all animals with subacute presentation died. The mortality rate for New World camelids with severe local tissue reaction and systemic signs of envenomation was 58%. New World camelids that sustain rattlesnake envenomation and severe facial swelling precluding prehension and mastication have a guarded prognosis for survival. Aggressive treatment is recommended to optimize the chances of survival. Animals with less severe local tissue reaction and absence of systemic signs have a better prognosis.

Ethnomedicinal plants of the Bauri tribal community of Moulvibazar District, Bangladesh.

PubMed

Das, Protiva Rani; Islam, Md Tabibul; Mostafa, Mohd Nabil; Rahmatullah, Mohammed

2013-01-01

Bangladesh reportedly has more than 100 tribal communities; however, documentation of their medicinal practices is markedly absent. The aim of the present study was to conduct an ethnomedicinal survey among the little known Bauri tribe of Bangladesh, whose tribal medicinal practices are yet to be documented. The survey was carried out among the Bauri tribal community of Purbo Tila village in Moulvibazar District. The community is believed to be the only Bauri community in the country and had four tribal healers who continue their traditional medicinal practices. Interviews of the healers were carried out with the help of a semi-structured questionnaire and the guided field-walk method where the healers took the interviewers on guided field-walks through areas from where they collected their medicinal plants. Here they identified the plants and described their uses. The Bauri healers were observed to use 40 different plant species and one bird species for treatment of ailments such as fever, respiratory tract disorders, pain, gastrointestinal disorders, eye problems like cataract and conjunctivitis, jaundice, abscess, cardiovascular disorders, urinary problems, paralysis, dog bite, snake bite, helminthiasis, lesions on the tongue or lips and piles. Leaves were the major plant part used and constituted 38.3% of total uses followed by fruits at 14.9%. A review of the relevant scientific literature showed that a number of medicinal plants used by the Bauri healers possess pharmacological activities, which were in line with the traditional uses, thus validating their use by the Bauri tribe.

Incidence, pathology, and treatment of adder (Vipera berus L.) bites in man.

PubMed Central

Reading, C J

1996-01-01

A review of published reports on the incidence, pathology, and treatment of adder (Vipera berus) bites in man in the United Kingdom and Europe produced numerous case studies but little information about the impact od adders as a threat to public health. Adder bites in man are not uncommon (at least 44/year and probably more than 90/year in the United Kingdom) and, although they have been recorded for every month of the year between February and October, envenoming is most likely to occur during June, July, and August. Most adder bites are on the hand (51.6%) or foot (38.2%). The effects of adder bite envenoming are now know. Effective treatment protocols can reduce both the length of time victims spend in hospital and the morbidity in the affected areas: they have resulted in a decline in the death rate over the last 30 years, so that deaths are now rare. PMID:8894864

Innovation in prediction planning for anterior open bite correction.

PubMed

Almuzian, Mohammed; Almukhtar, Anas; O'Neil, Michael; Benington, Philip; Al Anezi, Thamer; Ayoub, Ashraf

2015-05-01

This study applies recent advances in 3D virtual imaging for application in the prediction planning of dentofacial deformities. Stereo-photogrammetry has been used to create virtual and physical models, which are creatively combined in planning the surgical correction of anterior open bite. The application of these novel methods is demonstrated through the surgical correction of a case.

Misdiagnosis of spider bite in a 3-year-old child.

PubMed

Alizadeh, Anahita; Vahabzadeh, Maryam; Azarfar, Anoush; Ravanshad, Yalda

2018-01-01

Abdominal pain is a common complaint among children with a vast differential diagnosis. Hip pain is also a nonspecific sign. Here, we present a case of a 3-year-old boy with a complaint of abdominal pain and pain in both hips, much on the right one. After evaluations, the diagnosis was a spider bite.

A cross-sectional study for predicting tail biting risk in pig farms using classification and regression tree analysis.

PubMed

Scollo, Annalisa; Gottardo, Flaviana; Contiero, Barbara; Edwards, Sandra A

2017-10-01

Tail biting in pigs has been an identified behavioural, welfare and economic problem for decades, and requires appropriate but sometimes difficult on-farm interventions. The aim of the paper is to introduce the Classification and Regression Tree (CRT) methodologies to develop a tool for prevention of acute tail biting lesions in pigs on-farm. A sample of 60 commercial farms rearing heavy pigs were involved; an on-farm visit and an interview with the farmer collected data on general management, herd health, disease prevention, climate control, feeding and production traits. Results suggest a value for the CRT analysis in managing the risk factors behind tail biting on a farm-specific level, showing 86.7% sensitivity for the Classification Tree and a correlation of 0.7 between observed and predicted prevalence of tail biting obtained with the Regression Tree. CRT analysis showed five main variables (stocking density, ammonia levels, number of pigs per stockman, type of floor and timeliness in feed supply) as critical predictors of acute tail biting lesions, which demonstrate different importance in different farms subgroups. The model might have reliable and practical applications for the support and implementation of tail biting prevention interventions, especially in case of subgroups of pigs with higher risk, helping farmers and veterinarians to assess the risk in their own farm and to manage their predisposing variables in order to reduce acute tail biting lesions. Copyright © 2017 Elsevier B.V. All rights reserved.

Insights into the epidemiological link between biting flies and pemphigus foliaceus in southeastern Brazil.

PubMed

Vernal, Sebastian; Pepinelli, Mateus; Casanova, Claudio; Goulart, Thais M; Kim, Olivia; De Paula, Natalia A; Pinto, Mara C; Sá-Nunes, Anderson; Roselino, Ana Maria

2017-12-01

Black fly and sandfly bites are related to the endemicity of pemphigus foliaceus (PF); however, an immune reaction against the salivary proteins from these flies still requires confirmation in the case of PF patients living in southeastern Brazil. To georeference the distribution of Simuliidae (Diptera: Simuliidae) and Phlebotominae (Diptera: Psychodidae) and of PF cases in the northeastern region of São Paulo State, and to assess the humoral immune response against salivary gland extracts (SGEs) from biting flies in PF patients, relatives, and neighbours. PF patients' medical information recorded between 1965 and 2014 were obtained from the database of the University Hospital. Data on the distribution of fly species were collected from scientific reports and epidemiological databases. Spatial maps relating the distribution of biting flies with PF cases were plotted. Serum IgG antibodies against the SGEs from Simulium nigrimanum, Nyssomyia neivai, and Aedes aegypti (as control) were determined by ELISA. Two hundred and eighty-five PF cases were distributed in 60 municipalities with a prevalence of 57.5 per million inhabitants, revealing well-defined geographical clusters. S. nigrimanum and N. neivai specimens were registered in eight (13.3%) and 26 (43.3%) of these municipalities, respectively. PF patients, and their relatives presented higher levels of IgG against the SGEs of S. nigrimanum and N. neivai (P<0.001 for both), but not against the SGE from A. aegypti (P=0.115 and P=0.552, respectively), as compared to controls. IgG against the SGEs from S. nigrimanum and N. neivai but not against the SGE from A. aegypti correlated with levels of anti-Desmoglein 1 in PF patients (r=0.3848, P=0.039; and r=0.416, P=0.022, respectively). An epidemiological link between biting flies and PF in southeastern Brazil is proposed, implying a possible role of the salivary proteins from these flies in PF etiopathogenesis. Copyright © 2017 Elsevier B.V. All rights reserved.

Safety profile of snake antivenom (use) in Hong Kong - a review of 191 cases from 2008 to 2015.

PubMed

Mong, Rupeng; Ng, Vember C H; Tse, Man Li

2017-12-01

The mainstay of treatment for significant envenoming from snakebites is antivenom. However, there is insufficient data regarding the safety of antivenom used in Hong Kong. We describe the incidence of hypersensitivity reactions from antivenom use and review the frequency and reasons for intensive care unit (ICU) admission. The Hong Kong Poisons Information Centre database was reviewed. All patients given snake antivenom between 2008 and 2015 were included. Patient demographics, species of snake involved, details of antivenom used, treatment location, use of pre-treatment, reasons for ICU admission (where applicable) and details of early and late antivenom reactions were extracted. There were 191 patients who received snake antivenom. Most (93%) were treated with either the green pit viper antivenom from Thailand or the Agkistrodon halys antivenom from China. The incidences of early hypersensitivity reactions to green pit viper antivenom and Agkistrodon Halys antivenom were 4.7% and 1.4%, respectively. Most patients (69%) were managed in the ED observation ward or general ward. There were 59 patients managed in ICU, most (90%) of whom were admitted for close monitoring during antivenom administration. There were no cases of significant morbidity from antivenom administration. Eight patients (5.6%) had features suggestive of mild serum sickness. The incidence of immediate hypersensitivity reaction to antivenom commonly used in Hong Kong is low. Majority of patients were managed safely in the emergency department observation ward or general ward. Serum sickness appears to be uncommon and possible cases presented with mild features.

DNA profiling of trace evidence--mitigating evidence in a dog biting case.

PubMed

Brauner, P; Reshef, A; Gorski, A

2001-09-01

A young girl was the victim of a severe dog attack. An animal, suspected of having caused the attack, was later impounded for investigation. Microclots of blood, recovered from the dog's fur, were analyzed by STR DNA. Results showed that this blood was not related to the biting. Other forensic evidence--hairs, fibers, and odontology--failed to connect a particular animal to the attack. The implications of these findings for the dog and its owners are discussed as well as other forensic methods for resolving such cases.

Oral Rehabilitation With Orthognathic Surgery After Dental Implant Placement for Class III Malocclusion With Skeletal Asymmetry and Posterior Bite Collapse.

PubMed

Ohba, Seigo; Nakatani, Yuya; Kawasaki, Takako; Tajima, Nobutaka; Tobita, Takayoshi; Yoshida, Noriaki; Sawase, Takashi; Asahina, Izumi

2015-08-01

Increasing numbers of older patients are seeking orthognathic surgery to treat jaw deformity. However, orthodontic and orthognathic surgical treatment is difficult in cases without occlusal vertical stop. A 55-year-old man presented with Class III malocclusion and mandibular protrusion including esthetic problems and posterior bite collapse. He underwent dental implant treatment to reconstruct an occlusal vertical stop before orthognathic surgery. His occlusal function and esthetic problems improved after surgery, and his skeletal and occlusal stability has been maintained for 6 years. Dental implant placement at appropriate positions could help to determine the position of the proximal segment at orthognathic surgery and could shorten the time required to restore esthetic and occlusal function. This case demonstrates how skeletal and dental stability can be maintained long after surgery in a patient with jaw deformity and posterior bite collapse.

Management of post midface distraction occlusal discrepancy using temporary anchorage devices in a cleft patient

PubMed Central

Koteswara Prasad, N. K.; Hussain, Syed Altaf; Chitharanjan, Arun B.; Murthy, Jyotsna

2015-01-01

Open bite deformity following a successful midface advancement by distraction osteogenesis is a common complication. Temporary anchorage devices can be deployed during the distraction and post-distraction settling phases for restoring the occlusion even in severe cases. The following report describes the management of severe anterior open bite following maxillary distraction. PMID:25991895

Respiratory and digestive lesions caused by Salmonella arizonae in two snakes.

PubMed

Orós, J; Rodríguez, J L; Herráez, P; Santana, P; Fernández, A

1996-08-01

Cases of diphtheritic necrotizing gastritis in a Rosy Boa (Lichanura trivirgata) and of necrotizing tracheitis in a double-headed Kingsnake (Lampropeltis hondurensis), both associated with Salmonella arizonae, are described. An immunoperoxidase technique indicated that S. arizonae played a role in the causation of the lesions. In addition, the study showed the value of the technique for the detection of S. arizonae in the tissues of infected snakes.

Self-inflicted finger injury in individuals with spinal cord injury: an analysis of 5 cases.

PubMed

Frost, Frederick S; Mukkamala, Sridevi; Covington, Edward

2008-01-01

To describe the occurrence of finger autophagia in 5 persons with traumatic spinal cord injury and to present a discussion of putative causes and potential treatments. Minor self-mutilating actions, such as nail biting and hair pulling, are common in humans and usually benign. In some circumstances, these behaviors are associated with obsessive-compulsive personality traits. In humans, self-injurious biting behaviors are well described in the setting of mental retardation and psychosis and in persons with Lesch-Nyhan syndrome. Rare cases of human autophagia in persons with intact cognition have been reported, most commonly in the setting of acquired nervous system lesions. After spinal cord injury, it has been suggested that this behavior constitutes a human variant of animal autotomy and a response to neuropathic pain. Case presentation narrative. Photographic and radiological study, administration of Yale-Brown Obsessive-Compulsive Scale (YBOCS). In 5 patients with complete tetraplegia, pain in the hands was present in only one instance. The severity of autoamputation varied from minor to extreme. In all cases, damage was confined to analgesic body parts. In 3 cases, autophagia behavior was discovered in progress. Treatments included pharmacotherapy, counseling, and behavioral therapy, with mixed results. All patients were intelligent, willing to discuss their issues, and able to identify conditions of stress and isolation in their lives. Mild preinjury obsessive-compulsive behaviors, such as nail biting, were universal. On the YBOCS, only 1 patient scored in a range indicative of mild obsessive-compulsive symptomatology. This group exhibited heterogeneous medical, social, and cultural characteristics. A link between pain and self-injurious behavior could not be demonstrated. This behavior may be viewed as an extreme variant of nail biting, with potential ominous complications. Treatment strategies have been employed with mixed results.

Malocclusions in a juvenile medieval skull material.

PubMed

Larsson, E

1983-01-01

From a mostly medieval skull material--the "Schreiner collections" in Oslo--juvenile crania were selected as follows: Group A: Crania with complete and intact primary dentition. n = 20. Group B: Crania with early mixed dentition. Incisors only erupted or under eruption. n = 47. Group C: Crania with late mixed dentition. n = 14. The author recorded visually: Sagittal and transversal dental relation, frontal dental contact, anterior cross-bite, rotation and crowding. There was good basal stability. Sagittally 1 moderately postnormal dentition was recorded, transversally there were no anomalies. Slight anterior cross-bite was recorded in 1 case, anterior cross-bite of one and two lateral incisors respectively in 2 others, and tête-à-tête contact in 3 cases. Crowding was recorded in 6 cases, in one of them being general, in the others located solely in the mandibular incisor segment. Broken contact and more or less pronounced rotation occurred in these dentitions. Rotation was also recorded in 2 other cases. The prevalence of malocclusions of the type that can be related to continuing finger-sucking or sucking of dummylike objects was very low in this material. This observation prompted the author to discuss a hypothesis concerning the aetiology of dummy- and finger-sucking habits.

[Evaluation of effectiveness of several repellents against mosquito bites available at the Polish market].

PubMed

Mikulak, Ewa; Gliniewicz, Aleksandra; Królasik, Agnieszka; Sawicka, Bozena; Rabczenko, Daniel

2012-01-01

BACKGROUND. Mosquitoes are blood-sucking insects, nuisance to humans and animals. Their bites cause itching and allergic reactions. These insects are also vectors of several viruses, bacteria and parasites. Protection against mosquitoes is therefore justified and desirable. This can give repellents and products for protection small outdoor areas such as terraces, home gardens. OBJECTIVE. The aim of this study was to evaluate the effectiveness of eight selected products with different formulations used against mosquitoes including: 5 preparations for use on the body or clothing (repellents A, B, C, D, E and 3 products for use in small outdoor spaces (I, J, K). [corrected] Repellents were tested in laboratory trials, when volunteers were exposed to Aedes aegypti females breeding in the laboratory. Products I, J, K were tested in field trials; volunteers were exposed to female mosquitoes at various ages from the environment (Aedes sp, Culex sp). The results showed that all tested repellents were efficient during 4 hrs. After this time their effectiveness decreased--fast in the case of repellent B (10% DEET), not very fast, but significant--in the case of repellent C (15% DEET). Three products for small area protection gave (each of them) 3-hour protection against mosquito bites. Product K (21,97% allethrin) was 100% effective (no bites at all). Both kinds of product can give effective protection against mosquito bites. Their use is most effective, cheaper and more safe for the environment method of protection against mosquitoes than chemical spraying of large areas.

[Tarantism in Spain in the eighteen century: latrodectism and suggestion].

PubMed

Corral-Corral, I; Corral-Corral, C

2016-10-16

Tarantism is the disease caused by the bite of the tarantula, in which the music tarantella triggers an involuntary dance. It is known in Italy since the sixteenth century. To analyze the tarantism reported in Spain at the end of the eighteenth century, with special attention to its neurological aspects, and to propose its medical and psychopathological explanation. An epidemic of people affected by the tarantula bite occurred in Spain in 1782. Spanish doctors described appropriately the clinical effects, identical to those produced by the bite of the spider black widow (Latrodectus tredecimguttatus), which was at that time identified as a tarantula. The cases reported by Francisco Xavier Cid cured with the involuntary dance triggered by the tarantella, as was described in Italy since the sixteenth century. Our interpretation is that this curative effect of dance in Spain was induced by suggestion. In Spanish patients there were no behavioral disturbances, periodic recurrences or collective involvement as those reported by Italian authors, which suggest an hysterical phenomenon, probably a continuation of the dancing mania of the Middle Age. Tarantism reported in Spain in the eighteenth century includes two different phenomena: the systemic symptoms produced by the tarantula bite, which is actually latrodectism, and the curative effect of the tarantella, explained by suggestion. The psychiatric disturbances, with a hysterical nature, falsely associated to the tarantula bite, observed in Italy, were not present among the Spanish cases of tarantism in the eighteenth century.

DNA barcoding using skin exuviates can improve identification and biodiversity studies of snakes.

PubMed

Khedkar, Trupti; Sharma, Rashmi; Tiknaik, Anita; Khedkar, Gulab; Naikwade, Bhagwat S; Ron, Tetsuzan Benny; Haymer, David

2016-01-01

Snakes represent a taxonomically underdeveloped group of animals in India with a lack of experts and incomplete taxonomic descriptions being the main deterrents to advances in this area. Molecular taxonomic approaches using DNA barcoding could aid in snake identification as well as studies of biodiversity. Here a non-invasive sampling method using DNA barcoding is tested using skin exuviates. Taxonomically authenticated samples were collected and tested for validation and comparisons to unknown snake exuviate samples. This approach was also used to construct the first comprehensive study targeting the snake species from Maharashtra state in India. A total of 92 skin exuviate samples were collected and tested for this study. Of these, 81 samples were successfully DNA barcoded and compared with unknown samples for assignment of taxonomic identity. Good quality DNA was obtained irrespective of age and quality of the exuviate material, and all unknown samples were successfully identified. A total of 23 species of snakes were identified, six of which were in the list of Endangered species (Red Data Book). Intra- and inter-specific distance values were also calculated, and these were sufficient to allow discrimination among species and between species without ambiguity in most cases. Two samples were suspected to represent cryptic species based on deep K2P divergence values (>3%), and one sample could be identified to the genus level only. Eleven samples failed to amplify COI sequences, suggesting the need for alternative PCR primer pairs. This study clearly documents how snake skin exuviates can be used for DNA barcoding, estimates of diversity and population genetic structuring in a noninvasive manner.

Crotalus oreganus lutosus (Great Basin Rattlesnake). Defensive behavior/head hiding and tongue display

USGS Publications Warehouse

Johnson, Alexander K.; Medica, Phil A.

2017-01-01

A variety of snake species employ head hiding as defensive behavior (Greene 1973. J. Herpetol. 7:143–161), but such behavior seems to be rarely observed in rattlesnakes. A recent report (Medica 2009. Herpetol. Rev. 40:95–97) presented observations on Crotalus scutulatus scutulatus and cited cases of similar behavior involving C. atrox, C. ruber, and C. viridis viridis. Here we report an encounter on 28 May 2016 with a C. oreganus lutosus (total length ca. 900 mm) observed 16 km S of Fallon, Churchill County, Nevada, USA. At 0925 h this snake was spotted by AKJ near the edge of the pavement on U.S. Hwy. 95. When approached, the snake presented typical active defensive behavior, with the rattle elevated (although not rattling), striking occasionally, and frequently flicking its conspicuous lavender and black tongue. As AKJ continued to take pictures the snake coiled more tightly (Fig. 1A), maintaining its rattle concealed and finally hiding its head beneath its coils (Fig. 1B). After photographing this pose AKJ made his first physical contact with the snake by scooping it up with a small shovel and placing it off the road. At this point the snake recovered its feisty attitude and would not retreat despite attempts to move it further away from the road. The snake did not rattle during the entire encounter (which lasted less than 5 min). Head hiding as a “last resort” in response to a persistent unavoidable threat may be more widespread within the family Crotalidae than previously documented.

Training Family Day Care Providers to Use Behavior Modification Procedures: A Case Study.

ERIC Educational Resources Information Center

Powers, Michael D.

Effects of brief time out on the biting behavior of a 21- month-old boy enrolled in a day care setting was examined. The Motivation Assessment Scale (MAS; Durand, 1983) was used to determine the function of the child's biting. A parent report survey, the MAS assesses disruptive behavior using a Likert-type scale and discriminates the function of a…

[Amblyomma spp. case related to overseas travel].

PubMed

Beyhan, Yunus Emre; Mungan, Mesut; Babür, Cahit

2014-01-01

Ticks are a threat to human health by blood sucking and vectoring many disease agents. Tick-borne diseases are seen all over the world and play an important role in the dissemination of diseases. Although many of the tick species are present in Turkey, Amblyomma genus is seen more in South America and Africa. In this case,a person returning to the country after travelling to Africa who presented to the hospital complaining of tick bites and brought ticks to the parasitology laboratory was identified as Ablyomma spp. nymph. This case is a report concerning care of tick bites when travelling abroad and shows that these ticks can transmit disease agents from abroad.

Hunting for tularaemia - a review of cases in North Carolina.

PubMed

Rimawi, R H; Shah, K B; Chowdhary, R A; Cook, P P

2015-05-01

Human infections with Francisella tularensis can be acquired via numerous routes, including ingestion, inhalation, arthropod bite or direct contact with infected animals. Since 1991, there have been 25 reported cases of tularaemia in North Carolina, most of which were associated with rabbit hunting or cat bites. We present two adults cases of pulmonary and oropharyngeal tularaemia and review the reported cases since 1991-2013. We also present the fifth case of pulmonary empyema. While cavitary pneumonias are primarily treated with drainage, we illustrate a case of cavitary pneumonia associated with tularaemia successfully treated with oral ciprofloxacin after drainage. Tularaemia should be considered in patients with a perplexing radiographic image, animal exposure and lack of response to conventional empiric broad-spectrum antibiotics. Even in serious cases of pneumonic tularaemia, fluoroquinolones may provide a suitable alternative to aminoglycosides. © 2014 Blackwell Verlag GmbH.

How not to train your dragon: a case of a Komodo dragon bite.

PubMed

Borek, Heather A; Charlton, Nathan P

2015-06-01

Komodo dragons (Varanus komodoensis) are the world's largest lizards, known for killing prey that exceed their body mass. Reports of bites to humans in the popular press suggest high degrees of morbidity and mortality. Reports in the medical literature are lacking. We describe the case of a zookeeper who was bitten by a Komodo dragon, with a resultant mallet finger. We further discuss the various potential mechanisms of Komodo dragon lethality, including sepsis and venom deposition theories that are useful in guiding management. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Anterior Crossbite Correction in Early Mixed Dentition Period Using Catlan's Appliance: A Case Report

PubMed Central

Prakash, Prashanth; Durgesh, B. H.

2011-01-01

Single tooth anterior dental crossbite is the commonly encountered malocclusion during the development of occlusion in children. Various treatment options such as removable and fixed appliances have been suggested by different authors in the past literature. This paper presents two cases of anterior crossbite corrected using the standard Catlan's appliance (Lower Inclined Bite Plane) in a short period of three weeks without any damage to the tooth or the periodontium. This fixed appliance is a simple and traditional method which does not depend on patient cooperation to reverse the bite. PMID:21991464

Successful snakebite treatment in three juvenile African wild dogs (Lycaon pictus) with polyvalent antivenom: a Namibian case report.

PubMed

Weise, Florian J; van Vuuren, Rudie J; Echement, Katherine E; Cleverley, Matthew P; van Vuuren, Marlice

2013-03-27

This article reports the first documented treatment of venomous snakebite with a polyvalent snake antivenom from the South African Institute for Medical Research in endangered African wild dogs (Lycaon pictus). Three juvenile male animals (6.5 months of age) showed clinical signs after being bitten by an unidentified venomous snake. The signs included loss of appetite, disorientation, impaired locomotion, excessive facial swelling, profuse salivation, reduced respiratory effort and an apparent depressed mental state. Intravenous treatment with isotonic Ringer lactate solution, hetastarch 6% and dexamethazone, subcutaneous administration of procaine benzylpenicillin and benzathine benzylpenicillin, and ultimately intravenous administration of the polyvalent snake antivenom resulted in the complete recovery of all three wild dogs.

Homoclinic snaking in the discrete Swift-Hohenberg equation

NASA Astrophysics Data System (ADS)

Kusdiantara, R.; Susanto, H.

2017-12-01

We consider the discrete Swift-Hohenberg equation with cubic and quintic nonlinearity, obtained from discretizing the spatial derivatives of the Swift-Hohenberg equation using central finite differences. We investigate the discretization effect on the bifurcation behavior, where we identify three regions of the coupling parameter, i.e., strong, weak, and intermediate coupling. Within the regions, the discrete Swift-Hohenberg equation behaves either similarly or differently from the continuum limit. In the intermediate coupling region, multiple Maxwell points can occur for the periodic solutions and may cause irregular snaking and isolas. Numerical continuation is used to obtain and analyze localized and periodic solutions for each case. Theoretical analysis for the snaking and stability of the corresponding solutions is provided in the weak coupling region.

Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite.

PubMed

Lavonas, Eric J; Gerardo, Charles J; O'Malley, Gerald; Arnold, Thomas C; Bush, Sean P; Banner, William; Steffens, Mark; Kerns, William P

2004-02-01

Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) effectively treats patients bitten by rattlesnakes. The copperhead snake (Agkistrodon contortrix) caused 37% of venomous snakebites reported to US poison centers in 2001 and is the major envenomating reptile in the southeastern United States. FabAV has not been tested in human beings envenomated by copperhead snakes. In this preliminary study, we performed a retrospective chart review of all copperhead snake envenomations reported to the Carolinas Poison Center that were treated with FabAV. Progression of limb swelling, coagulopathy, and hemodynamic status before and after FabAV administration, adverse effects of FabAV therapy, and recurrence phenomena were recorded. Of approximately 400 copperhead envenomation cases reported to the poison center during the study period, 32 received FabAV and were included. Most patients had moderate envenomation. The median time to FabAV administration was 4.0 hours. The median time to achieve initial control was 1.0 hour, with a median dose of 4 vials of FabAV. A rapid initial response, defined as cessation of the progression of local tissue injury within 4 hours of FabAV administration, occurred in 28 cases (88%; 95% confidence interval [CI] 76% to 99%). Four cases (13%; 95% CI 1% to 24%) were considered treatment failures. Recurrent swelling occurred in 6 cases (19%; 95% CI 5% to 32%). The incidence of recurrent swelling was not reduced by administration of repeated doses of antivenom on a planned schedule. One patient developed late-onset coagulopathy. One minor allergic reaction was observed. In this select group of patients bitten by copperhead snakes, local tissue effects of envenomation halted promptly after FabAV treatment in most cases. Treatment failures occurred, and recurrence of swelling and defibrination syndrome was sometimes problematic. Time to return to work and long-term limb function were not assessed. A controlled trial with long-term follow-up is needed to define the role of FabAV treatment for copperhead envenomation.

Snakes! Snakes! Snakes!

ERIC Educational Resources Information Center

Nature Naturally, 1983

1983-01-01

Designed for students in grades 4-6, the teaching unit presents illustrations and facts about snakes. Topics include common snakes found in the United States, how snakes eat, how snakes shed their skin, poisonous snakes, the Eastern Indigo snake, and the anatomy of a snake. A student page includes a crossword puzzle and surprising snake facts. A…

Pilot study assessing the effectiveness of factory-treated, long-lasting permethrin-impregnated clothing for the prevention of tick bites during occupational tick exposure in highly infested military training areas, Germany.

PubMed

Faulde, Michael K; Rutenfranz, Martin; Keth, Alexander; Hepke, Jürgen; Rogge, Mareike; Görner, Andreas

2015-02-01

The protective effectiveness of factory-based permethrin-impregnated polymer-coated battle dress uniforms (PTBDUs) against tick bites was evaluated at four military training areas in southwestern and central Germany where tick bite incidence is known to be high. Data were analyzed by comparing tick bite incidence using non-permethrin-treated BDUs (NTBDUs) during 2009 versus PTBDUs during 2010 and 2011, the first two years after their formal introduction for in-country use in the German Bundeswehr. During 2009, 262 individual tick bites were reported at the four training sites, resulting in a tick bite incidence of 8.8 % per exposed person when wearing NTBDUs only. In 2010 and 2011, one tick bite case occurred under field conditions each year that PTBDUs were worn, corresponding to a protective effectiveness of 99.6 and 98.6 %. These data imply an annual tick bite incidence of 0.035 and 0.078 % per exposed person, respectively. Between 2010 and 2011, a 0.8 % decline in the protective effectiveness of PTBDUs was observed. Five tick bite incidents occurred while wearing non-impregnated parkas over correctly worn PTBDUs. Ixodes ricinus ticks were collected by standard tick drags from 2009 to 2011, with high mean annual densities ranging from 28.9 to 106.5 ticks per 100 m(2), while single drags revealed tick densities between zero and 381 ticks per 100 m(2). Overall, 4596 I. ricinus ticks (54 ♂, 82 ♀, 1776 nymphs, and 2684 larvae) were collected, of which 128 (2.8 %; mean annual range, 0-10.1 %) were Borrelia burgdorferi s.l. positive. The Borrelia genospecies distribution was as follows: 112 (87.5 %) Borrelia afzelii, 10 (7.8 %) B. burgdorferi s.s., and 6 (4.7 %) Borrelia garinii. Neither the tick density means from 2009 to 2011 nor associated B. burgdorferi s.l. prevalences differed significantly among the military locations investigated. The documented tick bite reductions clearly demonstrate the powerful protective effectiveness of properly worn PTBDUs against tick bites. Nevertheless, all apparel worn over PTBDUs should also be impregnated with permethrin in order to prevent tick infestation and subsequent bites.

Incidence & prognosis of acute kidney injury in individuals of snakebite in a tertiary care hospital in India.

PubMed

Pulimaddi, Ramulu; Parveda, Amruth Rao; Brahmanpally, Balkishan; Kalakanda, Paul Marx; Ramakrishna, K; Chinnapaka, Venkata Ramana Devi

2017-12-01

The snakebites are considered to be an occupational hazard in agriculture workers and the snake handlers, resulting in a considerable morbidity, mortality and economical implications. This study was conducted to determine the incidence, clinical presentation, renal injury and clinical outcome in snakebite victims who developed acute kidney injury (AKI). This hospital-based prospective, observational study was done on 100 cases who were admitted for the management of snakebite and found to develop AKI in a tertiary care hospital at Hyderabad, India. Renal function tests, complete blood picture, urine routine examination, ultrasound examination of abdomen and coagulation profile were done and the prognosis was assessed by noting recovery, mortality, morbidity and/or progress to chronic stage. A total of 100 patients with a mean age of 43.80±12.63 yr (range 18-70); 62 males and 38 females were studied. All had bites on lower limbs. A total of 86 patients arrived in the hospital within 24 h, and 14 arrived after 24 h. Oliguria was found in 60, bleeding tendencies in 64, haemodynamic instability noted - tachycardia in 86. Systolic blood pressure (BP) was <120 mm Hg in 68 and BP was not recordable in four patients. Twelve patients were in stage III kidney disease and needed haemodialysis. Of the 100 cases of snakebite-induced acute kidney failure, 86 recovered and six died. On follow up, after six months eight patients developed chronic kidney failure. A cascade of events tends to occur in severe haemotoxic envenomation such as bleeding disorders, hypotension/circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory disease syndrome (ARDS). The findings of this study showed that early hospitalization, quick antisnake venom administration and adequate supporting care provided promising results.

Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center.

PubMed

Garvey, Erin M; Twitchell, Denice K; Ragar, Rebecca; Egan, John C; Jamshidi, Ramin

2015-02-01

Pediatric dog bite injuries are common and vary in severity. We sought to characterize predisposing factors, required interventions, and morbidity. A prospective clinical database at a level one pediatric trauma center was reviewed for dog bite injuries over 74 consecutive months ending December 2013. This included all patients brought in by ambulance and/or seen by the trauma team. Of 650 dog bite incidents, 282 met the criteria for inclusion in the trauma database. Median age was 5 years (range, 2 months to 17 years) and 55% (154/282) of patients were male. Pit bulls were most frequently responsible, accounting for 39% (83/213) of incidents in which dog breed was documented. Fifty-three percent (150/282) of dogs belonged to the patient's immediate or extended family. Sixty-nine percent (194/282) of patients required operative intervention: 76% laceration repairs, 14% tissue transfers, and 2% neurosurgical interventions. The most severe injuries were depressed skull fractures, intracranial hemorrhage, laryngotracheal transection, and bilateral orchiectomy. Median length of stay was 1 day (range, 0 to 25 days). There were no mortalities. Pediatric dog bites span a wide range of ages, frequently require operative intervention, and can cause severe morbidity. Dog familiarity did not confer safety, and in this series, Pit bulls were most frequently responsible. These findings have great relevance for child safety. Pediatric dog bites are common and can vary in severity from superficial wounds to life-threatening injuries. Dog familiarity may confer a false sense of safety. A national dog bite prevention and education campaign should be developed with the goal of decreasing the incidence of pediatric dog bites. Copyright © 2015 Elsevier Inc. All rights reserved.

The venom of South American rattlesnakes inhibits macrophage functions and is endowed with anti-inflammatory properties

PubMed Central

Silva, Maria C. C. de Sousa e; Gonçalves, Luis R. C.

1996-01-01

The injection of Crotalus durissus terrificus venom into the foot pad of mice did not induce a significant inflammatory response as evaluated by oedema formation, increased vascular permeability and cell migration. The subcutaneous injection of the venom, or its addition to cell cultures, had an inhibitory effect on the spreading and phagocytosis of resident macrophages, without affecting the viability of the cells. This effect was not observed when the venom was added to cultures of thioglycollate elicited macrophages, but it was able to inhibit these macrophage functions when the cells were obtained from animals injected simultaneously with the venom and thioglycollate. These observations suggest that the venom interferes with the mechanisms of macrophage activation. Leukocyte migration induced by intraperitoneal injection of thioglycollate was also inhibited by previous venom injection. This down-regulatory activity of the venom on macrophage functions could account for the mild inflammatory response observed in the site of the snake bite in Crotalus durissus terrificus envenomation in man. PMID:18475692

Antivenom for Neuromuscular Paralysis Resulting From Snake Envenoming

PubMed Central

Silva, Anjana; Hodgson, Wayne C.; Isbister, Geoffrey K.

2017-01-01

Antivenom therapy is currently the standard practice for treating neuromuscular dysfunction in snake envenoming. We reviewed the clinical and experimental evidence-base for the efficacy and effectiveness of antivenom in snakebite neurotoxicity. The main site of snake neurotoxins is the neuromuscular junction, and the majority are either: (1) pre-synaptic neurotoxins irreversibly damaging the presynaptic terminal; or (2) post-synaptic neurotoxins that bind to the nicotinic acetylcholine receptor. Pre-clinical tests of antivenom efficacy for neurotoxicity include rodent lethality tests, which are problematic, and in vitro pharmacological tests such as nerve-muscle preparation studies, that appear to provide more clinically meaningful information. We searched MEDLINE (from 1946) and EMBASE (from 1947) until March 2017 for clinical studies. The search yielded no randomised placebo-controlled trials of antivenom for neuromuscular dysfunction. There were several randomised and non-randomised comparative trials that compared two or more doses of the same or different antivenom, and numerous cohort studies and case reports. The majority of studies available had deficiencies including poor case definition, poor study design, small sample size or no objective measures of paralysis. A number of studies demonstrated the efficacy of antivenom in human envenoming by clearing circulating venom. Studies of snakes with primarily pre-synaptic neurotoxins, such as kraits (Bungarus spp.) and taipans (Oxyuranus spp.) suggest that antivenom does not reverse established neurotoxicity, but early administration may be associated with decreased severity or prevent neurotoxicity. Small studies of snakes with mainly post-synaptic neurotoxins, including some cobra species (Naja spp.), provide preliminary evidence that neurotoxicity may be reversed with antivenom, but placebo controlled studies with objective outcome measures are required to confirm this. PMID:28422078

Metabolism, body size and life span: a case study in evolutionarily divergent populations of the garter snake (Thamnophis elegans).

PubMed

Bronikowski, Anne; Vleck, David

2010-11-01

We present a case study of metabolism, life history and aging in the western terrestrial garter snake (Thamnophis elegans). Early research in the field supported the rate-of-living hypothesis as an explanation of aging, which was based on an apparent negative relationship between mass-specific metabolic rate and lifespan in endotherms. This hypothesis in its original form has not withstood additional tests and comparisons between the two main lineages of endotherms-birds and mammals, but there is still much to be discovered of the causative links among rate of oxygen consumption, physiology and life history, particularly in ectothermic reptiles. We present data that show adult short-lived snakes, from naturally occurring ecotypes of garter snakes, have higher mass-specific resting metabolic rates at any given body mass (metabolic intensity) across a series of normal activity temperatures (15-32°C). The short-lived ecotype in this geographic region reaches a larger body size, and has life-history traits that place it at the fast end of a pace-of-life continuum (fast growth, early maturation, high reproductive output) relative to individuals of the small-bodied long-lived ecotype. The difference between ecotypes in metabolic intensity, even after acclimation to identical conditions, may reflect evolutionary divergence and genetic differences between ecotypes. The difference in metabolic intensity is not, however, present at birth, so an alternative is that developmental environment may permanently influence metabolic rate and life history. Such developmental canalization could lead to altered gene expression via environmental influences on the epigenome and result in altered metabolic trajectories in the snakes' natural habitats.

Ethnomedicinal plants of the Bauri tribal community of Moulvibazar District, Bangladesh

PubMed Central

Das, Protiva Rani; Islam, Md. Tabibul; Mostafa, Mohd. Nabil; Rahmatullah, Mohammed

2013-01-01

Context: Bangladesh reportedly has more than 100 tribal communities; however, documentation of their medicinal practices is markedly absent. Aim: The aim of the present study was to conduct an ethnomedicinal survey among the little known Bauri tribe of Bangladesh, whose tribal medicinal practices are yet to be documented. Settings and Design: The survey was carried out among the Bauri tribal community of Purbo Tila village in Moulvibazar District. The community is believed to be the only Bauri community in the country and had four tribal healers who continue their traditional medicinal practices. Materials and Methods: Interviews of the healers were carried out with the help of a semi-structured questionnaire and the guided field-walk method where the healers took the interviewers on guided field-walks through areas from where they collected their medicinal plants. Here they identified the plants and described their uses. Results: The Bauri healers were observed to use 40 different plant species and one bird species for treatment of ailments such as fever, respiratory tract disorders, pain, gastrointestinal disorders, eye problems like cataract and conjunctivitis, jaundice, abscess, cardiovascular disorders, urinary problems, paralysis, dog bite, snake bite, helminthiasis, lesions on the tongue or lips and piles. Leaves were the major plant part used and constituted 38.3% of total uses followed by fruits at 14.9%. Conclusions: A review of the relevant scientific literature showed that a number of medicinal plants used by the Bauri healers possess pharmacological activities, which were in line with the traditional uses, thus validating their use by the Bauri tribe. PMID:24501442

Adder bite: an uncommon cause of compartment syndrome in northern hemisphere

PubMed Central

2010-01-01

Snakebite envenomation is an uncommon condition in the northern hemisphere, but requires high vigilance with regard to both the systemic effects of the venom and the locoregional impact on the soft tissues. Bites from the adder, Vipera Berus, may have serious clinical consequences due to systemic effects. A case of a 44-year-old man is reported. The patient was bitten in the right hand. He developed fasciotomy-requiring compartment syndrome of the upper limb. Recognition of this most seldom complication of an adder bite is vital to save the limb. We recommend that the classical signs and symptoms of compartment syndrome serve as indication for surgical decompression. PMID:20854675

Rabies Situation in Cambodia

PubMed Central

Ly, Sowath; Buchy, Philippe; Heng, Nay Yim; Ong, Sivuth; Chhor, Nareth; Bourhy, Hervé; Vong, Sirenda

2009-01-01

Background Rabies, a fatal but preventable zoonosis, is a major public health problem in developing countries. In Cambodia the disease burden is largely underestimated because patients with encephalitis following dog bites are rarely hospitalized and die at home. Since 1998 Institut Pasteur in Cambodia (IPC), Phnom Penh has been the only source of free post-exposure prophylaxis (PEP) and post-mortem diagnosis. Methods The 1998–2007 data compiled by IPC was analyzed to describe all treated patients for PEP, results of human testing and confirmed rabies cases, and results of animal testing. From dog bites' characteristics, we defined a suspected rabid dog bite injury (SRDBI) in humans as a bite that was unprovoked, from a dog that died spontaneously, or from a dog that was reported sick. We applied a deterministic probability model to estimate 2007 rabies human mortality nationwide from the estimated incidence of rabid dog bites, the body distribution of bite wounds, and the probability of PEP access. Results During 1998–2007, 124,749 patients received PEP at IPC (average 12,470; range 8,907–14,475), and 63 fatal human cases presenting with encephalitis following a dog bite were reported, in which 73% were confirmed positive for rabies by direct immunofluorescence assay or by reverse-transcriptase polymerase chain reaction. During 1998–2007, IPC tested 1,255 animal brain samples; 1,214 (97%) were from dogs including 610 (49%) positive samples. In 2007, 14,475 patients received PEP (100 PEP/100,000 people in Cambodia) including 95% who resided in Phnom Penh (615 PEP/100,000) or five neighboring provinces. The predictive model estimated 810 human rabies deaths would occur in 2007 (95%confidence interval [CI] 394–1,607), an incidence of 5.8/100,000 (95% CI 2.8–11.5). Conclusions Access to PEP is only sufficient for Phnom Penh residents. In 2007, the estimated rabies related mortality exceeded that of malaria and that of dengue. A national rabies control program is needed to improve surveillance and access to PEP, and to initiate vaccination campaigns in dogs. PMID:19907631

Phosphorus losses from an irrigated watershed in the northwestern United States: case study of the upper snake rock watershed.

PubMed

Bjorneberg, David L; Leytem, April B; Ippolito, James A; Koehn, Anita C

2015-03-01

Watersheds using surface water for irrigation often return a portion of the water to a water body. This irrigation return flow often includes sediment and nutrients that reduce the quality of the receiving water body. Research in the 82,000-ha Upper Snake Rock (USR) watershed from 2005 to 2008 showed that, on average, water diverted from the Snake River annually supplied 547 kg ha of total suspended solids (TSS), 1.1 kg ha of total P (TP), and 0.50 kg ha of dissolved P (DP) to the irrigation tract. Irrigation return flow from the USR watershed contributed 414 kg ha of TSS, 0.71 kg ha of TP, and 0.32 kg ha of DP back to the Snake River. Significantly more TP flowed into the watershed than returned to the Snake River, whereas there was no significant difference between inflow and return flow loads for TSS and DP. Average TSS and TP concentrations in return flow were 71 and 0.12 mg L, respectively, which exceeded the TMDL limits of 52 mg L TSS and 0.075 mg L TP set for this section of the Snake River. Monitoring inflow and outflow for five water quality ponds constructed to reduce sediment and P losses from the watershed showed that TSS concentrations were reduced 36 to 75%, but DP concentrations were reduced only 7 to 16%. This research showed that continued implementation of conservation practices should result in irrigation return flow from the USR watershed meeting the total maximum daily load limits for the Snake River. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

A retrospective evaluation of coral snake envenomation in dogs and cats: 20 cases (1996-2011).

PubMed

Pérez, Mayrim L; Fox, Karlie; Schaer, Michael

2012-12-01

To describe the clinical signs, treatment, and outcomes of dogs and cats following envenomation by the eastern coral snake and to report our clinical experience with the use of Coralmyn. Retrospective study (1996-2011). University teaching hospital. Sixteen dogs and 4 cats with eastern coral snake envenomation. Medical records meeting the study inclusion criteria were reviewed and evaluated for signalment, date and time of the snake encounter, elapsed time between encounter and hospital examination, initial physical examination findings, antivenom type, length of hospitalization, and outcome. Initial physical examination findings included: quiet mentation, tetraparesis, ptyalism, tachypnea, abdominal breathing, shallow breathing, decreased to absent gag reflex, ataxia, muscle fasciculations, and decreased spinal reflexes. Laboratory findings in dogs included proteinuria, bilirubinuria, hemeproteinuria, increased aspartate aminotransferase activity, increased alanine aminotransferase activity, and hemolysis. Four dogs and 2 cats received Coralmyn and 4 dogs received North American Coral Snake Antivenom. Adverse reaction to antivenom was suspected in 1 dog that received North American Coral Snake Antivenom. Eight of 11 envenomated dogs survived with a median length of hospitalization of 4.5 days. Two of 3 envenomated cats survived with a median length of hospitalization of 4 days. Two dogs were euthanized, 1 dog suffered acute respiratory arrest, and 1 cat developed tachycardia that progressed to pulseless electrical activity. Five dogs and 1 cat in the encounter group survived to discharge. Diagnosis of eastern coral snake envenomation is likely in the dog that has concomitant lower motor neuron neuropathy, bulbar palsy, and hemolysis. Early diagnosis is crucial as antivenom administration can reduce morbidity. Prognosis is considered good with 71% of the envenomated patients in this study surviving to discharge. Supportive care that may include ventilator assistance and antivenom administration are the mainstays of therapy. © Veterinary Emergency and Critical Care Society 2012.

Identification of chromosomal locations associated with tail biting and being a victim of tail-biting behaviour in the domestic pig (Sus scrofa domesticus).

PubMed

Wilson, Kaitlin; Zanella, Ricardo; Ventura, Carlos; Johansen, Hanne Lind; Framstad, Tore; Janczak, Andrew; Zanella, Adroaldo J; Neibergs, Holly Louise

2012-11-01

The objective of this study was to identify loci associated with tail biting or being a victim of tail biting in Norwegian crossbred pigs using a genome-wide association study with PLINK case-control analysis. DNA was extracted from hair or blood samples collected from 98 trios of crossbred pigs located across Norway. Each trio came from the same pen and consisted of one pig observed to initiate tail biting, one pig which was the victim of tail biting and a control pig which was not involved in either behaviour. DNA was genotyped using the Illumina PorcineSNP60 BeadChip whole-genome single-nucleotide polymorphism (SNP) assay. After quality assurance filtering, 53,952 SNPs remained comprising 74 animals (37 pairs) for the tail biter versus control comparison and 53,419 SNPs remained comprising 80 animals (40 pairs) for the victim of tail biting versus control comparison. An association with being a tail biter was observed on Sus scrofa chromosome 16 (SSC16; p = 1.6 × 10(-5)) and an unassigned chromosome (p = 3.9 × 10(-5)). An association with being the victim of tail biting was observed on Sus scrofa chromosomes 1 (SSC1; p = 4.7 × 10(-5)), 9 (SSC9; p = 3.9 × 10(-5)), 18 (SSC18; p = 7 × 10(-5) for 9,602,511 bp, p = 3.4 × 10(-5) for 9,653,881 bp and p = 5.3 × 10(-5) for 29,577,783 bp) and an unassigned chromosome (p = 6.1 × 10(-5)). An r(2) = 0.96 and a D' = 1 between the two SNPs at 9 Mb on SSC18 indicated extremely high linkage disequilibrium, suggesting that these two markers represent a single locus. These results provide evidence of a moderate genetic association between the propensity to participate in tail-biting behaviour and the likelihood of becoming a victim of this behaviour.

[Tetanus after cat scratch and bites in a previously immunized patient].

PubMed

Fica, Alberto; Gaínza, Daniela; Ortigosa, Pablo

2017-04-01

Tetanus is declining due to vaccination, professional labor management and appropriate wound care. Tetanus cases have been reported despite immunization. We report the case of a previously healthy 21 years old female patient that presented a mild generalized tetanus requiring admission after mild and recurrent cat scratch and bites. She had received six vaccine shots during childhood, and a booster dose five years earlier after a rabbit bite. Symptoms appeared seven weeks after the last contact, and included headache, muscle spasms and mild opisthotonus. Laboratory evaluation, including CSF analysis and microbiological investigation, as well as imaging studies were all normal. The patient received 6,000 IU of human antitoxin immunoglobulin. No autonomic manifestations or respiratory compromise were registered. Symptoms resolved rapidly and she was discharge after seven days with an order to complete a tetanus toxoid immunization schedule with three doses. Tetanus is possible in urban settings with a declining epidemiologic curve of disease in previously immunized patients. Severity of disease is modulated by previous vaccination.

Physician reported incidence of early and late Lyme borreliosis.

PubMed

Hofhuis, Agnetha; Harms, Margriet; Bennema, Sita; van den Wijngaard, Cees C; van Pelt, Wilfrid

2015-03-15

Lyme borreliosis is the most common vector-borne disease in Europe and North America. The objective of this study is to estimate the incidence of tick bites and Lyme borreliosis, representative of our entire country, including erythema migrans, disseminated Lyme borreliosis and persisting symptoms attributed to Lyme borreliosis. A questionnaire on clinical diagnoses of Lyme borreliosis was sent to all GPs, company physicians, and medical specialists. To adjust for possible misclassification and telescoping bias, we sent additional questionnaires to categorize reported cases according to likelihood of the diagnosis and to exclude cases diagnosed outside the target period. Adjusted annual incidence rate for disseminated Lyme borreliosis was 7.7 GP reports per 100,000 inhabitants, and for persisting symptoms attributed to Lyme borreliosis was 5.5 GP reports per 100,000 inhabitants, i.e. approximately 1,300 and 900 cases respectively. GP consultations for tick bites and erythema migrans diagnoses were 495 and 132 per 100,000 inhabitants, respectively, i.e. 82,000 and 22,000 cases in 2010. This is the first reported nationwide physician survey on the incidence of tick bites and the whole range of manifestations of Lyme borreliosis, including persisting symptoms attributed to Lyme borreliosis. This is crucial for complete assessment of the public health impact of Lyme borreliosis.

Responses by king snakes (Lampropeltis getulus) to chemicals from colubrid and crotaline snakes.

PubMed

Weldon, P J; Schell, F M

1984-10-01

Four litters of king snakes (Lampropeltis getulus), a snake-eating species, were tested for responses to chemicals from colubrid and crotaline snakes. King snakes presented with swabs rubbed against the dorsal skin of living snakes and with swabs treated with methylene chloride extracts of shed snake skins tongue-flicked more to swabs from a northern copperhead (Agkistrodon contortrix), a crotaline, than to swabs from some colubrid snakes or to blank swabs. Six out of 10 king snakes in one litter attacked and attempted to ingest swabs treated with snake skin chemicals, implicating these chemicals as feeding stimuli for these ophiophagous snakes. Ingestively naive king snakes presented with plain air and snake odors in an olfactometer tongue-flicked more to snake odors. This study and others suggest that crotaline and colubrid snakes can be distinguished by chemical cues.

Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014–15: a retrospective follow-up survey

PubMed Central

Etheart, Melissa Dominique; Kligerman, Maxwell; Augustin, Pierre Dilius; Blanton, Jesse D; Monroe, Benjamin; Fleurinord, Ludder; Millien, Max; Crowdis, Kelly; Fenelon, Natael; Wallace, Ryan MacLaren

2017-01-01

Summary Background Haiti has an integrated bite case management (IBCM) programme to counsel animal-bite victims on the risk of rabies and appropriate treatment, as well as the Haiti Animal Rabies Surveillance Program (HARSP) to examine the animals. We assessed the usefulness of the IBCM programme to promote best practices for rabies prophylaxis after exposure in a low-income rabies-endemic setting. Methods We did a retrospective follow-up survey of randomly selected bite victims who were counselled by Haiti's IBCM programme between May 15, 2014, and Sept 15, 2015. We classified participants by HARSP decisions of confirmed, probable, suspected, or non-rabies exposures. We compared health-care outcomes in people who sought medical care before IBCM counselling with those in people who sought care after counselling. We used decision trees to estimate the probability of actions taken in the health-care system, and thereby human deaths. Findings During the study period, 1478 dog bites were reported to HARSP for assessment. 37 (3%) were confirmed exposures, 76 (5%) probable exposures, 189 (13%) suspected exposures, and 1176 (80%) non-rabies exposures. 115 of these cases were followed up in the survey. IBCM counselling was associated with a 1.2 times increase in frequency of bite victims seeking medical care and of 2.4 times increase in vaccination uptake. We estimated that there would be four human rabies deaths among the 1478 people assessed by IBCM during the survey period, and 11 in the absence of this programme, which would equate to a 65% decrease in rabies deaths. Among three people dead at the time of the follow-up survey, one was deemed to be due to rabies after a probable rabies exposure. Interpretation Adherence to medical providers' recommendations might be improved through counselling provided by IBCM programmes. PMID:28911750

[Pre- and post-surgical orthodontic treatment for skeletal open bite].

PubMed

Zhou, Y; Hu, W; Sun, Y

2001-05-01

To Study the principles and rules of pre- and post-surgical orthodontic treatment for skeletal open bite patients. Thirty-two surgically treated open bite cases were analyzed, of which 9 were males, and 23 were females, aged from 16 to 38. Open bite was from 1 to 8.5 mm, average was 4 mm. 31 patients were Class III malocclusion, while 1 patient was Class II malocclusion. 1. Totally 21 patients were treated with orthodontics before and after orthognathic surgery, while 8 patients had pre-surgical orthodontics only, and other 3 had post-surgical orthodontics only. The duration for pre-surgical orthodontics was from 4 to 33 months, average was 12 months. The duration for post-surgical orthodontics was from 3 to 17 months, average was 8.5 months. 2. Presurgical orthodontic treatment included: Alignment of arches, decompensation of incisors, avoiding extrusion of incisors, and slight expansion of arches for coordination of arches. 3. Post-surgical orthodontic treatment included: Closure of residual spaces in the arches, realignment of arches, vertical elastics and Class II or III intermaxillary elastics. Skeletal open bites require combined orthodontic-orthognathic surgery for optimal and esthetical pleasing results.

The importance of accurate muscle modelling for biomechanical analyses: a case study with a lizard skull

PubMed Central

Gröning, Flora; Jones, Marc E. H.; Curtis, Neil; Herrel, Anthony; O'Higgins, Paul; Evans, Susan E.; Fagan, Michael J.

2013-01-01

Computer-based simulation techniques such as multi-body dynamics analysis are becoming increasingly popular in the field of skull mechanics. Multi-body models can be used for studying the relationships between skull architecture, muscle morphology and feeding performance. However, to be confident in the modelling results, models need to be validated against experimental data, and the effects of uncertainties or inaccuracies in the chosen model attributes need to be assessed with sensitivity analyses. Here, we compare the bite forces predicted by a multi-body model of a lizard (Tupinambis merianae) with in vivo measurements, using anatomical data collected from the same specimen. This subject-specific model predicts bite forces that are very close to the in vivo measurements and also shows a consistent increase in bite force as the bite position is moved posteriorly on the jaw. However, the model is very sensitive to changes in muscle attributes such as fibre length, intrinsic muscle strength and force orientation, with bite force predictions varying considerably when these three variables are altered. We conclude that accurate muscle measurements are crucial to building realistic multi-body models and that subject-specific data should be used whenever possible. PMID:23614944

Gastric adenocarcinoma in a diamond python (Morelia spilota spilota).

PubMed

Baron, H R; Allavena, R; Melville, L M; Doneley, R J T

2014-10-01

A 5-year-old captive male diamond python (Morelia spilota spilota) was presented with a 1-month history of regurgitation and anorexia and discrete coelomic distention. Physical examination revealed a firm, immobile mass at approximately two-thirds of the snout-vent length from the front of the head. Ultrasound-guided fine needle aspirate biopsy of the mass in the region of the stomach showed necrosis with bacterial infiltration and possibly neoplastic changes. A gastroscopy was conducted, but showed grossly normal gastric mucosa, confirmed by biopsy. On exploratory coeliotomy, it was confirmed the mass involved most of the stomach wall and occluded the gastric lumen. The mass was completely excised and based on histopathology, a diagnosis of gastric adenocarcinoma was made. The snake was found dead 12 h postoperatively, but no specific cause of death was found on postmortem examination. Most cases of adenocarcinoma in snakes go undiagnosed. This case report illustrates that the architecture of gastric masses may lead to false-negative gastric biopsy results in snakes with neoplasia. © 2014 Australian Veterinary Association.

Increasing role of arthropod bites in tularaemia transmission in Poland - case reports and diagnostic methods.

PubMed

Formińska, Kamila; Zasada, Aleksandra A; Rastawicki, Waldemar; Śmietańska, Karolina; Bander, Dorota; Wawrzynowicz-Syczewska, Marta; Yanushevych, Mariya; Niścigórska-Olsen, Jolanta; Wawszczak, Marek

2015-01-01

The study describes four cases of tularaemia - one developed after contact with rabbits and three developed after an arthropod bite. Due to non-specific clinical symptoms, accurate diagnosis of tularaemia may be difficult. The increasing contribution of the arthropod vectors in the transmission of the disease indicates that special effort should be made to apply sensitive and specific diagnostic methods for tularaemia, and to remind health-care workers about this route of Francisella tularensis infections. The advantages and disadvantages of various diagnostic methods - molecular, serological and microbiological culture - are discussed. The PCR as a rapid and proper diagnostic method for ulceroglandular tularaemia is presented.

Expert disagreement in bitemark casework.

PubMed

Bowers, C Michael; Pretty, Iain A

2009-07-01

Bitemark cases continue to raise controversy due to the degree of expert disagreement which is frequently seen. Using a case mix of 49 bitemark cases from 2000 to 2007 each injury was independently assessed for its forensic significance using a previously described bitemark severity scale. Following the assessment, the mean value for the bites was categorized according to the crime type, the degree of expert agreement, and the judicial outcome. Results suggest that bitemarks found in child abuse cases have statistically significantly lower forensic value than those in other crime types, that bites where there is mutual agreement between experts will have higher forensic value than those where there is disagreement at trial, and that cases in which DNA has provided an exoneration will demonstrate similar quality to those where a conviction was secured. Forensic odontologists should carefully assess bitemark evidence and ensure that it meets certain minimums in relation to the presence of class and unique features before undertaking an analysis.

Attacks by packs of dogs involving predation on human beings

PubMed Central

Borchelt, Peter L.; Lockwood, Randall; Beck, Alan M.; Voith, Victoria L.

1983-01-01

Dog bites are a medical problem for millions of people, children being the most common victims. Human deaths attributable to dog bite injury (not rabies) are relatively infrequent. There have been some epidemiologic reviews, but this study is the first attempt to arrive at an understanding of bites involving predation on human beings by conducting behavioral examinations under controlled conditions of the dogs involved, and by interviewing victims, witnesses, and people familiar with the animals. The three cases studied involved two fatalities and an attack that was nearly fatal. The victims were 11, 14, and 81. In each case, owned pet dogs consumed some human tissue. The severity of the victims' injuries was not the consequence of a single dog bite, but the result of repeated attacks by dogs behaving as a social group. Factors that might contribute to a dog's regarding human beings as potential prey were examined, including hunger, prior predation, group behaviors, defense of territory, previous interactions with people, the presence of estrous female dogs, and environmental stimuli. In two of the cases, it was possible, by using similar stimuli, to duplicate the circumstances at the time of the attack. The results of the observations showed the value of behavioral analysis and simulations methods in evaluating possible factors in dog attacks. Among the many factors probably involved in severe dog attacks are the size, number, and nutritional status of the dogs; the dogs' previous aggressive contacts with people; the victim's age, size, health, and behavior; and the absence of other human beings in the vicinity. Imagesp61-ap61-bp61-c PMID:6828639

Correlation analysis of symmetry breaking in the surface nanostructure ordering: case study of the ventral scale of the snake Morelia viridis

NASA Astrophysics Data System (ADS)

Kovalev, A.; Filippov, A.; Gorb, S. N.

2016-03-01

In contrast to the majority of inorganic or artificial materials, there is no ideal long-range ordering of structures on the surface in biological systems. Local symmetry of the ordering on biological surfaces is also often broken. In the present paper, the particular symmetry violation was analyzed for dimple-like nano-pattern on the belly scales of the skin of the pythonid snake Morelia viridis using correlation analysis and statistics of the distances between individual nanostructures. The results of the analysis performed on M. viridis were compared with a well-studied nano-nipple pattern on the eye of the sphingid moth Manduca sexta, used as a reference. The analysis revealed non-random, but very specific symmetry violation. In the case of the moth eye, the nano-nipple arrangement forms a set of domains, while in the case of the snake skin, the nano-dimples arrangement resembles an ordering of particles (molecules) in amorphous (glass) state. The function of the nano-dimples arrangement may be to provide both friction and strength isotropy of the skin. A simple model is suggested, which provides the results almost perfectly coinciding with the experimental ones. Possible mechanisms of the appearance of the above nano-formations are discussed.

Capnocytophaga canimorsus Sepsis Following a Minor Dog Bite to the Finger: Case Report.

PubMed

Dedy, Nicolas J; Coghill, Sarah; Chandrashekar, Nanda Kumar S; Bindra, Randy R

2016-01-01

Capnocytophaga canimorsus is a gram-negative bacillus present in the oral cavities of 22% to 74% of healthy dogs. Capnocytophaga canimorsus has unique virulence factors that enable it to evade the human immune system and cause life-threatening sepsis following a dog bite. We report a previously well 68-year-old woman who presented with septic shock and multiorgan failure following a seemingly minor dog bite to the finger. The patient required intensive care treatment, intravenous antibiotic therapy, and multiple surgical procedures including amputation of the affected finger. The septicemia and coagulopathy that ensued resulted in gangrene and amputation of additional fingers and toes. The purpose of this report is to raise awareness of this organism among hand surgeons when faced with a patient presenting in septic shock and minimal signs at the site of a dog bite. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Transparent aligners: An invisible approach to correct mild skeletal class III malocclusion

PubMed Central

Yezdani, A. Arif

2015-01-01

This case report highlights the treatment of a mild skeletal class III malocclusion with an invisible thermoplastic retainer. A 15-year-old female patient presented with a mild skeletal class III malocclusion with a retrognathic maxilla, orthognathic mandible, a low mandibular plane angle with Angle's class III malocclusion with maxillary lateral incisors in anterior cross-bite with crowding of maxillary anteriors, imbricated and rotated mandibular incisors and deep bite. Accurate upper and lower impressions and a bite registration were taken with polyvinyl siloxane rubber base impression material. This was then sent to the lab for the processing of a series of ClearPath aligners. The ClearPath virtual set-up sent from the lab provided the treatment plan and interproximal reduction estimation complete with posttreatment results. This enabled the clinician to actively participate in the treatment plan and provide the necessary suggestions. The ClearPath three-dimensional aligner was found to have effectively corrected the anterior cross-bite and crowding of the maxillary anteriors. PMID:26015738

Self-Inflicted Finger Injury in Individuals With Spinal Cord Injury: An Analysis of 5 Cases

PubMed Central

Frost, Frederick S; Mukkamala, Sridevi; Covington, Edward

2008-01-01

Objective: To describe the occurrence of finger autophagia in 5 persons with traumatic spinal cord injury and to present a discussion of putative causes and potential treatments. Background: Minor self-mutilating actions, such as nail biting and hair pulling, are common in humans and usually benign. In some circumstances, these behaviors are associated with obsessive-compulsive personality traits. In humans, self-injurious biting behaviors are well described in the setting of mental retardation and psychosis and in persons with Lesch-Nyhan syndrome. Rare cases of human autophagia in persons with intact cognition have been reported, most commonly in the setting of acquired nervous system lesions. After spinal cord injury, it has been suggested that this behavior constitutes a human variant of animal autotomy and a response to neuropathic pain. Design: Case presentation narrative. Main Outcome Measures: Photographic and radiological study, administration of Yale-Brown Obsessive-Compulsive Scale (YBOCS). Findings: In 5 patients with complete tetraplegia, pain in the hands was present in only one instance. The severity of autoamputation varied from minor to extreme. In all cases, damage was confined to analgesic body parts. In 3 cases, autophagia behavior was discovered in progress. Treatments included pharmacotherapy, counseling, and behavioral therapy, with mixed results. All patients were intelligent, willing to discuss their issues, and able to identify conditions of stress and isolation in their lives. Mild preinjury obsessive-compulsive behaviors, such as nail biting, were universal. On the YBOCS, only 1 patient scored in a range indicative of mild obsessive-compulsive symptomatology. Conclusions: This group exhibited heterogeneous medical, social, and cultural characteristics. A link between pain and self-injurious behavior could not be demonstrated. This behavior may be viewed as an extreme variant of nail biting, with potential ominous complications. Treatment strategies have been employed with mixed results. PMID:18533422

Reproductive strategies in snakes.

PubMed Central

Shine, Richard

2003-01-01

Snakes of both sexes display remarkable flexibility and diversity in their reproductive tactics. Many features of reproduction in female snakes (such as reproductive mode and frequency, seasonality and multiple mating) allow flexible maternal control. For example, females can manipulate not only the genotypes of their offspring (through mate choice or enhanced sperm competition) but also the phenotypes of their offspring (through allocation 'decisions', behavioural and physiological thermoregulation, and nest-site selection). Reliance on stored energy ('capital') to fuel breeding results in low frequencies of female reproduction and, in extreme cases, semelparity. A sophisticated vomeronasal system not only allows male snakes to locate reproductive females by following scent trails, but also facilitates pheromonally mediated mate choice by males. Male-male rivalry takes diverse forms, including female mimicry and mate guarding; combat bouts impose strong selection for large body size in males of some species. Intraspecific (geographical) variation and phenotypic plasticity in a wide array of reproductive traits (offspring size and number; reproductive frequency; incidence of multiple mating; male tactics such as mate guarding and combat; mate choice criteria) provide exceptional opportunities for future studies. PMID:12803888

Development and use of a real-time polymerase chain reaction assay for the detection of Ophidiomyces ophiodiicola in snakes.

PubMed

Allender, Matthew C; Bunick, David; Dzhaman, Elena; Burrus, Lucienne; Maddox, Carol

2015-03-01

Fungal pathogens threatening the conservation of wildlife are becoming increasingly common. Since 2008, free-ranging snakes across North America have been experiencing a marked increase in the prevalence of snake fungal disease associated with Ophidiomyces ophiodiicola. Diagnosis has historically relied on histology, microbiology, and conventional polymerase chain reaction (PCR). More sensitive methods are needed to adequately characterize the epidemiology. The current study describes the development of a real-time PCR (qPCR) assay for detecting a segment of the internal transcribed spacer 1 region between the 18S and 5.8S ribosomal RNA gene. The assay was able to detect as few as 1.05 × 10(1) gene copies per reaction. An additional 4 positive cases were detected when comparing a conventional PCR (n = 3) and the qPCR (n = 7) when used on swab samples from 47 eastern massasauga rattlesnakes. The newly developed assay is a sensitive and specific tool for surveillance and monitoring in the conservation of free-ranging snakes. © 2015 The Author(s).

Reproductive strategies in snakes.

PubMed

Shine, Richard

2003-05-22

Snakes of both sexes display remarkable flexibility and diversity in their reproductive tactics. Many features of reproduction in female snakes (such as reproductive mode and frequency, seasonality and multiple mating) allow flexible maternal control. For example, females can manipulate not only the genotypes of their offspring (through mate choice or enhanced sperm competition) but also the phenotypes of their offspring (through allocation 'decisions', behavioural and physiological thermoregulation, and nest-site selection). Reliance on stored energy ('capital') to fuel breeding results in low frequencies of female reproduction and, in extreme cases, semelparity. A sophisticated vomeronasal system not only allows male snakes to locate reproductive females by following scent trails, but also facilitates pheromonally mediated mate choice by males. Male-male rivalry takes diverse forms, including female mimicry and mate guarding; combat bouts impose strong selection for large body size in males of some species. Intraspecific (geographical) variation and phenotypic plasticity in a wide array of reproductive traits (offspring size and number; reproductive frequency; incidence of multiple mating; male tactics such as mate guarding and combat; mate choice criteria) provide exceptional opportunities for future studies.

Changing picture of renal cortical necrosis in acute kidney injury in developing country

PubMed Central

Prakash, Jai; Singh, Vijay Pratap

2015-01-01

Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome (HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications (septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main (60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients. PMID:26558184

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal.

PubMed

Pandey, Deb Prasad; Subedi Pandey, Gita; Devkota, Kamal; Goode, Matt

2016-06-02

Venomous snakebite and its effects are a source of fear for people living in southern Nepal. As a result, people have developed a negative attitude towards snakes, which can lead to human-snake conflicts that result in killing of snakes. Attempting to kill snakes increases the risk of snakebite, and actual killing of snakes contributes to loss of biodiversity. Currently, snake populations in southern Nepal are thought to be declining, but more research is needed to evaluate the conservation status of snakes. Therefore, we assessed attitudes, knowledge, and awareness of snakes and snakebite by Chitwan National Park's (CNP) buffer zone (BZ) inhabitants in an effort to better understand challenges to snake conservation and snakebite management. The results of this study have the potential to promote biodiversity conservation and increase human health in southern Nepal and beyond. We carried out face-to-face interviews of 150 randomly selected CNP BZ inhabitants, adopting a cross-sectional mixed research design and structured and semi-structured questionnaires from January-February 2013. Results indicated that 43 % of respondents disliked snakes, 49 % would exterminate all venomous snakes, and 86 % feared snakes. Farmers were the most negative and teachers were the most ambivalent towards snakes. Respondents were generally unable to identify different snake species, and were almost completely unaware of the need of conserve snakes and how to prevent snakebites. Belief in a snake god, and the ability of snakes to absorb poisonous gases from the atmosphere were among many superstitions that appeared to predispose negativity towards snakes of BZ residents. People with predisposed negativity towards snakes were not proponents of snake conservation. Fear, negativity, ambivalence towards, and ignorance about, snakes and the need for snake conservation were strong indicators of the propensity to harm or kill snakes. It seems that if wanton killing of snakes continues, local snake populations will decline, and rare and endangered snake species may even become locally extirpated. Moreover, inappropriate perception and knowledge about snakes and snakebites may put BZ people at increased risk of venomous snakebite. Therefore, intensive, pragmatic educational efforts focused on natural history and ecology of snakes and prevention of snakebite should be undertaken in communities and at schools and universities.

Taboos Related to Dog Bite in an Urban Area of Kancheepuram District of Tamil Nadu, India

PubMed Central

Chinnaian, Sivagurunathan; Ramachandran, Umadevi; Ravi, Rama; Pandurangan, Mohan Kumar

2015-01-01

Background India is known for its diverse social and cultural backgrounds with wide range of myths and misconceptions related to diseases/illnesses. One such belief is certain food taboos and diet restrictions practiced following dog bite, which is widely prevalent. Materials and Methods This is a community based cross- sectional study conducted among adults population in Anakaputhur area of Kancheepuram district. The sample size was estimated to be 275 based on previous study data and simple random sampling method was used for data collection. Data collected was analysed using SPSS version 16 and results described using descriptive statistics and Chi-square test was used for finding statistical association. Results About 84.4% of the study participants said that some kind of restrictions should be followed in case of dog bite, among them 68.7% said non vegetarian foods should be avoided. About 81 % of those bitten by dogs followed some form of food restrictions. Nearly 93.6% of those bitten did follow certain restrictions, based on advice of family members/relatives while about 6.4% of the study group followed restrictions based on advice by ‘medical personnel’. Illiterates and those educated up to high school; participants with no history of animal bite in their family, were more at risk of having misconceptions (p<0.05). Pet owners have more misconceptions compared to non pet owners. Conclusion This study reveals the existence of certain food taboos in case of dog bite among the study population. These practices and taboos are of no use and can be harmful at times. It is important to clear these misconceptions through appropriate health education measures for better health seeking behaviour and management. PMID:26393149

Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program

PubMed Central

Wallace, Ryan M; Reses, Hannah; Franka, Richard; Dilius, Pierre; Fenelon, Natael; Orciari, Lillian; Etheart, Melissa; Destine, Apollon; Crowdis, Kelly; Blanton, Jesse D; Francisco, Calvin; Ludder, Fleurinord; Del Rio Vilas, Victor; Haim, Joseph; Millien, Max

2015-01-01

The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 –December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries. PMID:26600437

Unexplained Cases of Allergic Reactions Linked to Red Meat

MedlinePlus

... that starts after being bitten by a lone star tick may cause unexplained cases of recurrent anaphylaxis. ... after eating meat. Previous studies have linked lone star tick bites to this unusual food allergy. The ...

Category 2: Adult malocclusion with open bite.

PubMed

Kim, Keum-Ryung

2009-01-01

This case report was displayed by the American Board of Orthodontics at the Annual Session of the American Association of Orthodontists, as an example of a successfully completed case from the 2006 ABO clinical exam.

Fatal presumed tiger snake (Notechis scutatus) envenomation in a cat with measurement of venom and antivenom concentration.

PubMed

Padula, Andrew M; Winkel, Kenneth D

2016-04-01

A fatal outcome of a presumed tiger snake (Notechis scutatus) envenomation in a cat is described. Detectable venom components and antivenom concentrations in serum from clotted and centrifuged whole blood and urine were measured using a sensitive and specific ELISA. The cat presented in a paralysed state with a markedly elevated serum CK but with normal clotting times. The cat was treated with intravenous fluids and received two vials of equine whole IgG bivalent (tiger and brown snake) antivenom. Despite treatment the cat's condition did not improve and it died 36 h post-presentation. Serum concentration of detectable tiger snake venom components at initial presentation was 311 ng/mL and urine 832 ng/mL, this declined to non-detectable levels in serum 15-min after intravenous antivenom. Urine concentration of detectable tiger snake venom components declined to 22 ng/mL at post-mortem. Measurement of equine anti-tiger snake venom specific antibody demonstrated a concentration of 7.2 Units/mL in serum at post-mortem which had declined from an initial high of 13 Units/mL at 15-min post-antivenom. The ELISA data demonstrated the complete clearance of detectable venom components from serum with no recurrence in the post-mortem samples. Antivenom concentrations in serum at initial presentation were at least 100-fold higher than theoretically required to neutralise the circulating concentrations of venom. Despite the fatal outcome in this case it was concluded that this was unlikely that is was due to insufficient antivenom. Copyright © 2016 Elsevier Ltd. All rights reserved.

Ophidian Spectaculitis and Spectacular Dysecdysis: A Histologic Description.

PubMed

Da Silva, M O; Bertelsen, M F; Heegaard, S; Garner, M M

2015-11-01

The histologic features of abnormal spectacles in 60 snakes from the 5 families of Boidae, Colubridae, Elapidae, Pythonidae, and Viperidae are described in a retrospective study conducted on specimens submitted to a private diagnostic service during a period of 15 years. Fifty-two snakes had inflammatory reactions in the spectacle. The stroma and outer epithelium of the spectacle were the layers most often involved in inflammatory disease. Lesions of the outer epithelium included edema, hyperkeratosis, and granulocyte infiltration occasionally with bacterial colonies and fungal elements. The stroma had infectious agents and inflammatory reactions in vessels and between the collagen fibrils. The inner epithelium had varying degrees of hyperplasia and hypertrophy, but no infectious agents were seen. Infectious agents in these cases included mites, bacterial disease, fungal disease, or a combination of bacterial and fungal disease. Special stains identified the bacteria most commonly involved to be Gram-positive cocci. Thirteen snakes had dysecdysis of the spectacle. Of these, 5 displayed a concurrent inflammatory reaction of the spectacle, while the remaining 8 snakes had extra keratin layers on a spectacle with an otherwise normal appearance. These keratin layers were attached to serocellular crusts located on the inner surface of the periocular scales. The cause for dyskeratotic lesions of the spectacle was not always apparent, and concurrent acariasis, other forms of dermatitis, trauma, suboptimal husbandry, and visceral disease were considered possible contributing factors. It was notable that only 4% of the submitted cases were found to have spectaculitis and/or spectacular dysecdysis. © The Author(s) 2015.

Airway injury associated with cervical bite wounds in dogs and cats: 56 cases.

PubMed

Jordan, C J; Halfacree, Z J; Tivers, M S

2013-01-01

To investigate the frequency of airway injury and damage to other vital structures associated with cervical bite wounds in dogs and cats and the implications for management and outcome. A retrospective search of electronic patient records was used to identify dogs and cats suffering cervical bite wounds that were presented to a large multidisciplinary veterinary hospital over a four year period. Complete records were available for 55 animals, with one animal suffering two separate injuries. Fourteen animals (25%) had injuries to vital structures, including airway injury in nine (17%) which was surgically confirmed and treated in six (11%). Airway injuries were associated with either subcutaneous or mediastinal emphysema in all affected animals. Other structures injured included the jugular vein, pharynx, oesophagus and spine. Airway injuries were treated with primary repair in five animals and a fasciomuscular patch in one. Temporary tracheostomy was performed in three animals. Median duration of hospitalisation was one day (0-19) with 53 animals (54 cases) (96%) surviving to discharge. Long-term follow-up (16-114 months) revealed that 43 of 49 animals were alive with six that died due to unrelated reasons. Cervical bite wounds are associated with significant injury to vital structures. Up to 17% of animals may have injury to their airway. Identification and treatment of airway injury is vital and was associated with an excellent outcome in six animals.

"Closed Reduction" Principles Can Manage Diverse Conditions of Temporomandibular Joint Vertical Height Loss: From Displaced Condylar Fractures to Idiopathic Condylar Resorption.

PubMed

Nitzan, Dorrit W; Palla, Sandro

2017-06-01

The aim of this case series was to describe a modification of the classic "closed reduction" technique to manage unilateral or anterior open bite owing to a loss in vertical height (LVH) caused by several disorders and pathologies other than displaced condylar fractures. The protocol included insertion of an occlusal appliance to increase the height of the premature contact and the width of the open bite, stabilization of the dental arches by rigid arches, and the use, during sleep, of rubber bands in the open bite region to pull the mandible cranially. In addition, when awake, the patient performed physiotherapy exercises to guide the mandible into maximum intercuspation. The increased open bite enhanced the effect of the rubber bands in guiding the mandible into the original habitual occlusion and the rigid arches served to minimize tooth eruption. The present cases showed the favorable outcome of this low-risk treatment in the re-establishment of the original habitual occlusion within 1 to 4 weeks and without reconstruction of the LVH. The efficacy of this complication-free approach to correct occlusion in various conditions of LVH suggests that this protocol should be applied before venturing into surgical intervention. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

50 CFR 226.205 - Critical habitat for Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River...

Code of Federal Regulations, 2012 CFR

2012-10-01

... salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook salmon. 226.205 Section... Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook... River salmon (except reaches above impassable natural falls, and Dworshak and Hells Canyon Dams...

50 CFR 226.205 - Critical habitat for Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River...

Code of Federal Regulations, 2013 CFR

2013-10-01

... salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook salmon. 226.205 Section... Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook... River salmon (except reaches above impassable natural falls, and Dworshak and Hells Canyon Dams...

50 CFR 226.205 - Critical habitat for Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River...

Code of Federal Regulations, 2014 CFR

2014-10-01

... salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook salmon. 226.205 Section... Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook... River salmon (except reaches above impassable natural falls, and Dworshak and Hells Canyon Dams...

50 CFR 226.205 - Critical habitat for Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River...

Code of Federal Regulations, 2010 CFR

2010-10-01

... salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook salmon. 226.205 Section... Snake River sockeye salmon, Snake River fall chinook salmon, and Snake River spring/summer chinook salmon. The following areas consisting of the water, waterway bottom, and adjacent riparian zone of...

A hand tracking algorithm with particle filter and improved GVF snake model

NASA Astrophysics Data System (ADS)

Sun, Yi-qi; Wu, Ai-guo; Dong, Na; Shao, Yi-zhe

2017-07-01

To solve the problem that the accurate information of hand cannot be obtained by particle filter, a hand tracking algorithm based on particle filter combined with skin-color adaptive gradient vector flow (GVF) snake model is proposed. Adaptive GVF and skin color adaptive external guidance force are introduced to the traditional GVF snake model, guiding the curve to quickly converge to the deep concave region of hand contour and obtaining the complex hand contour accurately. This algorithm realizes a real-time correction of the particle filter parameters, avoiding the particle drift phenomenon. Experimental results show that the proposed algorithm can reduce the root mean square error of the hand tracking by 53%, and improve the accuracy of hand tracking in the case of complex and moving background, even with a large range of occlusion.

Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model

PubMed Central

Sprong, Hein; van den Wijngaard, Cees C.; Harms, Margriet G.; Fonville, Manoj; Docters van Leeuwen, Arieke; Simões, Mariana; van Pelt, Wilfrid

2017-01-01

Background Understanding and quantification of the risk of Lyme borreliosis after a tick bite can aid development of prevention strategies against Lyme borreliosis. Methods We used 3,525 single tick bite reports from three large prospective studies on the transmission risk of tick-borne pathogens to humans, with 50 reports of Lyme borreliosis during the follow-up period, among 1,973 reports with known outcome. A structural equation model was applied to estimate the risk of Lyme borreliosis after a tick bite, and quantify the influence of: developmental stage of the tick, detection of Borrelia burgdorferi s.l. DNA in the tick by PCR, tick engorgement, patient-estimated duration of tick attachment, and patient age. Results The overall risk of developing Lyme borreliosis after a tick bite was 2.6% (95%CI 1.4–5.1). The risk increased with: - Tick engorgement: 1.4% (95%CI 0.7%-2.3%) for low engorgement to 5.5% (95%CI 2.8%-9.2%) for substantially engorged ticks; - Rising patient-estimated tick attachment duration: 2.0% (95%CI 1.3%-2.8%) after <12 hours, to 5.2% (95%CI 3.0%-8.9%) after ≥4 days; - Detection of Borrelia burgdorferi s.l. DNA in ticks: 6.7% (95%CI 3.6%-13.5%), versus 1.4% (95%CI 0.7%-2.9%) when ticks tested negative. The highest observed risk of Lyme borreliosis was 14.4% (95%CI 6.8%-24.6%) after one tick bite of a substantially engorged tick that tested positive for Borrelia burgdorferi s.l. DNA, which corresponds to one new case of Lyme borreliosis per 7 (95%CI 4–15) of such tick bites. Conclusions An individual's risk of Lyme borreliosis after a tick bite can be predicted with tick engorgement, patient-estimated duration of tick attachment, and detection of Borrelia burgdorferi s.l. DNA in the tick. PMID:28742149

Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model.

PubMed

Hofhuis, Agnetha; van de Kassteele, Jan; Sprong, Hein; van den Wijngaard, Cees C; Harms, Margriet G; Fonville, Manoj; Docters van Leeuwen, Arieke; Simões, Mariana; van Pelt, Wilfrid

2017-01-01

Understanding and quantification of the risk of Lyme borreliosis after a tick bite can aid development of prevention strategies against Lyme borreliosis. We used 3,525 single tick bite reports from three large prospective studies on the transmission risk of tick-borne pathogens to humans, with 50 reports of Lyme borreliosis during the follow-up period, among 1,973 reports with known outcome. A structural equation model was applied to estimate the risk of Lyme borreliosis after a tick bite, and quantify the influence of: developmental stage of the tick, detection of Borrelia burgdorferi s.l. DNA in the tick by PCR, tick engorgement, patient-estimated duration of tick attachment, and patient age. The overall risk of developing Lyme borreliosis after a tick bite was 2.6% (95%CI 1.4-5.1). The risk increased with: - Tick engorgement: 1.4% (95%CI 0.7%-2.3%) for low engorgement to 5.5% (95%CI 2.8%-9.2%) for substantially engorged ticks;- Rising patient-estimated tick attachment duration: 2.0% (95%CI 1.3%-2.8%) after <12 hours, to 5.2% (95%CI 3.0%-8.9%) after ≥4 days;- Detection of Borrelia burgdorferi s.l. DNA in ticks: 6.7% (95%CI 3.6%-13.5%), versus 1.4% (95%CI 0.7%-2.9%) when ticks tested negative.The highest observed risk of Lyme borreliosis was 14.4% (95%CI 6.8%-24.6%) after one tick bite of a substantially engorged tick that tested positive for Borrelia burgdorferi s.l. DNA, which corresponds to one new case of Lyme borreliosis per 7 (95%CI 4-15) of such tick bites. An individual's risk of Lyme borreliosis after a tick bite can be predicted with tick engorgement, patient-estimated duration of tick attachment, and detection of Borrelia burgdorferi s.l. DNA in the tick.

[The primary closure approach of dog bite injuries of the nose].

PubMed

Zieliński, Tomasz

2010-01-01

Biting of humans by domestic animals, especially by dogs, is common injury which causes suffering and pain, might be a cause of disability or even death. It is associated with high risk of bacterial infection of the wounds or even transfection of rabies virus. Bites are usually to the upper and lower limbs, while the face is third in a raw localization of bites. Within the face, the nose and lips are injured the most often. The goal of this paper is presentation selected methods and obtained results of primary closure of dog bite injures of the nose. There were 16 patients with dog bites injures of the nose treated in the Department of Plastic, Reconstructive and Aesthetic Surgery of the Medical University of Łódź in the years 2003-2008. The patients were 11 to 46 years old. Bites caused either superficial laceration of the skin, tearing of the nostril wing or even major defects of the tissues. In 7 patients superficial wounds a direct closure was done and antibiotic ointment was applied. In 7 patients a defect of the skin was covered with a skin graft taken from retroauricular area, but in 2 of the patients of this group repair of mucosa and alar cartilage was done. In two persons with full thickness defects of the nose reconstruction was performed with the use of a pedicled nosolabial flap. Complications occurred only in 1 patient who developed infection in the wound. In all other patients there were no complications. Good aesthetic results were obtained. Primary closure approach of bite injures with tissue defect is not associated with larger risk than in the case in secondary such approach, and should be implemented always whenever it is possible in order to avoid risk of wound and scars which require further reconstructive procedures in future.

Tongue Blade Bite Test Predicts Mandible Fractures

PubMed Central

Neiner, John; Free, Rachael; Caldito, Gloria; Moore-Medlin, Tara; Nathan, Cherie-Ann

2015-01-01

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility. PMID:27162567

Covert Conditioning: Case Studies in Self-Management.

ERIC Educational Resources Information Center

Yager, Geoffrey G.

The self-management of thoughts and mental images was used in a series of empirical case studies to influence behavior changes. The target behaviors in the cases reported were smoking, overeating, fingernail biting, thinking self-depreciative thoughts, and responding assertively. Self-monitoring, covert positive reinforcement, covert…

A proteomic analysis of Pakistan Daboia russelii russelii venom and assessment of potency of Indian polyvalent and monovalent antivenom.

PubMed

Mukherjee, Ashis K; Kalita, Bhargab; Mackessy, Stephen P

2016-07-20

To address the dearth of knowledge on the biochemical composition of Pakistan Russell's Viper (Daboia russelii russelii) venom (RVV), the venom proteome has been analyzed and several biochemical and pharmacological properties of the venom were investigated. SDS-PAGE (reduced) analysis indicated that proteins/peptides in the molecular mass range of ~56.0-105.0kDa, 31.6-51.0kDa, 15.6-30.0kDa, 9.0-14.2kDa and 5.6-7.2kDa contribute approximately 9.8%, 12.1%, 13.4%, 34.1% and 30.5%, respectively of Pakistan RVV. Proteomics analysis of gel-filtration peaks of RVV resulted in identification of 75 proteins/peptides which belong to 14 distinct snake venom protein families. Phospholipases A2 (32.8%), Kunitz type serine protease inhibitors (28.4%), and snake venom metalloproteases (21.8%) comprised the majority of Pakistan RVV proteins, while 11 additional families accounted for 6.5-0.2%. Occurrence of aminotransferase, endo-β-glycosidase, and disintegrins is reported for the first time in RVV. Several of RVV proteins/peptides share significant sequence homology across Viperidae subfamilies. Pakistan RVV was well recognized by both the polyvalent (PAV) and monovalent (MAV) antivenom manufactured in India; nonetheless, immunological cross-reactivity determined by ELISA and neutralization of pro-coagulant/anticoagulant activity of RVV and its fractions by MAV surpassed that of PAV. The study establishes the proteome profile of the Pakistan RVV, thereby indicating the presence of diverse proteins and peptides that play a significant role in the pathophysiology of RVV bite. Further, the proteomic findings will contribute to understand the variation in venom composition owing to different geographical location and identification of pharmacologically important proteins in Pakistan RVV. Copyright © 2016. Published by Elsevier B.V.

Jararhagin disruption of endothelial cell anchorage is enhanced in collagen enriched matrices.

PubMed

Baldo, C; Lopes, D S; Faquim-Mauro, E L; Jacysyn, J F; Niland, S; Eble, J A; Clissa, P B; Moura-da-Silva, A M

2015-12-15

Hemorrhage is one of the most striking effects of bites by viper snakes resulting in fast bleeding and ischemia in affected tissues. Snake venom metalloproteinases (SVMPs) are responsible for hemorrhagic activity, but the mechanisms involved in SVMP-induced hemorrhage are not entirely understood and the study of such mechanisms greatly depends on in vivo experiments. In vivo, hemorrhagic SVMPs accumulate on basement membrane (BM) of venules and capillary vessels allowing the hydrolysis of collagen IV with consequent weakness and rupture of capillary walls. These effects are not reproducible in vitro with conventional endothelial cell cultures. In this study we used two-dimension (2D) or three-dimension (3D) cultures of HUVECs on matrigel and observed the same characteristics as in ex vivo experiments: only the hemorrhagic toxin was able to localize on surfaces or internalize endothelial cells in 2D cultures or in the surface of tubules formed on 3D cultures. The contribution of matrigel, fibronectin and collagen matrices in jararhagin-induced endothelial cell damage was then analyzed. Collagen and matrigel substrates enhanced the endothelial cell damage induced by jararhagin allowing toxin binding to focal adhesions, disruption of stress fibers, detachment and apoptosis. The higher affinity of jararhagin to collagen than to fibronectin explains the localization of the toxin within BM. Moreover, once located in BM, interactions of jararhagin with α2β1 integrin would favor its localization on focal adhesions, as observed in our study. The accumulation of toxin in focal adhesions, observed only in cells grown in collagen matrices, would explain the enhancement of cell damage in these matrices and reflects the actual interaction among toxin, endothelial cells and BM components that occurs in vivo and results in the hemorrhagic lesions induced by viper venoms. Copyright © 2015 Elsevier Ltd. All rights reserved.

Coral snake mimicry: live snakes not avoided by a mammalian predator.

PubMed

Beckers, Gabriel J L; Leenders, Twan A A M; Strijbosch, Henk

1996-06-01

The occurrence of coral snake coloration among unrelated venomous and non-venomous New World snake species has often been explained in terms of warning coloration and mimicry. The idea that snake predators would avoid coral snakes in nature seems widely established and is postulated in many discussions on coral snake mimicry. However, the few workers that have tested a potential aposematic function of the conspicuous colour pattern focused exclusively on behaviour of snake predators towards coloured abstract models. Here we report on behaviour of temporarily caged, wild coatis (Nasua narica) when confronted with co-occurring live snakes, among which were two species of venomous coral snakes. Five different types of responses have been observed, ranging from avoidance to predation, yet none of the coatis avoided either of the two coral snake species or other species resembling these. As in earlier studies coatis appeared to avoid coral snake models, our findings show that results from studies with abstract snake models cannot unconditionally serve as evidence for an aposematic function of coral snake coloration.

Effect of experience with pine (Pituophis melanoleucus) and king (Lampropeltis getulus) snake odors on Y-maze behavior of pine snake hatchlings.

PubMed

Burger, J; Boarman, W; Kurzava, L; Gochfeld, M

1991-01-01

The abilities of hatchling pine snakes (Pituophis melanoleucus) and king snakes (Lampropeltis getulus) to discriminate the chemical trails of pine and king snakes was investigated inY-maze experiments. Pine snakes were housed for 17 days either with shavings impregnated with pine snake odor, king snake odor, or no odor to test for the effect of experience on choice. Both pine and king snake hatchlings entered the arm with the pine snake odor and did not enter the arm with the king snake odor. The data support the hypothesis that hatchlings of both species can distinguish conspecific odors from other odors and that our manipulation of previous experience was without effect for pine snake hatchlings.

Update on human rabies in a dog- and fox-rabies-free country.

PubMed

Stahl, J-P; Gautret, P; Ribadeau-Dumas, F; Strady, C; Le Moal, G; Souala, F; Maslin, J; Fremont, B; Bourhy, H

2014-07-01

Rabies is responsible for 50,000 deaths per year worldwide. Mainland France has been officially freed from rabies in non-flying animals since 2001. We wanted to provide an update on the French situation, using published data, and describe possible options since official guidelines are lacking. Post-exposure prophylaxis (PEP) (early and careful cleaning and dressing of the wound, vaccination, and in case of high-risk exposure, injection of specific anti-rabies immunoglobulins) is known to be efficient except in rare cases. It is recommended after grade II contact (+specific immunoglobulins in immunodepressed patients), or grade III contact (vaccination+immunoglobulins). Mainland France being rabies-free, 3 options may be considered in case of bite by a dog or a cat that cannot be monitored in France: (a) consider the risk of rabies as null, so no PEP should be administrated, whatever the severity of bites; (b) consider there is a weak but lethal risk, so the international recommendations should be applied, using immunoglobulins in some cases; (c) consider that the risk is extremely low but cannot be excluded, and that the patient should be vaccinated to be protected, but without adding immunoglobulins (whether in case of grade II or III bites). There are no national guidelines for rabies in France, and so the physician managing the patient is the one who will decide to treat or not. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Evaluation of rabies-suspected bites in Giresun, eastern Black-Sea region, Turkey].

PubMed

Torun, Mustafa

2010-10-01

This study was conducted to retrospectively evaluate a total of 4390 cases (1712 female, mean age: 25 years old; 2678 male, mean age: 35 years old) admitted to the rabies vaccine center of Giresun State Hospital, a province located at eastern Black-Sea region of Turkey, with the history of animal bite between the years of 2005-2009. It was determined that 74.5% of the cases were bitten by dogs, 22% by cats and 3.5% by wild animals and others. The most frequently bitten area was the lower extremities (n= 2678, 61%) (buttocks, legs and foot in order of decreasing frequency), followed by upper extremities (n= 1200, 27%) (hands, arms, head and neck area) and other areas (n=512, 11.6%) (back, abdomen, groin). According to the "Rabies Protection and Control Guidelines" of the Turkish Ministry of Health, 3210 cases (98.8%) were only vaccinated against rabies and 38 cases (1.2%) were both vaccinated and applied rabies antiserum according to the risk factors related to the suspected bite. Ten days follow-up of the suspected animal was recommended to 1142 (26%) cases and since no death were detected among these animals, no vaccination were applied. In conclusion, since this specific area with mountains and forests is suitable for the inhabitance of reservoir animals, risk groups such as workers in the forest should receive pre-exposure prophylaxis and specific precautions should be undertaken for the vaccination and/or care of dogs for effective rabies control.

Species Composition and Distribution of Adult Anopheles (Diptera: Culicidae) in Panama

PubMed Central

LOAIZA, J. R.; BERMINGHAM, E.; SCOTT, M. E.; ROVIRA, J. R.; CONN, J. E.

2010-01-01

Anopheles (Diptera: Culicidae) species composition and distribution were studied using human landing catch data over a 35-yr period in Panama. Mosquitoes were collected from 77 sites during 228 field trips carried out by members of the National Malaria Eradication Service. Fourteen Anopheles species were identified. The highest average human biting rates were recorded from Anopheles (Nyssorhynchus) albimanus (Wiedemann) (9.8 bites/person/night) and Anopheles (Anopheles) punctimacula (Dyar and Knab) (6.2 bites/person/night). These two species were also the most common, present in 99.1 and 74.9%, respectively, of the sites. Anopheles (Nyssorhynchus) aquasalis (Curry) was encountered mostly in the indigenous Kuna Yala Comarca along the eastern Atlantic coast, where malaria case history and average human biting rate (9.3 bites/person/night) suggest a local role in malaria transmission. An. albimanus, An. punctimacula, and Anopheles (Anopheles) vestitipennis (Dyar and Knab) were more abundant during the rainy season (May–December), whereas An. aquasalis was more abundant in the dry season (January–April). Other vector species collected in this study were Anopheles (Kerteszia) neivai (Howard, Dyar, and Knab) and Anopheles (Anopheles) pseudopunctipennis s.l. (Theobald). High diversity of Anopheles species and six confirmed malaria vectors in endemic areas of Panama emphasize the need for more detailed studies to better understand malaria transmission dynamics. PMID:18826025

Orthodontic management of a dilacerated central incisor and partially impacted canine with unilateral extraction - A case report.

PubMed

Felicita, A Sumathi

2017-10-01

To align a dilacerated maxillary central incisor and partially impacted canine with unilateral extraction in a young patient with skeletal deep bite. A 14 year old male patient reported to the hospital with skeletal deep bite (basal plane angle-17°), severe horizontal pattern of growth (Go-Gn to Sn -22°), upright maxillary incisors (U1 to NA -26°) and retroclined lower incisors (L1 to NB -11°). The maxillary left central incisor was dilacerated, and the maxillary left canine was partially impacted. Unilateral extraction of the left maxillary premolar and left mandibular central incisor was done. A canine disimpaction spring was used to align the impacted canine. An anterior bite plane was given to open the bite. Superimposition of lateral cephalogram (T1, T2) revealed bite opening, normal overjet and overbite. There was backward rotation of the mandible and increase in lower anterior facial height. There was no evidence of root resorption or loss of vitality in the dilacerated tooth. Clinically the canine was well aligned in the arch. Orthodontic management of a dilacerated incisor can be done without root resorption or loss of vitality. The partially impacted canine was well aligned in the arch. Unilateral extraction can produce good treatment results.

Cheek Plumper: An Innovative Anti-cheek Biting Appliance

PubMed Central

Srivastava, Nikhil; Kaushik, Noopur; Panthri, Prerna

2016-01-01

ABSTRACT One of the most challenging tasks for a pediatric dentist is the management of deleterious oral habits which adversely affect the dentofacial complex. However, if these habits can be intercepted and diagnosed well in time, they can save the patient from the psychological impact of undergoing long treatment therapies. One such rare deleterious oral habit is cheek biting that affects the buccal mucosa. Presented here is a case report which describes the interception of this deleterious habit in a 15-year-old female child who was a bilateral cheek biter with the help of an innovative intraoral appliance: The cheek plumper. How to cite this article: Rana V, Srivastava N, Kaushik N, Panthri P. Cheek Plumper: An Innovative Anti-cheek Biting Appliance. Int J Clin Pediatr Dent 2016;9(2):146-148. PMID:27365937

Anterior open-bite orthodontic treatment in an adult patient: A clinical case report.

PubMed

Gracco, Antonio; Siviero, Laura; de Stefani, Alberto; Bruno, Giovanni; Stellini, Edoardo

2016-06-01

A 45-year-old woman presented with an anterior open-bite complaining chiefly of her unpleasant smile esthetics and masticatory and speech problems. Treatment included speech therapy initiated immediately after bonding. Lingual spurs were positioned on the mandibular incisors in order to help tongue rehabilitation. During the working phase, temporary anchorage devices (TADs) were used at the mandibular anterior segment to intrude the lower left premolars. A splint was used to ensure retention in the upper and lower arches; an enveloppe linguale nocturne (ELN) was provided. Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.

Chin remodeling in a patient with bimaxillary protrusion and open bite by using mini-implants for temporary anchorage.

PubMed

Jiang, Chunmiao; Liu, Yinghong; Cheng, Qian; He, Wei; Fang, Shanbao; Lan, Tingting; Wang, Jun

2018-03-01

Patients with bimaxillary protrusion may have an unattractive profile with a retruded chin contour. Correction of the severely protrusive anterior alveolar bone and teeth combined with a moderate open bite without orthognathic surgery can be challenging. This case report describes the orthodontic treatment of a woman with severe bimaxillary protrusion and a moderate open bite. Excellent chin morphology and facial appearance were obtained with the extraction of 4 first premolars and 4 third molars, and total distalization of both arches with 4 mini-implants, one in each quadrant between the second premolar and the first molar. The total treatment time was 30 months. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Asplenic fulminant sepsis secondary to a dog bite complicated by toxic epidermal necrolysis/Stevens-Johnson syndrome.

PubMed

Teo, Ken G; Anavekar, Namrata S; Yazdabadi, Anosha; Ricketts, Sophie

2012-07-29

We report a case of asplenic fulminant sepsis in Australia following a dog bite which was complicated by toxic epidermal necrolysis/Stevens-Johnson syndrome (TENS/SJS). Capnocytophaga canimorsus, the infective organism, is a rare cause of septicaemia: a high degree of suspicion of this unusual organism and its early aggressive management is paramount. The diagnostic and management difficulties of TENS/SJS in the context of a patient with fulminant sepsis, DIC and on inotropes are also highlighted.

Characteristics of farm injuries in Greece.

PubMed

Alexe, D M; Petridou, E; Dessypris, N; Skenderis, N; Trichopoulos, D

2003-08-01

To assess the characteristics of occupational and leisure farm injuries in Greece. During a five-year period (1996-2000), 4,326 unintentional farm injuries have been recorded by the Emergency Department Injury Surveillance System in Greece. Data concerning demographic variables, accident conditions, and injury characteristics were collected by in person interviews. The data were analyzed by simple cross-tabulation and hierarchical cluster analysis. Injuries from falls on the same level are mainly lower-limb fractures and occur during the winter among older women. Falls from higher level concern migrant workers, who also tend to suffer severe multiple injuries, including concussions, particularly during autumn. Injuries resulting from cutting and piercing instruments, as well as from machinery, are generally open wounds in the upper-limbs, suffered by young migrant workers. Head injuries resulting from striking against an object are more generally spread across socio-demographic variables. Overexertion is the dominant mechanism for dislocations and sprains in the lower limbs. Snake and insect bites are common among younger migrant workers during summer, and they affect the upper limbs during manual work close to the ground. Non-traffic injuries from vehicles are frequently severe, involving head concussion of generally young individuals. In Greece, farm injuries are frequently serious and require hospitalization. These injuries show distinct patterns among older women (lower-limb fractures), young individuals (non-traffic vehicle-related injuries) and migrant workers (injuries from cutting and piercing instruments, falls from high level, and bites). Prevention strategies should give priority to these population groups. These prevention strategies should include guidance for poorly educated workers, including migrants, enforcement of safety regulations concerning farming machinery, and discouragement of risky farming activities among elderly individuals, particularly women.

Human sparganosis, a neglected food borne zoonosis.

PubMed

Liu, Quan; Li, Ming-Wei; Wang, Ze-Dong; Zhao, Guang-Hui; Zhu, Xing-Quan

2015-10-01

Human sparganosis is a food borne zoonosis caused by the plerocercoid larvae (spargana) of various diphyllobothroid tapeworms of the genus Spirometra. Human infections are acquired by ingesting the raw or undercooked meat of snakes or frogs, drinking untreated water, or using raw flesh in traditional poultices. More than 1600 cases of sparganosis have been documented worldwide, mostly in east and southeast Asia. Sporadic cases have been reported in South America, Europe, and Africa, and several cases have been described in travellers returning from endemic regions. Epidemiological data suggest that the increased effect of sparganosis on human health is because of greater consumption of raw meat of freshwater frogs and snakes. This Review provides information about the Spirometra parasites and their lifecycles, summarises clinical features, diagnosis, and treatment of human sparganosis, and describes geographical distribution and infection characteristics of Spirometra parasites in host animals. Copyright © 2015 Elsevier Ltd. All rights reserved.

Are Diet Preferences Associated to Skulls Shape Diversification in Xenodontine Snakes?

PubMed Central

Klaczko, Julia; Sherratt, Emma; Setz, Eleonore Z. F.

2016-01-01

Snakes are a highly successful group of vertebrates, within great diversity in habitat, diet, and morphology. The unique adaptations for the snake skull for ingesting large prey in more primitive macrostomatan snakes have been well documented. However, subsequent diversification in snake cranial shape in relation to dietary specializations has rarely been studied (e.g. piscivory in natricine snakes). Here we examine a large clade of snakes with a broad spectrum of diet preferences to test if diet preferences are correlated to shape variation in snake skulls. Specifically, we studied the Xenodontinae snakes, a speciose clade of South American snakes, which show a broad range of diets including invertebrates, amphibians, snakes, lizards, and small mammals. We characterized the skull morphology of 19 species of xenodontine snakes using geometric morphometric techniques, and used phylogenetic comparative methods to test the association between diet and skull morphology. Using phylogenetic partial least squares analysis (PPLS) we show that skull morphology is highly associated with diet preferences in xenodontine snakes. PMID:26886549

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, C.; Kewisch, J.; Huang, H.

At RHIC, the spin polarization is preserved with a pair of Siberian snakes on the oppo- site sides in each ring. The polarized proton beam with finite spin tune spread might cross spin resonances multiple times in two cases, one is when beam going through strong spin intrinsic resonances during acceleration, the other is when sweeping spin flipper’ frequency across the spin tune to flip the direction of spin polarization. The consequence is loss of spin polarization in both cases. Therefore, a scheme of min- imizing the spin tune spread by matching the dispersion primes at the two snakes wasmore » introduced based on the fact that the spin tune spread is proportional to the difference of dispersion primes at the two snakes. The scheme was implemented at fixed energies for the spin flipper study and during beam acceleration for better spin polarization transmission efficiency. The effect of minimizing the spin tune spread by matching the dispersion primes was observed and confirmed experimentally. The principle of minimizing the spin tune spread by matching the dispersion primes, the impact on the beam optics, and the effect of a narrower spin tune spread are presented in this report.« less

[Thumbsucking and malocclusion--presentation of a clinical case].

PubMed

Estripeaut, L E; Henriques, J F; de Almeida, R R

1989-01-01

The digital sucking habit have been significantly related with the malocclusions. These problems can be observed as in the deciduous and mixed as in the permanent dentition. Frequency, length, and intensity of the habit generate as a consequence: anterior open bite, retrusion of the mandible, protrusion of the maxilla, excessive overjet, labial version of the upper incisors, uprighting of the lower incisors, posterior cross bites, sometimes associated to a ogival palate, diastema between the upper incisors, and any others facial characteristics. According to various authors, when the habit persist for an extended period after the age of four years, is considered how malocclusion cause. In this case is requered the professional interference. The presentation of this study has the objective to show the clinic conduct for preventive orthodontics in face to cases who exhib harmful habits.

Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey.

PubMed

Etheart, Melissa Dominique; Kligerman, Maxwell; Augustin, Pierre Dilius; Blanton, Jesse D; Monroe, Benjamin; Fleurinord, Ludder; Millien, Max; Crowdis, Kelly; Fenelon, Natael; Wallace, Ryan MacLaren

2017-10-01

Haiti has an integrated bite case management (IBCM) programme to counsel animal-bite victims on the risk of rabies and appropriate treatment, as well as the Haiti Animal Rabies Surveillance Program (HARSP) to examine the animals. We assessed the usefulness of the IBCM programme to promote best practices for rabies prophylaxis after exposure in a low-income rabies-endemic setting. We did a retrospective follow-up survey of randomly selected bite victims who were counselled by Haiti's IBCM programme between May 15, 2014, and Sept 15, 2015. We classified participants by HARSP decisions of confirmed, probable, suspected, or non-rabies exposures. We compared health-care outcomes in people who sought medical care before IBCM counselling with those in people who sought care after counselling. We used decision trees to estimate the probability of actions taken in the health-care system, and thereby human deaths. During the study period, 1478 dog bites were reported to HARSP for assessment. 37 (3%) were confirmed exposures, 76 (5%) probable exposures, 189 (13%) suspected exposures, and 1176 (80%) non-rabies exposures. 115 of these cases were followed up in the survey. IBCM counselling was associated with a 1·2 times increase in frequency of bite victims seeking medical care and of 2·4 times increase in vaccination uptake. We estimated that there would be four human rabies deaths among the 1478 people assessed by IBCM during the survey period, and 11 in the absence of this programme, which would equate to a 65% decrease in rabies deaths. Among three people dead at the time of the follow-up survey, one was deemed to be due to rabies after a probable rabies exposure. Adherence to medical providers' recommendations might be improved through counselling provided by IBCM programmes. None. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.