1/94. A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.russell's viper is the most important cause of life-threatening snake bite and acute renal failure in sri lanka. Only equine polyspecific antivenoms imported from india are available. They have not proved effective clinically or in clearing venom antigenemia and they frequently cause reactions. In an attempt to reduce mortality and morbidity, a new monospecific ovine Fab fragment antivenom (PolongaTab; Therapeutic antibodies, Inc., london, United Kingdom) was raised against Sri Lankan russell's viper venom. In a preliminary dose-finding study in 35 patients, an initial dose of 3-4 g restored blood coagulability permanently and stopped systemic bleeding, even in severely envenomed patients. Venom antigenemia disappeared within 1 hr of antivenom treatment but recurred, probably as a result of continued absorption of venom from the site of the bite, after the rapid clearance of therapeutic antibody. Twelve patients (34%) experienced early reactions that were usually mild and always responded to epinephrine.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
2/94. The envenomation syndrome caused by the Australian Red-bellied Black Snake Pseudechis porphyriacus.The Australian elapids inject venom which is characteristic of each species; and which cause characteristic and specific envenomation syndromes in human victims of snakebite. Because many of the medically significant Australian elapids look similar, when glimpsed in the field by snakebite victims, defining human envenomation syndromes with secure species identification has been a slow process. Correlations between securely identified species and the human envenomation syndromes which they produce are still evolving. The genus Pseudechis is the most widespread in australia of the dangerous Australian elapid genera; and P. porphyriacus, the Red-bellied Black Snake, was the first terrestrial Australian elapid to be described and illustrated and the first to be the subject of experimental study. We present here five previously unreported cases of human envenomation in which the species diagnosis is secure. From these and with the perspective of a selected literature review, we describe the full envenomation syndrome of this species. Until the development of the Commonwealth serum laboratories' Venom Detection Kit in 1979 and the occasional case report of victims of securely identified species, envenomation syndromes for most Australian snake species have remained indeterminate, because of the lack of professional expertise in the identification of the species involved. Symptoms of the P. porphyriacus envenomation syndrome include those of bite-site pain, nausea and vomiting, generalised pruritis, chest pain, prostration and abnormalities of taste and smell. Signs include local necrosis and scarring of tissue at the bite-site, gross inflammation of surrounding tissues and, at least in one case, epilepsy. Although envenomation by the Red-bellied Black Snake is not lethal in adults, the correct therapy is Tiger Snake antivenom, administered with judgement, taking into account knowledge of the specific envenomation syndrome of this species and the clinical status of the victim.- - - - - - - - - - ranking = 0.00491509741681keywords = rate (Clic here for more details about this article) |
3/94. Severe systemic effects of Merrem's hump-nosed viper bite.OBJECTIVE: To report unpredictable severe systemic effects of hump-nosed viper envenomation. SETTING: Medical unit, General hospital, Anuradhapura. methods: The clinical outcome of seven patients bitten by Merrem's hump-nosed viper were monitored until recovery or death. Limited autopsies were performed on the latter. Offending snakes were positively identified by medical officers and in one instance by a herpetologist. CONCLUSION: Merrem's hump-nosed viper bites, caused an array of potentially fatal systemic manifestations. One patient developed neurological effects, severe Raynaud's syndrome leading to ascending gangrene of distal limbs and adult repiratory distress syndrome (ARDS), in addition to the known complications of severe renal cortical necrosis and haemostatic dysfunction. Two patients who developed acute renal failure and prolonged coagulopathy recovered completely. The combination of extensive renal cortical necrosis, disseminated intravascular coagulation, and ARDS proved fatal in three.- - - - - - - - - - ranking = 0.29851097655655keywords = death (Clic here for more details about this article) |
4/94. Rattlesnake envenomations: unusual case presentations.Rattlesnake envenomations are common in some areas of the united states. Although fatal rattlesnake envenomations are rare and usually preventable, morbidity may be significant. patients may present with localized edema, hypotension, coagulopathy, or thrombocytopenia. patients with progressive swelling or severe coagulopathy are typically treated with Crotalidae polyvalent antivenin. We present a series of 4 patients with unusual complications of rattlesnake envenomation to illustrate the wide spectrum of disease that may be encountered. These case presentations include anaphylaxis to rattlesnake venom, an acute airway emergency, progressive and marked edema with a large pleural fluid collection, and death.- - - - - - - - - - ranking = 0.30342607397336keywords = death, rate (Clic here for more details about this article) |
5/94. Acute pulmonary edema as a complication of anti-snake venom therapy.Polyvalent Anti-snake Venom (ASV) is a life-saving antivenin for severe envenomation due to snake bite in india. ASV infusion is occasionally associated with severe allergic reactions, i.e. anaphylaxis and death. We report a rare instance of non-cardiogenic pulmonary edema due to ASV infusion in an eleven years old boy.- - - - - - - - - - ranking = 0.29851097655655keywords = death (Clic here for more details about this article) |
6/94. Patient with purely extraocular manifestations from a pit viper snakebite (agkistrodon halys brevicaudus).Snake venom can cause myriad local and systemic signs and symptoms. Neurotoxic effects include difficulty seeing, diplopia, difficulty in opening the mouth, speaking, or swallowing, and difficulty getting out of bed the morning after the snakebite. Because of the unique structure of the extraocular muscles, they are particularly susceptible to the neurotoxin. Rarely, though, are symptoms of snakebite confined to the extraocular muscles. This case report describes a patient who experienced only extraocular manifestations of envenomation. It is important for clinicians to recognize this unique neurotoxic manifestation and to begin treatment of snakebites, because delay in treatment could cause permanent injury and even death.- - - - - - - - - - ranking = 0.29851097655655keywords = death (Clic here for more details about this article) |
7/94. Bites by non-native venomous snakes in the united states.Fifty-four consultations regarding bites by venomous snakes not native to the united states are summarized. These are from a database of 164 consultations during the period 1977- 1995. At least 29 non-native snake species were involved with cobras making up -40% of the group. There was one fatality. A high percentage of venomous snakebites in the united states involve deliberate interaction with snakes. The proportion of bites by non-native species seems to be increasing. Some of the snake species involved are discussed, and some principles for management of these bites are given.- - - - - - - - - - ranking = 0.00491509741681keywords = rate (Clic here for more details about this article) |
8/94. Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine).A 16-year-old boy presented to the emergency department with rapidly progressing extremity pain, edema, and ecchymosis after envenomation by a copperhead. Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) was infused. Six vials were placed in 250 mL of normal saline solution, and the infusion was gradually increased. Fifty minutes after beginning, the infusion was increased to 640 mL/h. Within minutes of the rate increase, the patient experienced full-body urticaria, facial edema, voice change, and tachycardia. The infusion was stopped. hydroxyzine pamoate, famotidine, methylprednisolone, and a 1-L bolus of normal saline solution were administered intravenously. The symptoms abated, and the remaining FabAV was infused at a slower rate without return of this reaction. This immediate hypersensitivity reaction was most likely a rate-related anaphylactoid reaction that has not been previously reported with FabAV.[Holstege CP, Wu J, Baer AB. Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine). Ann Emerg Med. June 2002;39:677-679.]- - - - - - - - - - ranking = 0.01474529225043keywords = rate (Clic here for more details about this article) |
9/94. Unusual neurotoxic envenomations by Vipera aspis aspis snakes in france.Vipera aspis aspis (V.a.a.) is the most dangerous poisonous snake in South-Eastern france. The clinical symptoms observed after V.a.a. envenomations involve mostly local signs (pain, edema) associated in the more severe cases with systemic symptoms (gastro-intestinal and cardiovascular manifestations). Since 1992, several unusual cases of moderate and severe 'neurotoxic' envenomations by V.a.a. snakes have been reported in a very localized area in South-Eastern france. Most of the human patients mainly suffered neurological signs owing to cephalic muscle paralysis. Drowsiness and dyspnea were observed for the most severe cases. Envenomed animals suffered respiratory distress and paralysis. The local signs were never as severe as observed after envenomations by vipers in other French regions. Human patients with moderate or severe clinical features received two intravenous injections of Viperfav antivenom, the first dose inducing the decrease of the neurological signs and the second reducing significantly the edema. Neurotoxic components immunologically cross-reacting with toxins from V. ammodytes ammodytes venom from Eastern europe were detected in the blood of all patients suffering neurological symptoms after a V.a.a. bite. The protective efficacy of various antivenoms was evaluated in mice. The existence of geographical variations in the composition of V.a.a. venom emphasizes on the use of polyvalent antivenom in the treatment of viper envenomations in france.- - - - - - - - - - ranking = 0.0098301948336199keywords = rate (Clic here for more details about this article) |
10/94. Necrotizing fasciitis of the upper extremity resulting from a water moccasin bite.aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture. The patient was treated with antivenom, a diuretic regimen, broad spectrum antibiotics, and 18 separate surgical procedures. After the application of skin grafts, the wound completely healed. This case illustrates that a venomous snakebite may result in infection with A hydrophila and can cause severe necrotizing fasciitis. Early and aggressive surgical intervention should be implemented as soon as the necrotizing fasciitis is diagnosed.- - - - - - - - - - ranking = 0.0098301948336199keywords = rate (Clic here for more details about this article) |
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