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Infestations and Bites
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Clinical presentation: The bite is often painless, but in cases of envenomation, it is followed by a sharp, penetrating pain after 2–8 hours. Paired puncta may be seen at the bite site. The bite area initially becomes pale with a penumbra of erythema (Figure 9.9). The severe pain is due to vaso-spasm and ischemia caused by sphingomyelinase D toxin. In severe cases, micro-hemorrhages may lead to acute renal failure.
The Trauma Epidemic
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The WHO estimates that approximately 2,500,000 people are envenomated in snake attacks each year, posing significant challenges for medical management and resulting in an estimated 125,000 deaths. Deaths due to envenomation depend not only on the lethality of the venom but also on the interaction between the local environment and available medical services. The inland taipan has the world’s most toxic venom, but it lives in the desert of eastern central Australia and has never caused a recorded fatality. There are approximately 100 adder bites per year in the UK, but there have been only 10 recorded deaths, the last of which was 30 years ago.
Spiders
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
The Sydney funnel web spider, Atrax robustus, is Australia’s most dangerous spider, capable of causing death in as little as 15 minutes;53 however, severe bite reactions are relatively rare, with only 5–10 cases occurring annually along a limited area of eastern Australia. There are several relatives of the Sydney funnel web that are also dangerous to humans such as Hadronyche cerberea and H. formidabilis.54 In many cases, little or no venom is injected during the biting event and no symptoms develop. If envenomization does occur, the bite site becomes extremely painful. Systemic symptoms may develop within minutes owing to the toxin’s direct effect on somatic and autonomic nerves, leading to the widespread release of neurotransmitter. Progressive hypotension and apnea may ensue.
Population pharmacokinetics of Pseudechis porphyriacus (red-bellied black snake) venom in snakebite patients
Published in Clinical Toxicology, 2021
Suchaya Sanhajariya, Stephen B. Duffull, Geoffrey K. Isbister
Population pharmacokinetic analysis has previously been used in clinical toxicology to investigate the time course of drugs in overdose, and determine if specific treatments such as activated charcoal influence drug exposure [5–7]. In addition, population pharmacokinetic-pharmacodynamic analysis has been used to describe the toxic effects of drugs in overdose and estimate the effect of treatments [8–10]. In a similar way, population-based modelling is an ideal tool for investigating the PK of snake venom, and the effect of antivenom. Similar to overdose patients, the dose is poorly defined, blood collection is often after the absorption period, due to travel time to hospital following the bite. For many types of snake envenomation, antivenom is given to all patients, after which venom concentrations are usually reduced to undetectable concentrations. However, antivenom is not always administered in RBBS envenomation, so we have the unique opportunity to investigate venom exposure in patients with and without antivenom, with sufficient serial venom concentrations in patients not given antivenom.
Report of a severe Heloderma suspectum envenomation
Published in Clinical Toxicology, 2021
Karim Amri, Jean-Philippe Chippaux
Helorderma bites usually occur in males during capture or care of captive specimen [2,4]. Most of bites are inflicted on the upper limb. Envenomation severity is variable but, most often the bite is painful, leading to local edema and mild general symptoms: dizziness, diaphoresis, nausea, vomiting, diarrhea. However, in few cases envenomation can be severe. Three life-threatening syndromes may be involved [4–9]: a) angioedema which can lead to respiratory tract obstruction, b) significant fluid losses due to diarrhea, vomiting and sweating, associated with hypokalemia and sometimes metabolic acidosis, and c) atrioventricular conduction disorders simulating cardiac ischemia. No deaths have been reported in more than 60 years. There is no currently available antivenom and the treatment is only symptomatic and supportive.
The effect of myocardial injury on the clinical course of snake envenomation in South Korea
Published in Clinical Toxicology, 2021
J. M. Moon, Y. J. Koo, B. J. Chun, K. H. Park, Y. S. Cho, J. C. Kim, S. D. Lee, Y. R. Min, H. S. Park
Intravenous administration of antivenom is the only specific treatment to counteract envenomation. The criteria for antivenom treatment provided by the World Health Organization (WHO) include local swelling and systemic symptoms defined as shock, hematotoxic or neurotoxic symptoms, rhabdomyolysis, and acute kidney injury but not myocardial injury [13]. In addition, several clinical grading scales for envenomation, including the snakebite severity scale, do not refer to myocardial injury as a domain of envenomation to determine severity and the dosage of administered antivenom [14]. Furthermore, indications for and the optimal dosage of antivenom have not been rigorously defined in Korea [5,15]. Because most studies related to snakebites have focused on the hematotoxic, myotoxic and neurotoxic aspects of envenomation and have not investigated any associated cardiotoxicity, the presence of myocardial injury might be neglected when physicians make decisions about whether to administer antivenom.