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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.
Clinician’s Guide to Common Arthropod Bites and Stings *
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
The mainstay of therapy for local bites and stings is keeping the area clean and applying topical antibiotics to prevent secondary infection (bacitracin or mupirocin are often used). The patient should seek immediate medical attention if progressive tenderness, erythema, linear streaking, rigor, eschar, or lymphadenopathy develop, particularly at days 5–7 after the initial bite or sting. It is also important to diminish inflammation, which can be done in several ways. This should begin with the most conservative approach—RICE therapy, which stands for Rest, Ice, Compression, and Elevation.11 Elevation allows gravity to drain cutaneous fluid, while the cold temperature and external compression induce vasoconstriction, keeping toxins and hypersensitivity fluids from arthropods local in addition to minimizing swelling. The next over-the-counter option is oral antihistamines to combat itching and swelling. Topical antihistamines have little efficacy and have increased sensitizing potential so they should be avoided. Potent to super-potent topical corticosteroids are quite effective anti-inflammatory agents and can be used immediately after the insult, as well as on an ongoing basis. Their potency can be increased by occlusion with a bandage. In envenomation where pain is quite impressive, such as scorpion stings or black widow bites, analgesics and topical or injectable anesthetics can be quite helpful.
Centipede Envenomation Effects on Human Beings and Scientific Research on Traditional Antivenom Agents
Published in Parimelazhagan Thangaraj, Medicinal Plants, 2018
Dhivya Sivaraj, Revathi Ponnusamy, Rahul Chandran, Parimelazhagan Thangaraj
Envenomation is responsible for several clinical complications of severe, systemic and local pathology. Immediate hypersensitivity triggered by venom may have direct toxic effects, inducing local reaction and clinical symptoms. The hypersensitivity is of four types based on their type of immune response and effector mechanism responsible for cell and tissue injury (Uzzaman and Cho 2012). Immediate or anaphylactic hypersensitivity (type I) is mediated by immunoglobulin E and results in eczema or skin damage. The primary cellular component of this type of hypersensitivity is mast cell and basinophills. The mast cell releases the histamines, platelet activation factors, vasoactive amines and allergens that result in itching and could cause erythema and local inflammation.
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.
Scorpion envenomation: a deadly illness requiring an effective therapy
Published in Toxin Reviews, 2021
Faez Amokrane Nait Mohamed, Fatima Laraba-Djebari
Envenomation is a significant public health threat in tropical and subtropical regions of the world. In Maghreb regions of North Africa, scorpion stings are the most frequently reported type of dangerous envenomation, with an average of 115,000 victims annually (Figure 1). Many victims do not seek or receive medical care in time (Soulaymani Bencheikh et al.2007, Hellal et al.2012, Chakroun-Walha et al.2018). Immunotherapy is the recommended treatment for scorpion stings in almost all countries. It is the only specific treatment for envenomation, however, its effectiveness remains limited, not only due to the inefficiency of antibodies but also to their delayed administration. Next-generation immunotherapies are needed to improve care for this often fatal event especially that the World Health Organization’s (WHO’s) recognition that new treatments are needed to improve treatment outcomes for victims of envenomation (Martin-Eauclaire et al.2019). The optimization of current specific immunotherapy and improvement of preventive treatment, such as a vaccine against the scorpion envenomation, is an important goal for immunologic research. Research and assessment of new adjuvants that can boost the immunogenicity of scorpion venom antigens are needed (Lila and Laraba-Djebari 2011, Nouri and Laraba-Djebari 2015). However, preserving antigenic presentation while removing toxic effects remains a major challenge in venom vaccine development. In this review, we will discuss the necessity for new, effective specific and preventive therapies against scorpion envenomation and its pathogenesis.
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.