medigraphic.com

2025, Number 1

<< Back Next >>

Toxicol Clin 2025; 1 (1)

Diagnosis and considerations in treatment in snake bite by viperids of Mexico

Canul-Caamal MA, López-Méndez AC, Azuara-Antonio O, Márquez-Martín R, Escalante-Galindo P, Juárez-Martínez A, Montes-Ventura DM, Madrigal-Anaya JC

Language: Spanish
References: 81
Page: 34-48
PDF size: 312.79 Kb.


ABSTRACT

The majority of snake bites in Mexico are caused by viperids, being considered a public health problem, both worldwide and in our country, causing sequelae and mortality when an adequate diagnosis and management is not made. The present work makes a proposal and an analysis of the diagnostic methods that we currently have, from adequate identification of the specimen, directed interrogation, physical examination and carrying out laboratory and office studies that complement it; as well as the appropriate way to approach the patient from a pre- and hospital perspective, considering that there is a specific antidote, which due to lack of knowledge of its correct application, has an impact on the patient, therapies that are still in study protocols are described, such as measures extracorporeal and that could be controversial, but that in the future could mean a better prognosis and limit the damage of the patient bitten by this type of snakes.


REFERENCES

  1. World Health Organization. Regional Action Plan for prevention and control of snakebite envenoming in the South-East Asia 2022-2030. New Delhi: World Health Organization, Regional Office for South-East Asia; 2022. Licence: CC BY-NC-SA 3.0 IGO.

  2. Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5(11):e218. doi: 10.1371/journal. pmed.0050218.

  3. Seifert SA, Armitage JO, Sanchez EE. Snake envenomation. N Engl J Med. 2022;386(1):68-78. doi: 10.1056/NEJMra2105228.

  4. Escalante GP. Guías de Práctica Clínica (GPC). Diagnóstico y Tratamiento de las Serpientes Venenosa. México, Secretaría de Salud 2010.

  5. Warrell DA. Venomous bites, stings, and poisoning: an update. Infect Dis Clin North Am. 2019;33(1):17-38. Available in: https://doi.org/10.1016/j.idc.2018.10.001

  6. Hamza M, Knudsen C, Gnanathasan CA, Monteiro W, Lewin MR, Laustsen AH, et al. Clinical management of snakebite envenoming: future perspectives. Toxicon X. 2021;11:100079. doi: 10.1016/j.toxcx.2021.100079.

  7. Carroll RR, Hall EL, Kitchens CS. Canebrake rattlesnake envenomation. Ann Emerg Med. 1997;30:45.

  8. Kitchens CS, Hunter S, Van Mierop LHS. Severe myonecrosis in a fatal case of envenomation by the canebrake rattlesnake (Crotalus horridus atricaudatus). Toxicon. 1987;25:455.

  9. Suchard JR, LoVecchio F. Envenomations by rattlesnakes thought to be dead. N Engl J Med. 1999;340(24):1930.

  10. Pucca MB, Knudsen C, S Oliveira I, Rimbault C, A Cerni F, Wen FH, et al. Current knowledge on snake dry bites. Toxins (Basel). 2020;12(11):668. doi: 10.3390/toxins12110668.

  11. Knudsen C, Jürgensen JA, Fons S, Haack AM, Friis RUW, Dam SH, et al.. Snakebite envenoming diagnosis and diagnostics. Front Immunol. 2021;12:661457. doi: 10.3389/fimmu.2021.661457.

  12. Sarkar S, Sinha R, Chaudhury AR, Maduwage K, Abeyagunawardena A, Bose N, et al. Snake bite associated with acute kidney injury. Pediatr Nephrol. 2021;36(12):3829-3840. doi: 10.1007/s00467-020-04911-x.

  13. Johnston CI, Isbister GK. Australian snakebite myotoxicity (ASP-23). Clin Toxicol (Phila). 2021;59(7):611-618. doi: 10.1080/15563650.2020.1836377.

  14. Williams HF, Layfield HJ, Vallance T, Patel K , Bicknell AB, Trim SA, Vaiyapuri S. The urgent need to develop novel strategies for the diagnosis and treatment of snakebites. Toxins. 2019;11:363; doi: 10.3390/toxins11060363.

  15. Gutiérrez JM, Calvete JJ, Habib AG, Harrison RA, Williams DJ, Warrell DA. Snakebite envenoming. Nat Rev Dis Primers. 2017;3:17063. doi: 10.1038/nrdp.2017.63.

  16. Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet. 2023;401(10385):1382-1398. doi: 10.1016/S0140-6736(23)00002-8.

  17. Potet J, Singh S, Ritmeijer K, Sisay K, Alcoba G, Jouberton F, et al. Snakebite envenoming at MSF: a decade of clinical challenges and antivenom access issues. Toxicon X. 2022;17:100146. doi: 10.1016/j.toxcx.2022.100146.

  18. Naik BS. "Dry bite" in venomous snakes: A review. Toxicon. 2017;133:63-67. doi: 10.1016/j.toxicon.2017.04.015.

  19. Liblik K, Byun J, Saldarriaga C, Perez GE, Lopez-Santi R, Wyss FQ, et al. Snakebite envenomation and heart: systematic review. Curr Probl Cardiol. 2022;47(9):100861. doi: 10.1016/j.cpcardiol.2021.100861.

  20. Dias da Silva W, De Andrade SA, Megale AAA, De Souza DA, Sant'Anna OA, Magnoli FC, et al. Antibodies as snakebite antivenoms: past and future. Toxins (Basel). 2022;14(9):606. doi: 10.3390/toxins14090606.

  21. Mion G, Larréché S, Benois A, Petitjeans F, Puidupin M. Hemostasis dynamics during coagulopathy resulting from Echis envenomation. Toxicon. 2013;76:103-109. doi: 10.1016/j.toxicon.2013.09.003.

  22. Hogan DE, Dire DJ. Anaphylactic shock secondary to rattlesnake bite. Ann Emerg Med. 1990;19(7):814-816. doi: 10.1016/s0196-0644(05)81710-x.

  23. Bush SP, Jansen PW. Severe rattlesnake envenomation with anaphylaxis and rhabdomyolysis. Ann Emerg Med. 1995;25(6):845-848. doi: 10.1016/s0196-0644(95)70218-0.

  24. Rencher L, Schwartz J, Wilson A. An anaphylactoid reaction to rattlesnake envenomation in a pediatric patient. Pediatr Emerg Care. 2018;34(6):e109-e110. doi: 10.1097/PEC.0000000000000977.

  25. Kang S, Moon J, Chun B. Does the traditional snakebite severity score correctly classify envenomated patients? Clin Exp Emerg Med. 2016;3(1):34-40. doi: 10.15441/ceem.16.123.

  26. Christopher DG, Rodning CB. Crotalidae envenomation. South Med J. 1986;79(2):159-162.

  27. Dart RC, Hurlbut KM, Garcia R, Boren J. Validation of a severity score for the assessment of crotalid snakebite. Ann Emerg Med. 1996;27(3):321-326. doi: 10.1016/s0196-0644(96)70267-6.

  28. Magalhaes SFV, Peixoto HM, Freitas LRS, Monteiro WM, Oliveira MRF. Snakebites caused by the genera Bothrops and Lachesis in the Brazilian Amazon: a study of factors associated with severe cases and death. Rev Soc Bras Med Trop. 2022;55:e05582021. doi: 10.1590/0037-8682-0558-2021.

  29. Lamb T, Abouyannis M, de Oliveira SS, Shenoy KR, Geevar T, Zachariah A, et al. The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy. PLoS Negl Trop Dis. 2021;15(8):e0009657. doi: 10.1371/journal.pntd.0009657. Erratum in: PLoS Negl Trop Dis. 2023;17(1):e0011080.

  30. Bhattacharyya P. Neurotoxic snake bite with respiratory failure. Indian Journal of Critical Care Medicine. 2007;11:10.4103/0972-5229.35627.

  31. Galvez K, Cortes C. Thromboelastography: new concepts in haemostasis physiology and correlation with trauma associated coagulopathy. Colombian Journal of Anestesiology. 2012;40(3):224-230. Available in: https://doi.org/10.1016/j.rca.2012.05.002

  32. Afroz A, Siddiquea BN, Shetty AN, Jackson TNW, Watt AD. Assessing knowledge and awareness regarding snakebite and management of snakebite envenoming in healthcare workers and the general population: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2023;17(2):e0011048. doi: 10.1371/journal.pntd.0011048.

  33. Maguiña-Vargas C, Chincha-Lino O, Vilcapoma-Balbín P, Morante D. Actualización en clínica y terapia de mordedura de serpiente (ofidismo). Revista Médica Herediana. 2020;31(1):48-55. Disponible en: https://doi.org/10.20453/rmh.v31i1.3729

  34. Harris JB, Faiz MA, Rahman MR, Jalil MM, Ahsan MF, Theakston RD, et al. Snake bite in Chittagong Division, Bangladesh: a study of bitten patients who developed no signs of systemic envenoming. Trans R Soc Trop Med Hyg. 2010;104(5):320-327. doi: 10.1016/j.trstmh.2009.12.006.

  35. Regional Office for South-East Asia, World Health Organization. Guidelines for the management of snakebites, 2nd ed. WHO Regional Office for South-East Asia. 2016. Available in: https://apps.who.int/iris/handle/10665/249547

  36. Coto FF, Murillo BF, Rocha MSM. Accidente ofídico: un enfoque al manejo en primer nivel de atención. Revista Médica Sinergia. 2022;7(02):15.

  37. Avau B, Borra V, Vandekerckhove P, De Buck E. The treatment of snake bites in a first aid setting: a systematic review. PLoS Negl Trop Dis. 2016;10(10):e0005079. Available in: https://doi.org/10.1371/journal.pntd.0005079

  38. Pham HX, Mullins ME. Safety of nonsteroidal anti-inflammatory drugs in copperhead snakebite patients. Clin Toxicol (Phila). 2018;56(11):1121-1127. doi: 10.1080/15563650.2018.1468447.

  39. Alberts MB, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann Emerg Med. 2004;43(2):181-186. doi: 10.1016/S0196064403008138.

  40. Ralph R, Faiz MA, Sharma SK, Ribeiro I, Chappuis F. Managing snakebite. BMJ. 2022;376:e057926. doi: 10.1136/bmj-2020-057926.

  41. Richardson WH 3rd, Barry JD, Tong TC, Williams SR, Clark RF. Rattlesnake envenomation to the face of an infant. Pediatr Emerg Care. 2005;21(3):173-176.

  42. Khimani A, McNierney A, Surani S, Surani S. Snake envenomation causing distant tracheal myonecrosis. Case Rep Pulmonol. 2013;2013:364195. doi: 10.1155/2013/364195.

  43. Pawar DK, Singh H. Elapid snake bite. Br J Anaesth. 1987;59(3):385-387. doi: 10.1093/bja/59.3.385.

  44. Mehta V, Kumar R, Prabhakar R, Sharma CB, Thomas A. Dramatic neuromuscular paralysis following occult snakebites: an awareness for the primary care physician. J Family Med Prim Care. 2022;11(1):386-389. doi: 10.4103/jfmpc.jfmpc_1652_21.

  45. Smelski G, Cardwell M, Larsen J. Neurotoxic respiratory failure absent following Arizona rattlesnake bites, Toxicon, Volume 224, 2023,107034, ISSN 0041-0101, Available in: https://doi.org/10.1016/j.toxicon.2023.107034

  46. Gnanathasan A, Rodrigo C. Pulmonary effects and complications of snakebites. Chest. 2014;146(5):1403-1412. doi: 10.1378/chest.13-2674.

  47. Kim OH, Lee JW, Kim HI, Cha K, Kim H, Lee KH, Hwang SO, Cha YS. Adverse cardiovascular events after a venomous snakebite in Korea. Yonsei Med J. 2016;57(2):512-517. doi: 10.3349/ymj.2016.57.2.512.

  48. Liblik K, Byun J, Saldarriaga C, Perez GE, Lopez-Santi R, Wyss FQ, et al. Neglected tropical diseases and other infectious diseases affecting the heart (the NET-Heart project). Snakebite envenomation and heart: Systematic Review. Curr Probl Cardiol. 2022;47(9):100861. doi: 10.1016/j.cpcardiol.2021.100861.

  49. Vohra R, Cantrell FL, Williams SR. Fasciculations after rattlesnake envenomations: a retrospective statewide poison control system study. Clin Toxicol (Phila). 2008;46(2):117-121. doi: 10.1080/15563650701638925.

  50. Gutiérrez, José María. Envenenamientos por mordeduras de serpientes en América Latina y el Caribe: Una visión integral de carácter regional. Boletín de Malariología y Salud Ambiental. 2011;51(1): 1-16. Recuperado en 07 de enero de 2025, de http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-46482011000100001&lng=es&tlng=es.

  51. Bush SP, Ruha AM, Seifert SA, Morgan DL, Lewis BJ, Arnold TC, et al.. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi: 10.3109/15563650.2014.974263.

  52. Márquez-Martin R, Reyna-Sepúlveda F, Cantú-Alejo DR, et al. Effect of antivenom therapy on serum venom levels in Viperidae family snakebite cases in Mexico. Rev Educ Investig Emer. 2023;5(3):152-157. doi: 10.24875/REIE.21000141.

  53. García-De-Castro S, Vela-Fernández X. El manejo de las mordeduras de serpiente en Sudamérica. Emergencias. 2005;17:267-273.

  54. Canul-Caamal MA, Madrigal-Anaya JDC, Pastelin-Palacios R, Escalante-Galindo P, Moreno-Eutimio MA. Cryotherapy as a coadjuvant in crotaline snakebite management with F(ab')2 antivenom: a randomized pilot study. Complement Ther Med. 2020;54:102569. doi: 10.1016/j.ctim.2020.102569.

  55. Habib AG. Tetanus complicating snakebite in northern Nigeria: clinical presentation and public health implications. Acta Trop. 2003;85(1):87-91. doi: 10.1016/s0001-706x(02)00234-6.

  56. García-De-Castro S, Vela-Fernández X. El manejo de las mordeduras de serpiente en Sudamérica. Emergencias. 2005;17:267-273.

  57. Garg A, Sujatha S, Garg J, Acharya NS, Chandra PS. Wound infections secondary to snakebite. J Infect Dev Ctries. 2009;3(3):221-223. doi: 10.3855/jidc.39.

  58. Resiere D, Mehdaoui H, Névière R, Olive C, Severyns M, Beaudoin A, et al. Infectious complications following snakebite by Bothrops lanceolatus in martinique: a case series. Am J Trop Med Hyg. 2020;102(1):232-240. doi: 10.4269/ajtmh.19-0369.

  59. Lam KK, Crow P, Ng KH, Shek KC, Fung HT, Ades G, Grioni A, Tan KS, Yip KT, Lung DC, Que TL, Lam TS, Simpson ID, Tsui KL, Kam CW. A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China. Emerg Med J. 2011;28(2):107-114. doi: 10.1136/emj.2009.086694.

  60. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Pautas de práctica para el diagnóstico y manejo de infecciones de piel y tejidos blandos: actualización de 2014 de la sociedad de enfermedades infecciosas de América. Clin Infect Dis. 2014;59:147-159.

  61. Wagener M, Naidoo M, Aldous C. Wound infection secondary to snakebite. S Afr Med J. 2017;107(4):315-319. doi: 10.7196/SAMJ.2017.v107i4.12084.

  62. Rathinam SP. Corticosteroids and snake bite. BMJ. 2005;330(7481):33.

  63. Theakston RDG, Smith DC. Antivenenos. Una revisión del estado actual y desarrollos futuros. Productos Biofarmacéuticos. 1997;7:366-375.

  64. Sancy Mary Sam, Prakash Krishnan, Padmaja Udaykuma, SanithaKuriachan, Reshmina Dsouza. Role of concomitant therapy in the treatment of snakebite - A prospective, hospital based, observational study. MedPulse International Journal of Pharmacology. 2021;18(3):13-18. Available in: https://www.medpulse.in/Pharmacology/

  65. Boels D, Hamel JF, Bretaudeau Deguigne M, Harry P. European viper envenomings: assessment of Viperfav™ and other symptomatic treatments. Clin Toxicol (Phila). 2012;50:189-196.

  66. Díez M, Alonso D, García P, López A. Tratamiento por víbora en España. Semergen. 2016;42(5):320-326.

  67. Lavonas EJ, Ruha AM, Banner W, Bebarta V, Bernstein JN, Bush SP, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med. 2011;11:2.

  68. Sierra MC, Nogué S, Munné P. Envenenamiento por mordedura de serpiente. Med Integral. 2002;40(7):287-297.

  69. Maguiña C, Chincha O, Vilcapoma P, Morante D. Actualización en clínica y terapia de mordedura de serpiente. Rev Med Hered. 2020;31:48-55. Disponible en: http://dx.doi.org/10.20453/rmh.v31i1.3729

  70. Weiss H, Phillips L, Hopewell W. Heparin therapy in a patient bitten by a saw-scaled viper (Echis carinatus), a snake whose venom activates prothrombin. Am J Med. 1973;54:653-662.

  71. Paul V, Prahlad KA, Earali J, Francis S, Lewis F. Trial of heparin in viper bites. J Assoc Physicians India. 2003;51:163-166.

  72. Dhar D. Compartment syndrome following snake bite. Oman Med J. 2015;30(2):e082. Available in: https://doi.org/10.5001/omj.2015.32

  73. Kim YH, Choi JH, Kim J, Chung YK. Fasciotomy in compartment syndrome from snakebite. Arch Plastic Surg. 2019;46(1):69-74. Available in: https://doi.org/10.5999/aps.2018.00577

  74. Algieri RD, Fernández JP, Ferrante MS, Paglilla P, Ahualli N. Utilización de la ultrasonografía y aplicación del Doppler para la evaluación de ejes vasculares periféricos y la prevención del síndrome compartimental. Int J Med Surg Sci. 2016;3(4):981-989.

  75. Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg. 2002;89(4):397-412.

  76. Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America? Clin Toxicol (Phila). 2011;49(5):351-365. doi: 10.3109/15563650.2011.597032.

  77. Oliveira ME, Campanholi J, Cavalcante RL, Moreno FS, Yoshida EH, Dini MMJ, et al. Experimental model for removal of snake venom via hemoperfusion in rats. J Vet Emerg Crit Care (San Antonio). 2020;30(3):286-294. doi: 10.1111/vec.12949.

  78. Korkmaz S, Solmaz Medeni S, Demirkan F, KalayogluBesisik S, Altay Dadin S, Akgun Cagliyan G, et al. The Turkish experience with therapeutic plasma exchange: a national survey. Transfus Apher Sci. 2019;58(3):287-292.

  79. Berber I, Korkmaz S, Sarici A, Erkurt MA, Kuku I, Kaya E, Bicim S, Ozgul M. Therapeutic plasma exchange for envenomation: is it reasonable? Transfus Apher Sci. 2021;60(5):103241. Available in: https://doi.org/10.1016/j.transci.2021.103241

  80. Isbister GK, Buckley NA, Page CB, Scorgie FE, Lincz LF, Seldon M, et al. A randomized controlled trial of fresh frozen plasma for treating venom-induced consumption coagulopathy in cases of Australian snakebite (ASP-18). J Thromb Haemost. 2013;11(7):1310-1318. doi: 10.1111/jth.12218.

  81. Holla SK, Rao HA, Shenoy D, Boloor A, Boyanagari M. The role of fresh frozen plasma in reducing the volume of anti-snake venom in snakebite envenomation. Trop Doct. 2018;48(2):89-93. doi: 10.1177/0049475518756083.




2020     |     www.medigraphic.com