Detection of Venom after Antivenom Is Not Associated with Persistent Coagulopathy in a Prospective Cohort of Russell's Viper (Daboia russelii) Envenomings
| Autor: | Harindra Karunathilake, Margaret A. O'Leary, Kalana Maduwage, Fahim Mohamed, Chandana Abeysinghe, Christeine Ariaranee Gnanathasan, Lisa F. Lincz, Seyed Shahmy, Fiona E. Scorgie, Geoffrey K. Isbister |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Critical Care and Emergency Medicine Antivenom Snake Bites Venom Gastroenterology Cohort Studies Immunoenzyme Techniques 0302 clinical medicine Medicine and Health Sciences Prospective Studies 030212 general & internal medicine Aged 80 and over medicine.diagnostic_test Antivenins lcsh:Public aspects of medicine Hematology Blood Coagulation Disorders Middle Aged 3. Good health Infectious Diseases Russell's Viper Female Immunotherapy Snake Venoms Research Article Adult medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine VIPeR Adolescent lcsh:RC955-962 Immunology 030231 tropical medicine Viper Venoms complex mixtures Young Adult 03 medical and health sciences Internal medicine medicine Coagulopathy Animals Humans Blood Coagulation Aged Pharmacology Prothrombin time business.industry Public Health Environmental and Occupational Health Biology and Life Sciences lcsh:RA1-1270 medicine.disease Snake bites Surgery Pharmacodynamics Clinical Immunology Clinical Medicine business |
| Zdroj: | PLoS Neglected Tropical Diseases, Vol 8, Iss 12, p e3304 (2014) PLoS Neglected Tropical Diseases |
| ISSN: | 1935-2735 |
| Popis: | Background Venom recurrence or persistence in the circulation after antivenom treatment has been documented many times in viper envenoming. However, it has not been associated with clinical recurrence for many snakes, including Russell's viper (Daboia spp.). We compare the recovery of coagulopathy to the recurrence or persistence of venom in patients with Russell's viper envenoming. Methodology/Principal Findings The study included patients with Russell's viper (D. russelii) envenoming presenting over a 30 month period who had Russell's viper venom detected by enzyme immunoassay. Demographics, information on the snake bite, and clinical effects were collected for all patients. All patients had serum collected for venom specific enzyme immunoassay and citrate plasma to measure fibrinogen levels and prothrombin time (international normalised ratio; INR). Patients with venom recurrence/persistence were compared to those with no detectable recurrence of venom. There were 55 patients with confirmed Russell's viper envenoming and coagulopathy with low fibrinogen concentrations: 31 with venom recurrence/persistence, and 24 with no venom detected post-antivenom. Fibrinogen concentrations increased and INR decreased after antivenom in both the recurrence and non-recurrence patients. Clinical features, laboratory parameters, antivenom dose and length of hospital were similar for both groups. Pre-antivenom venom concentrations were higher in patients with venom recurrence/persistence with a median venom concentration of 385 ng/mL (16–1521 ng/mL) compared to 128 ng/mL (14–1492 ng/mL; p = 0.008). Conclusion Recurrence of Russell's viper venom was not associated with a recurrence of coagulopathy and length of hospital stay. Further work is required to determine if the detection of venom recurrence is due to the venom specific enzyme immunoassay detecting both venom-antivenom complexes as well as free venom. Author Summary Snakebite is a major public health problem and understanding the effectiveness of antivenom is essential to improving health outcomes. The measurement of venom in blood has been used to assess the effectiveness of antivenom. The absence of venom post-antivenom indicating that sufficient antivenom has been given, and the persistence or recurrence of venom indicating that insufficient antivenom has been given. There are numerous reports of venom recurrence with viper bites, including Russell's viper bites. However, it remains unclear if venom recurrence is always an indicator of inadequate antivenom and recurrence of clinical envenoming. In this study, we compare patients with and without the persistence or recurrence of venom who develop coagulopathy after Russell's viper bites. There was no difference in the recovery of the coagulopathy between the two groups of patients demonstrating that for Russell's viper envenoming, venom recurrence or persistence was not associated with the recurrence or persistence of clinical effects such as coagulopathy. Patients with detectable venom after antivenom did have higher pre-antivenom venom concentrations. Further investigation is required to interpret venom concentrations post-antivenom. |
| Databáze: | OpenAIRE |
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