Snakebite Research Papers - Academia.edu (original) (raw)

- by
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- Africa, East Asia, South Asia, Australia

Snakebites are common in tropical countries like Bangladesh where most snakebite victims dwell in rural areas. Among the
management options after snakebite in Bangladesh, snake charmers (Ozha in Bengali language) are the first contact following
a snakebite for more than 80% of the victims and they are treated mostly with the help of some medicinal plants. Our aim of the
study is to compile plants used for the treatment of snakebite occurrence in Bangladesh.The field survey was carried out in a period
of almost 3 years. Fieldwork was undertaken in Chittagong Hill Tracts, Bangladesh, including Chittagong, Rangamati, Bandarban,
and Khagrachari. Open-ended and semistructured questionnaire was used to interview a total of 110 people including traditional
healers and local people. A total of 116 plant species of 48 families were listed. Leaves were the most cited plant part used against
snake venom. Most of the reported species were herb in nature and paste mostly used externally is the mode of preparation. The
survey represents the preliminary information of certain medicinal plants having neutralizing effects against snake venoms, though
further phytochemical investigation, validation, and clinical trials should be conducted before using these plants as an alternative
to popular antivenom.

- by James Regun Karmoker
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- Snake venoms, Snakebite
- by Wolfgang Wüster
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- Herpetology, Proteomics, Snake venoms, Venomics

The Brooklyn Papyrus is an Egyptian medical treatise on the subject of snakebite cures. It is a part of the Brooklyn Museum’s Charles Edwin Wilbour collection (47.218.48 and 47.218.85). In the 1960s, the papyrus was translated into French by Egyptologist Serge Sauneron. This research paper includes the first full translation of the Brooklyn Papyrus, as well as an introductory essay, which analyzes the structural and religious elements of the work. It also compares the Brooklyn Papyrus to another notable work on snakebites, Nicander of Colophon’s Theriaca.

- by Montgomery Q . Stewart
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- Ancient Egyptian Religion, Herpetology, Egyptology, Classics

Many issues and complications in treating snakebite are a result of poor human social, economic and clinical intervention and management. As such, there is scope for significant improvements for reducing incidence and increasing patient outcomes. Snakes do not target humans as prey, but as our dwellings and farms expand ever farther and climate change increases snake activity periods, accidental encounters with snakes seeking water and prey increase drastically. Despite its long history, the snakebite crisis is neglected, ignored, underestimated and fundamentally misunderstood. Tens of thousands of lives are lost to snakebites each year and hundreds of thousands of people will survive with some form of permanent damage and reduced work capacity. These numbers are well recognized as being gross underestimations due to poor to non-existent record keeping in some of the most affected areas. These underestimations complicate achieving the proper recognition of snakebite's socioeconomic impact and thus securing foreign aid to help alleviate this global crisis. Antivenoms are expensive and hospitals are few and far between, leaving people to seek help from traditional healers or use other forms of ineffective treatment. In some cases, cheaper, inappropriately manufactured antivenom from other regions is used despite no evidence for their efficacy, with often robust data demonstrating they are woefully ineffective in neutralizing many venoms for which they are marketed for. Inappropriate first-aid and treatments include cutting the wound, tourniquets, electrical shock, immersion in ice water, and use of ineffective herbal remedies by traditional healers. Even in the developed world, there are fundamental controversies including fasciotomy, pressure bandages, antivenom dosage, premedication such as adrenalin, and lack of antivenom for exotic snakebites in the pet trade. This review explores the myriad of human-origin factors that influence the trajectory of global snakebite causes and treatment failures and illustrate that snakebite is as much a sociological and economic problem as it is a medical one. Reducing the incidence and frequency of such controllable factors are therefore realistic targets to help alleviate the global snakebite burden as incremental improvements across several areas will have a strong cumulative effect.

- by Bryan G Fry
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- Snake venoms, Snakebite, Snakes, Antivenom

Jashpur district of Chhattisgarh is mainly inhabited by different tribal communities whose main occupation is agriculture and collection of forest product. The aim of the study was given awareness of the local inhabitants about snake bite and documented their knowledge about treatment. Author select this area due to area is known as Naglok, Naag, Ghodakarait and Chitiare the main native snakes in this area. The tribal people are not use bed for sleep, still they are use local mat, in some part of this district not having electricity ,so people are live in danger. The present study highlights the medicinal plants used for treating snakebite by Oraontribe in Jashpur district, Chhattisgarh. This paper enumerates the traditional uses of 36 plant species belonging to 30 genera under 24 families that act as antidotes against snakebite and also described the interesting social aspect of oraon tribe.

- by GARPH Publication
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- Botany, Snakebite, Traditional plants extracts, Social aspect

Highest rates of snake envenoming and mortalities in South Asia, Southeast Asia, Sub-Share Africa with India reporting the most deaths. World Health Organization listed snakebite as a neglected disease. Clinical manifestations of snakebite include overwhelming fear, nausea vomiting diarrhea, vertigo, fainting, tachycardia, and cold, clammy skin. Most snakes cause neurotoxicity. Paresthesia throughout the body, as well as difficulty in speaking and breathing. Several other neurological features have been reported after snake envenomation which is likely to be direct neurotoxic effects. Mechanisms of many these acute manifestations are not clear. Myokymia has been reported mainly from United States following rattlesnake (Crotalusspp). Altered consciousness and deep comma has been reported in 64 % of patient after common krait envenomation. Delayed neurotoxicity also been reported. Anti-venom treatment should be given as soon possible, low dose anti-snake venom (ASV) is not inferior to high dose ASV. Improvement in neurotoxicity has been reported when anti-venom had been administered early. Prevention by avoiding areas heavily infested with snakes. Bite from a dead snake often contains large amount of venom. There is an urgent need for better treatment in neurotoxic envenoming.

- by Firdaus Hayati
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- Snake venoms, Snakebite, Neurotoxicity, Snakes

Venom variation occurs at all taxonomical levels and can impact significantly upon the clinical manifestations and efficacy of antivenom therapy following snakebite. Variation in snake venom composition is thought to be subject to strong natural selection as a result of adaptation towards specific diets. Members of the medically important genus Echis exhibit considerable variation in venom composition, which has been demonstrated to co-evolve with evolutionary shifts in diet. We adopt a venom gland transcriptome approach in order to investigate the diversity of toxins in the genus and elucidate the mechanisms which result in prey-specific adaptations of venom composition.

- by Wolfgang Wüster
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- Herpetology, Tropical Medicine, Snake venoms, Snakebite

Background: The explosive radiation and diversification of the advanced snakes (superfamily Colubroidea) was associated with changes in all aspects of the shared venom system. Morphological changes included the partitioning of the mixed ancestral glands into two discrete glands devoted for production of venom or mucous respectively, as well as changes in the location, size and structural elements of the venom-delivering teeth. Evidence also exists for homology among venom gland toxins expressed across the advanced snakes. However, despite the evolutionary novelty of snake venoms, in-depth toxin molecular evolutionary history reconstructions have been mostly limited to those types present in only two front-fanged snake families, Elapidae and Viperidae. To have a broader understanding of toxins shared among extant snakes, here we first sequenced the transcriptomes of eight taxonomically diverse rear-fanged species and four key viperid species and analysed major toxin types shared across the advanced snakes. Results: Transcriptomes were constructed for the following families and species: Colubridae-Helicops leopardinus, Heterodon nasicus, Rhabdophis subminiatus; Homalopsidae-Homalopsis buccata; Lamprophiidae-Malpolon monspessulanus, Psammophis schokari, Psammophis subtaeniatus, Rhamphiophis oxyrhynchus; and Viperidae-Bitis atropos, Pseudocerastes urarachnoides, Tropidolaeumus subannulatus, Vipera transcaucasiana. These sequences were combined with those from available databases of other species in order to facilitate a robust reconstruction of the molecular evolutionary history of the key toxin classes present in the venom of the last common ancestor of the advanced snakes, and thus present across the full diversity of colubroid snake venoms. In addition to differential rates of evolution in toxin classes between the snake lineages, these analyses revealed multiple instances of

- by Bryan G Fry and +1
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- Evolution, Snake venoms, Animal venoms and toxins, Snakebite

Although snake bites occur frequently in Benin City, the prevalence has not been documented. This study was therefore done to determine the prevalence, morbidity, mortality, and the orthodox treatment of victims. Results: Males were twice more often bitten than females, and teenagers and youths in their early twenties constituted the peak age range of victims. Most victims (59.5%) were bitten in the bush or farm. The limbs were the commonest sites of bite with the feet (73.5%) and arms (20.9%) more frequently bitten; both the upper and lower right limbs were also more frequently bitten than the corresponding left limbs. All patients who showed symptoms of envenomation (68.3%) received polyvalent antivenom, 67.4% received antibiotics while over 90% of patients received antitetanus prophylaxis. Some of the patients (61.5 %) were treated with analgesics, while 17.2% and 82.3% received diazepam and intravenous fluids, respectively. Although there was a high degree of morbidity as shown by the long stay of many patients in the hospital (mean duration of stay by patients in hospital is 5.7±5.1 days; range <1-23 days), mortality was not recorded. Conclusion: It is concluded that there is a high prevalence of snake bites with high morbidity especially among the very active youthful segment of the Benin City population.

- by david ojo
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- Pharmacology, Pharmacy, Treatment, Snakebite

The development of snake antivenoms more than a century ago should have heralded effective treatment of the scourge of snakebite envenoming in impoverished, mostly rural populations around the world. That snakebite still exists today, as a widely untreated illness that maims, kills and terrifies men, women and children in vulnerable communities, is a cruel anachronism. Antivenom can be an effective, safe and affordable treatment for snakebites, but apathy, inaction and the politicisation of public health have marginalised both the problem (making snakebite arguably the most neglected of all neglected tropical diseases) and its solution. For lack of any coordinated approach, provision of antivenoms has been pushed off the public health agenda, leading to an incongruous decline in demand for these crucial antidotes, excused and fed by new priorities, an absence of epidemiological data, and a poor regulatory framework. These factors facilitated the infiltration of poor quality products that degrade user confidence and undermine legitimate producers. The result is that tens of thousands are denied an essential life-saving medicine, allowing a toll of human suffering that is a summation of many individual catastrophes. No strategy has been developed to address this problem and to overcome the intransigence and inaction responsible for the global tragedy of snakebite. Attempts to engage with the broader public health community through the World Health Organisation (WHO), GAVI, and other agencies have failed. Consequently, the toxinology community has taken on a leadership role in a new approach, the Global Snakebite Initiative, which seeks to mobilise the resources, skills and experience of scientists and clinicians for whom venoms, toxins, antivenoms, snakes and snakebites are already fields of interest. Proteomics is one such discipline, which has embraced the potential of using venoms in bio-discovery and systems biology. The fields of venomics and antivenomics have recently evolved from this discipline, offering fresh hope for the victims of snakebites by providing an exciting insight into the complexities, nature, fundamental properties and significance of venom constituents. Such a rational approach brings with it the potential to design new immunising mixtures from which to raise potent antivenoms with wider therapeutic ranges. This addresses a major practical limitation in antivenom use recognised since the beginning of the 20th century: the restriction of therapeutic effectiveness to the specific venom immunogen used in production. Antivenomic techniques enable the interactions between venoms and antivenoms to be examined in detail, and if combined with functional assays of specific activity and followed up by clinical trials of effectiveness and safety, can be powerful tools with which to evaluate the suitability of current and new antivenoms for meeting urgent regional needs. We propose two mechanisms through which the Global Snakebite Initiative might seek to end the antivenom drought in Africa and Asia: first by establishing a multidisciplinary, multicentre, international collaboration to evaluate currently available antivenoms against the venoms of medically important snakes from specific nations in Africa and Asia using a combination of proteomic, antivenomic and WHO-endorsed preclinical assessment protocols, to provide a validated evidence base for either recommending or rejecting individual products; and secondly by bringing the power of proteomics to bear on the design of new immunising mixtures to raise Pan-African and Pan-Asian polyvalent antivenoms of improved potency and quality. These products will be subject to rigorous clinical assessment. We propose radically to change the basis upon which antivenoms are produced and supplied for the developing world. Donor funding and strategic public health alliances will be sought to make it possible not only to sustain the financial viability of antivenom production partnerships, but also to ensure that patients are relieved of the costs of antivenom so that poverty is no longer a barrier to the treatment of this important, but grossly neglected public health emergency.An international, multidisciplinary collaboration provides a mechanism to fund evaluation of existing antivenoms and production of new antivenoms using improved antigens. This donorfunded, regulated process would deliver safe, effective free antivenoms to snakebite victims.► Snakebite is arguably the most neglected of all the neglected tropical diseases. ► A global shortage of accessible, safe, effective antivenoms is a major barrier to improving snakebite treatment. ► Greater deployment of proteomic, and other techniques could produce improved antivenoms. ► A multi‐disciplinary, multi‐centre collaboration to improve access to safe, effective antivenoms is proposed.

- by Owen Paiva and +2
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- Snakebite, Neglected tropical diseases, Antivenom, SNAKE ANTIVENOM

Resultados: nesta região, os acidentes mais notificados são causados por serpentes, principalmente Bothrops, seguido dos acidentes por aranhas e escorpiões. Araruama foi o município onde ocorreram mais registros de acidentes, mas Armação de Búzios foi o município mais frequente quando se avalia o número de acidentes por habitante. Nos registros de acidentes por aranhas, a imensa maioria não conseguiu identificar a espécie causadora. Conclusão: os dados mostram que ainda existem falhas no fluxo de informação do SINAN e que ainda há uma falta de conhecimento pela população e pela própria área médica sobre as espécies da região e a importância das notificações, sendo necessário mais capacitações técnicas e maiores estudos epidemiológicos regionais.

- by Rafaela Cheung and +1
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- Epidemiology, Spiders, Snakebite, Poisoning
- by Nicole Hansen
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- Ancient History, Herpetology, Archaeology, Egyptology

Every year, more than 100,000 people are killed by snakebites in the world’s poorest regions, with three times that number left with severe disabilities such as amputations or paralysis. Despite this high mortality and disability burden, which is comparable to many better-publicised health issues such as the neglected tropical diseases, snakebite suffers from a lack of political attention and research funding both on the international stage and on national healthcare agendas.
This paper seeks to uncover the reasons for this neglect through a case study of snakebite that applies to it the social constructionist framework of political prioritisation proposed by Jeremy Shiffman. This framework identifies four areas of political power needed to increase the chances of any issue being placed high on the political agenda, which are: the power of the actors involved in an issue; the ideational power of how the issue is framed; the power of political contexts to shape reactions to the issue; and the power of the issue itself, in terms of its severity and tractability.
The analysis reveals that snakebite falls short to varying degrees in all four of these aspects, a situation that must be remedied if snakebite it to achieve a level of attention commensurate with the suffering it causes. The paper suggests that the easiest short-term solution to these problems would be to re-instate snakebite to the list of neglected tropical diseases, for which effective advocacy has ensured increasing attention and funding in the past decade.
Finally, it suggests that further research is sorely needed both on the medical, social, political, and economic factors preventing effective prevention and treatment of snakebite worldwide, and on the ethical and practical implications of a system in which prioritisation of health issues is clearly not based on the objective measurement of an issue’s health burden, but on the effectiveness of advocacy for the issue.

- by Sam Shorto
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- Global Health, Agenda-setting Theory, Agenda Setting, Snakebite

In South Asia, the "Big-4" venomous snakes Naja naja, Bungarus caeruleus, Daboia russelii, and Echis carinatus are so-called because they are the most medically important snakes in the region. Antivenom is the only effective treatment option for snakebite envenoming but antivenom is not produced domestically in Pakistan making the country reliant on polyvalent products imported from India and Saudi Arabia. The present study investigated the toxin composition and activity of the venoms of Pakistani specimens by means of proteomic and physio/phar-macological experiments. To evaluate the composition of venoms, 1D/2D-PAGE of crude venoms and RP-HPLC followed by SDS-PAGE were performed. Enzymatic, hemolytic, coagulant and platelet aggregating activities of crude venoms were assayed and were concordant with expectations based on the abundance of protein species in each. Neutralization assays were performed using Bharat polyvalent antivenom (BPAV), a product raised against venoms from Big-4 specimens from southern India. BPAV exhibited cross-reactivity against the Pakistani venoms, however, neutralization of clinically relevant activities was variable and rarely complete. Cumulatively, the presented data not only highlight geographical variations present in the venoms of the Big-4 snakes of South Asia, but also demonstrate the neutralization potential of Indian polyvalent against the venom of Pakistani specimens. Given the partial neutralization observed, it is clear that whilst BPAV is a life-saving product in Pakistan, in future it is hoped that a region-specific product might be manufactured domestically, using venoms of local snakes in the immunising mixture.

- by Amaila Fazal
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- Pharmacology, Biochemistry, Molecular Biology, Toxicology

Coral snake envenomations are well characterized to be lethally neurotoxic. Despite this, few multispecies, neurotoxicity and antivenom efficacy comparisons have been undertaken and only for the Micrurus genus; Micruroides has remained entirely uninvestigated. As the USA's supplier of antivenom has currently stopped production, alternative sources need to be explored. The Mexican manufacturer Bioclon uses species genetically related to USA species, thus we investigated the efficacy against Micrurus fulvius (eastern coral snake), the main species responsible for lethal envenomations in the USA as well as additional species from the Americas. The use of Coralmyn® coral snake antivenom was effective in neutralizing the neurotoxic effects exhibited by the venom of M. fulvius but was ineffective against the venoms of Micrurus tener, Micrurus spixii, Micrurus pyrrhocryptus, and Micruroides euryxanthus. Our results suggest that the Mexican antivenom may be clinically useful for the treatment of M. fulvius in the USA but may be of only limited efficacy against the other species studied.

- by Kevin Arbuckle and +1
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- Toxicology, Snake venoms, Snakebite, Antivenom

Objective To compare the efficacy and safety of three polyspecific antivenoms for bites by pit vipers. Design Randomised double blind comparative trial of three antivenoms. Setting Shell, Pastaza, southeastern Ecuador. Participants 210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001. Intervention One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms. Main outcome measures Permanent restoration of blood coagulability after 6 and 24 hours. Results The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal. Conclusions All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern.

- by Daniel J Dolley
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- Amazonian Ecuador, Snakebite, South America, Antivenom

A venomous snakebite is the single most important global cause of human injury from venomous and
poisonous animals of all types.1 The viper family (Viperaberus, Viperaammodites, Viperaursine)2 is the
2nd most important venomous snake family of major medical importance globally and they are found
in Albania. All have mobile fangs in the front of the mouth on hinged maxillae, allowing the fangs
to fold away against the roof of the mouth when not in use. These long fangs are often coupled with
large venom glands, allowing large quantities of venom to be injected, but “dry bites” can also occur.2
Snake venom contains toxins designed to kill or immobilize the snake’s prey. There are four
main types of snake venom: Hemotoxins, neurotoxins, cytotoxins, and myotoxins.

- by Toxicology and Forensic Medicine – Open Journal and +1
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- Snakebite, Antivenom, Vipera, Anaphylactic Reactions

Crotalus scutulatus (Mohave rattlesnake) is a clinically significant pit viper broadly distributed across much of the arid southwestern United States and mainland Mexico. Identification of C scutulatus is a concern among emergency medical service and emergency department personnel owing to its reputation for severe envenomations and difficulty in visually differentiating between C scutulatus and other species, primarily Crotalus atrox (western diamond-backed rattlesnake). We contrast distinctive characteristics of C scutulatus, C atrox, and 3 other sympatric species: Crotalus molossus, Crotalus ornatus, and Crotalus viridis (western and eastern black-tailed rattlesnakes and prairie rattlesnake, respectively). Greenish coloration eliminates C atrox but does not confirm C scutulatus. Obvious coarse and fine speckling of the dorsal pattern and a pale postocular stripe intersecting the mouth characterize C atrox. Dorsal speckling is insignificant or absent in the other species, whereas the pale postocular stripe passes above the mouth in C scutulatus and C viridis and is absent in C molossus and C ornatus. Tails boldly ringed with alternating black and white or contrasting shades of gray are shared by C atrox and C scutulatus, respectively, but a lack of boldly ringed tails characterizes the other species. The proximal rattle segment is yellow and black, or entirely yellow, in C scutulatus but black in the others. The most reliable visual identifications are based on evaluations of multiple traits, all of which are variable to some extent. Traits such as tail ring width and the size and number of crown scales have frequently been overemphasized in the past.

- by Michael Cardwell
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- Emergency Medicine, Snakebite, Venomous snakes
- by Shubhankar Mishra
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- Neurotoxicology, Snakebite, Neurotoxicity

Abstract: The development of snake antivenoms more than a century ago should have heralded effective treatment of the scourge of snakebite envenoming in impoverished, mostly rural
populations around the world. That snakebite still exists today, as a widely untreated illness
that maims, kills and terrifies men, women and children in vulnerable communities, is a
cruel anachronism. Antivenom can be an effective, safe and affordable treatment for
snakebites, but apathy, inaction and the politicisation of public health have marginalised
both the problem (making snakebite arguably the most neglected of all neglected tropical
diseases) and its solution. For lack of any coordinated approach, provision of antivenoms has
been pushed off the public health agenda, leading to an incongruous decline in demand for
these crucial antidotes, excused and fed by new priorities, an absence of epidemiological
data, and a poor regulatory framework. These factors facilitated the infiltration of poor
quality products that degrade user confidence and undermine legitimate producers. The
result is that tens of thousands are denied an essential life-saving medicine, allowing a toll of
human suffering that is a summation of many individual catastrophes. No strategy has been
developed to address this problem and to overcome the intransigence and inaction
responsible for the global tragedy of snakebite. Attempts to engage with the broader public
health community through the World Health Organisation (WHO), GAVI, and other agencies have failed. Consequently, the toxinology community has taken on a leadership role in a new
approach, the Global Snakebite Initiative, which seeks to mobilise the resources, skills and
experience of scientists and clinicians for whom venoms, toxins, antivenoms, snakes and
snakebites are already fields of interest. Proteomics is one such discipline, which has
embraced the potential of using venoms in bio-discovery and systems biology. The fields of
venomics and antivenomics have recently evolved from this discipline, offering fresh hope
for the victims of snakebites by providing an exciting insight into the complexities, nature,
fundamental properties and significance of venom constituents. Such a rational approach
brings with it the potential to design new immunising mixtures from which to raise potent
antivenoms with wider therapeutic ranges. This addresses a major practical limitation in
antivenom use recognised since the beginning of the 20th century: the restriction of
therapeutic effectiveness to the specific venom immunogen used in production.
Antivenomic techniques enable the interactions between venoms and antivenoms to be
examined in detail, and if combined with functional assays of specific activity and followed up
by clinical trials of effectiveness and safety, can be powerful tools with which to evaluate the
suitability of current and newantivenoms formeeting urgent regional needs.We propose two
mechanisms through which the Global Snakebite Initiative might seek to end the antivenom
drought in Africa and Asia: first by establishing amultidisciplinary,multicentre, international
collaboration to evaluate currently available antivenoms against the venoms of medically
important snakes from specific nations in Africa and Asia using a combination of proteomic,
antivenomic and WHO-endorsed preclinical assessment protocols, to provide a validated
evidence base for either recommending or rejecting individual products; and secondly by
bringing the power of proteomics to bear on the design of new immunising mixtures to raise
Pan-African and Pan-Asian polyvalent antivenoms of improved potency and quality. These
products will be subject to rigorous clinical assessment. We propose radically to change the
basis upon which antivenoms are produced and supplied for the developing world. Donor
funding and strategic public health alliances will be sought to make it possible not only to
sustain the financial viability of antivenom production partnerships, but also to ensure that
patients are relieved of the costs of antivenom so that poverty is no longer a barrier to the
treatment of this important, but grossly neglected public health emergency.
A pdf of this paper can be obtained from my website following the link.

- by Juan Calvete and +2
- •
- Herpetology, Africa, Clinical Trial, Proteomics

Objetivamos atualizar as informações dos acidentes por serpentes no estado do Rio de Janeiro, de 2007 a 2013. Serão avaliados os gêneros das serpentes causadoras do agravo, os municípios de prevalência, sexo, faixa etária, gravidade e tempo de atendimento, disponibilizadas pelo Sistema de Informação de Agravo de Notificação. Foram analisadas 3799 notificações de todo o estado, sendo que as notificações de seis municípios correspondem a 1337(35,1%) acidentes, sendo o acidente botrópico o mais comum, principalmente no sexo masculino e na faixa de 20 - 39 anos. Concluímos que as subnotificações, falhas de preenchimento das notificações, desconhecimento da clínica para ofidismo entre os profissionais de saúde e a limitação do banco de dados em fornecer dados atualizados sobre este agravo contribuem no agravamento do ofidismo na região

- by Claudio Machado and +1
- •
- Epidemiology, Snakebite, Snakes, Venomous snakes

Lancet 2010; 375: 89–91:
Panel: Key initiatives
• Community education about improved prevention and preclinical care on the basis of the specific needs of different regions, consistent advocacy, and comprehensive community engagement
• Improved injury surveillance, and advocacy for making snake bite a notifiable disease so that reporting becomes mandatory at local, national, and regional levels
• Further clinical and basic research with focus on an improved understanding of injury mechanisms and optimisation of interventions
• Systematic approaches to improve medical management,
education, and training of medical and paramedical personnel, focusing on the specific needs of different regions (teaching materials should be developed by those with first-hand experience of treating snake bites)
• Functional support for the prequalification of antivenoms (the only specific antidote for envenoming), research to improve their safety and clinical eff ectiveness, and storage conditions and hence shelf life
• Promotion of rehabilitation and prevention of disability through engagement with established stakeholders in this field so that the physical, economic, and psychological handicaps resulting from snake bite are kept to a minimum
• Build effective public health policy and governance frameworks, and create innovative fi nancing bridges to enable programmes to be put into practice

- by David Williams
- •
- Africa, East Asia, South Asia, Australia

First-aid methods recommended for snakebites are
included in the contents of Science textbooks in Brazil.
Books published before 1996 provided misleading
information with in this respect and it is possible that
such recommendations derived from North-American
experiences conducted at the beginning of the 20th
Century. The official evaluation of textbooks carried
out by the Ministry of Education in 1996 initiated
a major public discussion on the several mistakes
have been present in these materials, mainly those
relating to mistaken snakebite first-aid procedures.
As from 1996, a significant decrease in the number
of casualties from snakebites was reported, both in
the total number of deaths and among the patients
who had received medical assistance. The number of
deaths may be associated with the reduced number of
victims who developed complications resulting from
improper first-aid procedures. This article intends
to relate the changes implemented in textbooks as
a result from the first national evaluation with the
reduction in the number of casualties from snakebites
in the same period. Its was presented originally as a paper in a scientific congress heal at the Butantan Institute, the most prestigious scientific institution on the field in Brazil.

- by Nelio Bizzo and +1
- •
- Health Education, Snakebite, Science and Technology Textbooks, Snakebite and envenomation

Snakebites are common and lead to potential complications like neuromyopathies and stro k e s , these last associated with disturbances of blood coagulation. We re p o rt on a 65 years old woman of cerebral intraparenchymal hemorrhage associated with snakebite by a Bothrops jararaca that occurred in the Reconcavo of Bahia, BA, Brazil. The patient was submitted to a surgical evacuation of the hematoma, with a good result. This re p o rt is accompanied by a revision about the association among snakebite and neurological complications, emphasizing strokes. Statistics reveal a hight incidence of snakebite in the world, mainly in tropical countries and gets attention for his socioeconomic impact. The clinical and laboratorial characteristics to identify the victims that present a high risk of presenting strokes are discussed in ord e r to identify early those patients, so that they may be treated in a more precocious and effective way.

- by diana santana
- •
- Cognitive Science, Epidemiology, Brazil, Public Health
- by Nicole Hansen
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- Ancient History, Herpetology, Archaeology, Egyptology

There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country's population) were surveyed. The crude overall community incidence of...

- by Peter Diggle
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- Sri Lanka, Biological Sciences, Snakebite, Incidence

Snake bite incidents are on rise in Brazil. The present study updates the current state of knowledge about snake poisoning in Brazil, following a descriptive and retrospective method. The study is based on the information on 329,180 cases registered at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação-SINAN), for a period of 12 years starting from 2001 to 2012. The variables selected were spatial (Brazilian state) and temporal (month and year). Factors like poisoning due to genus of snake, time elapsed between the poisoning and the first emergency treatment, the age and the sex of the victim, seriousness and evolution of the poisoning etc are crucial elements that play a role in the recovery process. Poisoning incidents based on the relative risks (RR) in terms of age group for all geographic regions of the country were calculated using the Northern region as an index. The study observed an annual increase in the number of cases with seasonal variations. It exhibited a sizeable difference between the minimum and maximum monthly rates of incidents throughout the study period. As per the study, the highest number of cases occurred in the state of Pará with the greatest number of cases (5,317).The state of Tocantins witnessed the highest incidence (79.4/100,000 inhabitants) and the percentage of affected children and adolescents between 10 and 19 years of age are high in the North region (23.2%; CI 95% =22.9-23.4%). Seasonal, regional and local factors must be taken into account when training the teams responsible for treating victims and in the planning of the production and distribution of stocks of antivenom serum.

- by Rosany Bochner
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- Epidemiology, Snakebite, Clinical Toxicology, Snakes

Objetivo: Determinar a epidemiologia e fluxo de informação de notificação dos acidentes ofídicos no município
de Teresópolis (RJ). Métodos: Foi realizado um estudo descritivo, quantitativo e retrospectivo dos acidentes e
para isso os dados foram coletados por meio de consulta ao banco de dados SINAN NET e das fichas individuais
de investigação para notificação de acidentes por animais peçonhentos do SINAN, emitidas pelo Hospital das
Clínicas de Teresópolis Costantino Ottaviano no período de 01/2007 – 12/2010. Foram avaliadas as seguintes
variáveis: tipo, mês e ano do acidente, município de ocorrência, idade, escolaridade, ocupação, sexo, zona de
ocorrência, tempo de atendimento, local da picada, manifestações e complicações locais e sistêmicas, tempo de
coagulação, classificação, soroterapia, acidente relacionado ao trabalho e evolução do caso. Resultados: Foram
analisadas 121 fichas individuais de investigação do município enquanto no SINAN estão registrados 104 casos,
indicando uma subnotificação de 14,4%. O gênero Bothrops aparece como responsável pela maioria dos
acidentes atendidos com 81,8% dos casos, apresentando sazonalidade maior nos meses entre outubro e março
(72,7%), com predominância de acidentados do sexo masculino (78,5%), idade variando entre 20 e 59 anos
(80,2%) e maior acometimento dos membros inferiores (68,8%). Conclusões: Concluiu-se que o perfil dos
acidentes segue os padrões já descritos na literatura para a região sudeste, mas que existem falhas no
preenchimento das fichas individuais de investigação e falta de sintonia entre o processo de coleta de dados e a
apresentação dos dados no sistema SINAN NET, apesar deste ser de extrema importância para a informação
sobre acidentes com animais peçonhentos.

- by Claudio Machado
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- Epidemiology, Snakebite, Snakes

Snake bite incidents are on rise in Brazil. The present study updates the current state of knowledge about snake
poisoning in Brazil, following a descriptive and retrospective method. The study is based on the information on
329,180 cases registered at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de
Informação de Agravos de Notificação - SINAN), for a period of 12 years starting from 2001 to 2012.
The variables selected were spatial (Brazilian state) and temporal (month and year). Factors like poisoning due to
genus of snake, time elapsed between the poisoning and the first emergency treatment, the age and the sex of the
victim, seriousness and evolution of the poisoning etc are crucial elements that play a role in the recovery process.
Poisoning incidents based on the relative risks (RR) in terms of age group for all geographic regions of the country
were calculated using the Northern region as an index. The study observed an annual increase in the number of
cases with seasonal variations. It exhibited a sizeable difference between the minimum and maximum monthly rates
of incidents throughout the study period. As per the study, the highest number of cases occurred in the state of Pará
with the greatest number of cases (5,317).The state of Tocantins witnessed the highest incidence (79.4/100,000
inhabitants) and the percentage of affected children and adolescents between 10 and 19 years of age are high in
the North region (23.2%; CI95%=22.9-23.4%). Seasonal, regional and local factors must be taken into account when
training the teams responsible for treating victims and in the planning of the production and distribution of stocks of
antivenom serum.

- by Claudio Machado and +1
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- Epidemiology, Snakebite, Snakes

Compreender a situação dos envenenamentos na região da Superintendência de Saúde de Ponte Nova, Minas Gerais, entre 2007 e 2012. Método: estudo exploratório, em dados disponíveis no Sistema de Informação de Agravos de Notificação. Foram coletados e analisados segundo a incidência, distribuição territorial, Resultados: observou-se 3.128 casos, com a incidência anual média de 152,2 acidentes a cada cem mil habitantes e letalidade de 0,3%. O município de Raul Soares apresentou maior expressividade de agravos e os escorpiões foram os animais principalmente envolvidos, seguidos das serpentes. Entre os envenenamentos, 10,9% dos acidentes ofídicos e 62,3% dos araneídeos foram classificados como ignorados/brancos. Os indivíduos do sexo masculino com idade entre 20 e 39 anos foram predominantemente acometidos. Os acidentes evidenciaram, em sua maioria, classificação leve, atendimento em até 3 horas e evolução para cura. Conclusão: com o estudo possibilitou descrever características dos acidentes e identificar lacunas para permanência das investigações sobre: acometimentos escorpiônicos em crianças menores de um ano; associação dos envenenamentos aos acidentes de trabalho e determinação da causalidade dos elevados registros na categoria ignorado/branco.sazonalidade, idade, sexo, animal, gravidade, tempo de atendimento e evolução de caso.

- by Claudio Machado
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- Snakebite, Snakes, Snakebite and envenomation

- by Arunasalam Pathmeswaran
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- Geography, Sri Lanka, Biological Sciences, Snakebite

The potential of Mimosa pudica (Mimosaceae) against snake envenomation. In this study, neutralization of the lethal effects of Naja naja kaouthia venom was investigated by co-incubating the venom with water extracts of various plants. The mixture of venom-extract was then injected intraperitoneally (i.p.) into mice. From the 17 plants screened, only Mimosa pudica (Mimosaceae) showed 100% ability in neutralizing the 2LD 50 lethality of this venom. This plant was also found to show 50% or more ability in neutralizing the 2LD 50 toxicity of other venoms, namely, Ophiophagus hannah, Bungarus candidus, B. fasciatus and Calloselasma rhodostoma. Its active fraction (MP188ECT3) also showed interaction towards N. n. kaouthia venom. This was based on results of the 2-D electrophoresis (2-DE) established by using immobilized pH gradient 3-10 on this venom. Some spots representing proteins were found missing upon combining the venom with 0.7 mg of the fraction prior to 2-DE. Among these are isomers of a lethal protein identified by MALDI-TOF MS as phospholipase A 2 which have been significantly found to disappear in the treated gel compared with the 2-DE gel of the venom only. Results of the double immunodiffusion study showed binding capabilities between MP188ECT3 fraction and venom preparations with the formation of a venom-antivenom precipitin line. These results demonstrated the potential use of M. pudica as an antivenom agent of plant origin against five poisonous snake venoms found in Malaysia.

- by Halijah Ibrahim
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- Biology, Medicinal Plants, Snake venoms, Snakebite

With the rises of the AI technology in Healthcare, researchers have been using the technology to develop a computational system to aid diagnosis, commonly known as 'Clinical Decision Support Systems (CDSSs)'. The CDSS applications currently available are usually neither free, nor optimized for treating Thai patients. In this work, we propose a new CDSS platform intended as an open platform for the CDSS application in Thailand. As a prototype and proof of concept, we developed the Mahidol Snake Envenomation Support System (MSESS), as the first C DSS a pplication u sing o ur n ew p latform. MSESS was designed to help its user formulate a treatment plan for the patient with snake bite found in Thailand, particularly in rural areas, and guide the user through the treatment flow. The treatments suggested by MSESS strictly follows the Snake Envenomation guideline provided by the Ramathibodi Poison Center. The targeted user is the medical personnel such as general practitioner seeking a medical advice from specialists. The medical personnel will first e nter t he p atient information to the CDSS. The system will then retrieve the information, submit it to the inference engine unit hosted at our central computing facilities, and display the suggested actions to the medical personnel via our application. We discuss our lesson learn from the development of MSESS for the future development of CDSS applications on our platform.

- by Sahaphume Srisuma
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- Mobile application development, Snakebite

The binding of compounds to nicotinic acetylcholine receptors is of great interest in biomedical research. However, progress in this area is hampered by the lack of a high-throughput, cost-effective, and taxonomically flexible platform. Current methods are low-throughput, consume large quantities of sample, or are taxonomically limited in which targets can be tested. We describe a novel assay which utilizes a label-free bio-layer interferometry technology, in combination with adapted mimotope peptides, in order to measure ligand binding to the orthosteric site of nicotinic acetylcholine receptor alpha-subunits of diverse organisms. We validated the method by testing the evolutionary patterns of a generalist feeding species (Acanthophis antarcticus), a fish specialist species (Aipysurus laevis), and a snake specialist species (Ophiophagus hannah) for comparative binding to the orthosteric site of fish, amphibian, lizard, snake, bird, marsupial, and rodent alpha-1 nicotinic acetylcholine receptors. Binding patterns corresponded with diet, with the Acanthophis antarcticus not showing bias towards any particular lineage, while Aipysurus laevis showed selectivity for fish, and Ophiophagus hannah a selectivity for snake. To validate the biodiscovery potential of this method, we screened Acanthophis antarcticus and Tropidolaemus wagleri venom for binding to human alpha-1, alpha-2, alpha-3, alpha-4, alpha-5, alpha-6, alpha-7, alpha-9, and alpha-10. While A. antarcticus was broadly potent, T. wagleri showed very strong but selective binding, specifically to the alpha-1 target which would be evolutionarily selected for, as well as the alpha-5 target which is of major interest for drug design and development. Thus, we have shown that our novel method is broadly applicable for studies including evolutionary patterns of venom diversification, predicting potential neurotoxic effects in human envenomed patients, and searches for novel ligands of interest for laboratory tools and in drug design and development.

- by Bryan G Fry
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- Biosensors, Snake venoms, Snakebite, Neurotoxicity

Acidentes por animais peçonhentos na região serrana, Rio de Janeiro, Brasil Accidents for venomous animals in the mountain region, Rio de Janeiro, Brazil Accidentes com animales venenosos em la región serrana, Rio de Janeiro, Brasil RESUMO Objetivo: realizar mapeamento epidemiológico sobre os acidentes por animais peçonhentos na Região Serrana do estado do Rio de Janeiro. Método: estudo exploratório e quantitativo, em dados do Sistema de Informação de Agravos de Notificação, analisando os acidentes notificados entre os anos de 2007 a 2015 compreendidos nos municípios da região serrana do estado do Rio de Janeiro. Resultados: os acidentes mais notificados foram causados por serpentes, principalmente Bothrops, seguido dos acidentes por aranhas, e por escorpiões. Nova Friburgo foi o município onde ocorreu maior número de registros de acidentes (27,7%), mas ao analisar a incidência desses acidentes, Sumidouro teve um número de acidentes mais expressivo (6,3%). Na maior parte dos registros de acidentes por aranhas não foi possível identificar a espécie causadora. O mês com maior número de notificações foi dezembro e a parcela da população mais afetada pelos acidentes foi a masculina, na faixa etária entre 20 a 59 anos. Conclusão: os dados mostram que ainda existem falhas no fluxo de informação do SINAN, assim como falta de conhecimento pela população e da própria área médica sobre as espécies da região, principalmente relacionado às aranhas, sendo necessárias mais capacitações técnicas, material educativo e maiores estudos epidemiológicos regionais. ABSTRACT Objective: carry out an epidemiological mapping of accidents by venomous animals in mountain region of the state of Rio de Janeiro. Method: exploratory and quantitative study on data from the Notifiable Diseases Information System, analyzing the accidents between the years 2007 and 2015 in the cities of Mountain Region. Results: most of the notified accidents were caused by serpents, especially Bothrops, followed by spiders, and scorpions. Most of the registered accidents happened in Nova Friburgo (27,7%). However, analyzing the incidence, Sumidouro had the most significant number of accidents (6,3%). In most of the records regarding accidents caused by spiders, the specie was not identified. December was the month with most notifications, and the

- by Claudio Machado
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- Epidemiology, Spiders, Snakebite, Snakes

The development of snake antivenoms more than a century ago should have heralded effective treatment of the scourge of snakebite envenoming in impoverished, mostly rural populations around the world. That snakebite still exists today, as a widely untreated illness that maims, kills and terrifies men, women and children in vulnerable communities, is a cruel anachronism. Antivenom can be an effective, safe and affordable treatment for
snakebites, but apathy, inaction and the politicisation of public health have marginalised both the problem (making snakebite arguably the most neglected of all neglected tropical diseases) and its solution. For lack of any coordinated approach, provision of antivenoms has been pushed off the public health agenda, leading to an incongruous decline in demand for these crucial antidotes, excused and fed by new priorities, an absence of epidemiological data, and a poor regulatory framework. These factors facilitated the infiltration of poor quality products that degrade user confidence and undermine legitimate producers. The result is that tens of thousands are denied an essential life-saving medicine, allowing a toll of human suffering that is a summation of many individual catastrophes. No strategy has been developed to address this problem and to overcome the intransigence and inaction responsible for the global tragedy of snakebite. Attempts to engage with the broader public health community through the World Health Organisation (WHO), GAVI, and other agencies have failed. Consequently, the toxinology community has taken on a leadership role in a new
approach, the Global Snakebite Initiative, which seeks to mobilise the resources, skills and experience of scientists and clinicians for whom venoms, toxins, antivenoms, snakes and
snakebites are already fields of interest. Proteomics is one such discipline, which has embraced the potential of using venoms in bio-discovery and systems biology. The fields of venomics and antivenomics have recently evolved from this discipline, offering fresh hope for the victims of snakebites by providing an exciting insight into the complexities, nature, fundamental properties and significance of venom constituents. Such a rational approach
brings with it the potential to design new immunising mixtures from which to raise potent antivenoms with wider therapeutic ranges. This addresses a major practical limitation in antivenom use recognised since the beginning of the 20th century: the restriction of therapeutic effectiveness to the specific venom immunogen used in production. Antivenomic techniques enable the interactions between venoms and antivenoms to be examined in detail, and if combined with functional assays of specific activity and followed up by clinical trials of effectiveness and safety, can be powerful tools with which to evaluate the
suitability of current and newantivenoms formeeting urgent regional needs.We propose two mechanisms through which the Global Snakebite Initiative might seek to end the antivenom
drought in Africa and Asia: first by establishing a multidisciplinary,multicentre, international collaboration to evaluate currently available antivenoms against the venoms of medically important snakes from specific nations in Africa and Asia using a combination of proteomic, antivenomic and WHO-endorsed preclinical assessment protocols, to provide a validated evidence base for either recommending or rejecting individual products; and secondly by bringing the power of proteomics to bear on the design of new immunising mixtures to raise Pan-African and Pan-Asian polyvalent antivenoms of improved potency and quality. These products will be subject to rigorous clinical assessment. We propose radically to change the basis upon which antivenoms are produced and supplied for the developing world. Donor funding and strategic public health alliances will be sought to make it possible not only to sustain the financial viability of antivenom production partnerships, but also to ensure that patients are relieved of the costs of antivenom so that poverty is no longer a barrier to the treatment of this important, but grossly neglected public health emergency.

- by David Williams and +1
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- Herpetology, Africa, Clinical Trial, Proteomics

- by Gavin Laing
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- Colombia, Brazil, Treatment Outcome, Ecuador

- by Kavi Ratanabanangkoon
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- Herpetology, Africa, Clinical Trial, Proteomics