Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16).
BACKGROUND: Death adders (Acanthophis spp) are found in Australia, Papua New Guinea and parts of eastern Indonesia. This study aimed to investigate the clinical syndrome of death adder envenoming and response to antivenom treatment. METHODOLOGY/PRINCIPAL FINDINGS: Definite death adder bites were rec...
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ftdoajarticles:oai:doaj.org/article:7b639136c19e48e0a34c2f6fd9ac5290 2023-05-15T15:16:10+02:00 Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). Christopher I Johnston Margaret A O'Leary Simon G A Brown Bart J Currie Lambros Halkidis Richard Whitaker Benjamin Close Geoffrey K Isbister 2012-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0001841 https://doaj.org/article/7b639136c19e48e0a34c2f6fd9ac5290 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC3459885?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 doi:10.1371/journal.pntd.0001841 1935-2727 1935-2735 https://doaj.org/article/7b639136c19e48e0a34c2f6fd9ac5290 PLoS Neglected Tropical Diseases, Vol 6, Iss 9, p e1841 (2012) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2012 ftdoajarticles https://doi.org/10.1371/journal.pntd.0001841 2022-12-31T03:47:02Z BACKGROUND: Death adders (Acanthophis spp) are found in Australia, Papua New Guinea and parts of eastern Indonesia. This study aimed to investigate the clinical syndrome of death adder envenoming and response to antivenom treatment. METHODOLOGY/PRINCIPAL FINDINGS: Definite death adder bites were recruited from the Australian Snakebite Project (ASP) as defined by expert identification or detection of death adder venom in blood. Clinical effects and laboratory results were collected prospectively, including the time course of neurotoxicity and response to treatment. Enzyme immunoassay was used to measure venom concentrations. Twenty nine patients had definite death adder bites; median age 45 yr (5-74 yr); 25 were male. Envenoming occurred in 14 patients. Two further patients had allergic reactions without envenoming, both snake handlers with previous death adder bites. Of 14 envenomed patients, 12 developed neurotoxicity characterised by ptosis (12), diplopia (9), bulbar weakness (7), intercostal muscle weakness (2) and limb weakness (2). Intubation and mechanical ventilation were required for two patients for 17 and 83 hours. The median time to onset of neurotoxicity was 4 hours (0.5-15.5 hr). One patient bitten by a northern death adder developed myotoxicity and one patient only developed systemic symptoms without neurotoxicity. No patient developed venom induced consumption coagulopathy. Antivenom was administered to 13 patients, all receiving one vial initially. The median time for resolution of neurotoxicity post-antivenom was 21 hours (5-168). The median peak venom concentration in 13 envenomed patients with blood samples was 22 ng/mL (4.4-245 ng/mL). In eight patients where post-antivenom bloods were available, no venom was detected after one vial of antivenom. CONCLUSIONS/SIGNIFICANCE: Death adder envenoming is characterised by neurotoxicity, which is mild in most cases. One vial of death adder antivenom was sufficient to bind all circulating venom. The persistent neurological effects despite antivenom, ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 6 9 e1841 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Christopher I Johnston Margaret A O'Leary Simon G A Brown Bart J Currie Lambros Halkidis Richard Whitaker Benjamin Close Geoffrey K Isbister Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: Death adders (Acanthophis spp) are found in Australia, Papua New Guinea and parts of eastern Indonesia. This study aimed to investigate the clinical syndrome of death adder envenoming and response to antivenom treatment. METHODOLOGY/PRINCIPAL FINDINGS: Definite death adder bites were recruited from the Australian Snakebite Project (ASP) as defined by expert identification or detection of death adder venom in blood. Clinical effects and laboratory results were collected prospectively, including the time course of neurotoxicity and response to treatment. Enzyme immunoassay was used to measure venom concentrations. Twenty nine patients had definite death adder bites; median age 45 yr (5-74 yr); 25 were male. Envenoming occurred in 14 patients. Two further patients had allergic reactions without envenoming, both snake handlers with previous death adder bites. Of 14 envenomed patients, 12 developed neurotoxicity characterised by ptosis (12), diplopia (9), bulbar weakness (7), intercostal muscle weakness (2) and limb weakness (2). Intubation and mechanical ventilation were required for two patients for 17 and 83 hours. The median time to onset of neurotoxicity was 4 hours (0.5-15.5 hr). One patient bitten by a northern death adder developed myotoxicity and one patient only developed systemic symptoms without neurotoxicity. No patient developed venom induced consumption coagulopathy. Antivenom was administered to 13 patients, all receiving one vial initially. The median time for resolution of neurotoxicity post-antivenom was 21 hours (5-168). The median peak venom concentration in 13 envenomed patients with blood samples was 22 ng/mL (4.4-245 ng/mL). In eight patients where post-antivenom bloods were available, no venom was detected after one vial of antivenom. CONCLUSIONS/SIGNIFICANCE: Death adder envenoming is characterised by neurotoxicity, which is mild in most cases. One vial of death adder antivenom was sufficient to bind all circulating venom. The persistent neurological effects despite antivenom, ... |
format |
Article in Journal/Newspaper |
author |
Christopher I Johnston Margaret A O'Leary Simon G A Brown Bart J Currie Lambros Halkidis Richard Whitaker Benjamin Close Geoffrey K Isbister |
author_facet |
Christopher I Johnston Margaret A O'Leary Simon G A Brown Bart J Currie Lambros Halkidis Richard Whitaker Benjamin Close Geoffrey K Isbister |
author_sort |
Christopher I Johnston |
title |
Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). |
title_short |
Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). |
title_full |
Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). |
title_fullStr |
Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). |
title_full_unstemmed |
Death adder envenoming causes neurotoxicity not reversed by antivenom--Australian Snakebite Project (ASP-16). |
title_sort |
death adder envenoming causes neurotoxicity not reversed by antivenom--australian snakebite project (asp-16). |
publisher |
Public Library of Science (PLoS) |
publishDate |
2012 |
url |
https://doi.org/10.1371/journal.pntd.0001841 https://doaj.org/article/7b639136c19e48e0a34c2f6fd9ac5290 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 6, Iss 9, p e1841 (2012) |
op_relation |
http://europepmc.org/articles/PMC3459885?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 doi:10.1371/journal.pntd.0001841 1935-2727 1935-2735 https://doaj.org/article/7b639136c19e48e0a34c2f6fd9ac5290 |
op_doi |
https://doi.org/10.1371/journal.pntd.0001841 |
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PLoS Neglected Tropical Diseases |
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6 |
container_issue |
9 |
container_start_page |
e1841 |
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