Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis
Abstract Background: Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well c...
Published in: | Journal of Venomous Animals and Toxins including Tropical Diseases |
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ftdoajarticles:oai:doaj.org/article:ca6a3e6014d94bc38cb4b0e22ee019c9 2023-05-15T15:15:33+02:00 Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis Liao-Chun Chiang Wei-Jen Tsai Po-Yu Liu Cheng-Hsuan Ho Hung-Yuan Su Chih-Sheng Lai Kuo-Lung Lai Wen-Loung Lin Chi-Hsin Lee Yi-Yuan Yang Uyen Vy Doan Tri Maharani Yan-Chiao Mao https://doi.org/10.1590/1678-9199-jvatitd-2020-0043 https://doaj.org/article/ca6a3e6014d94bc38cb4b0e22ee019c9 EN eng SciELO http://www.scielo.br/pdf/jvatitd/v26/1678-9199-jvatitd-26-e20200043.pdf http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-91992020000100329&tlng=en https://doaj.org/toc/1678-9199 1678-9199 doi:10.1590/1678-9199-jvatitd-2020-0043 https://doaj.org/article/ca6a3e6014d94bc38cb4b0e22ee019c9 Journal of Venomous Animals and Toxins including Tropical Diseases Trimeresurus stejnegeri stejnegeri Snakebites Snake antivenom Chinese green tree viper Stejneger’s bamboo pitviper Arctic medicine. Tropical medicine RC955-962 Toxicology. Poisons RA1190-1270 Zoology QL1-991 article ftdoajarticles https://doi.org/10.1590/1678-9199-jvatitd-2020-0043 2022-12-31T13:42:30Z Abstract Background: Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Journal of Venomous Animals and Toxins including Tropical Diseases 26 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Trimeresurus stejnegeri stejnegeri Snakebites Snake antivenom Chinese green tree viper Stejneger’s bamboo pitviper Arctic medicine. Tropical medicine RC955-962 Toxicology. Poisons RA1190-1270 Zoology QL1-991 |
spellingShingle |
Trimeresurus stejnegeri stejnegeri Snakebites Snake antivenom Chinese green tree viper Stejneger’s bamboo pitviper Arctic medicine. Tropical medicine RC955-962 Toxicology. Poisons RA1190-1270 Zoology QL1-991 Liao-Chun Chiang Wei-Jen Tsai Po-Yu Liu Cheng-Hsuan Ho Hung-Yuan Su Chih-Sheng Lai Kuo-Lung Lai Wen-Loung Lin Chi-Hsin Lee Yi-Yuan Yang Uyen Vy Doan Tri Maharani Yan-Chiao Mao Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
topic_facet |
Trimeresurus stejnegeri stejnegeri Snakebites Snake antivenom Chinese green tree viper Stejneger’s bamboo pitviper Arctic medicine. Tropical medicine RC955-962 Toxicology. Poisons RA1190-1270 Zoology QL1-991 |
description |
Abstract Background: Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite. |
format |
Article in Journal/Newspaper |
author |
Liao-Chun Chiang Wei-Jen Tsai Po-Yu Liu Cheng-Hsuan Ho Hung-Yuan Su Chih-Sheng Lai Kuo-Lung Lai Wen-Loung Lin Chi-Hsin Lee Yi-Yuan Yang Uyen Vy Doan Tri Maharani Yan-Chiao Mao |
author_facet |
Liao-Chun Chiang Wei-Jen Tsai Po-Yu Liu Cheng-Hsuan Ho Hung-Yuan Su Chih-Sheng Lai Kuo-Lung Lai Wen-Loung Lin Chi-Hsin Lee Yi-Yuan Yang Uyen Vy Doan Tri Maharani Yan-Chiao Mao |
author_sort |
Liao-Chun Chiang |
title |
Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
title_short |
Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
title_full |
Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
title_fullStr |
Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
title_full_unstemmed |
Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
title_sort |
envenomation by trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis |
publisher |
SciELO |
url |
https://doi.org/10.1590/1678-9199-jvatitd-2020-0043 https://doaj.org/article/ca6a3e6014d94bc38cb4b0e22ee019c9 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Journal of Venomous Animals and Toxins including Tropical Diseases |
op_relation |
http://www.scielo.br/pdf/jvatitd/v26/1678-9199-jvatitd-26-e20200043.pdf http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-91992020000100329&tlng=en https://doaj.org/toc/1678-9199 1678-9199 doi:10.1590/1678-9199-jvatitd-2020-0043 https://doaj.org/article/ca6a3e6014d94bc38cb4b0e22ee019c9 |
op_doi |
https://doi.org/10.1590/1678-9199-jvatitd-2020-0043 |
container_title |
Journal of Venomous Animals and Toxins including Tropical Diseases |
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26 |
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1766345928129642496 |