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TropicalMed
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Treatment Strategies for Toxicity Caused by Venomous Animals
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Treatment Strategies for Toxicity Caused by Venomous Animals

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 17711

Special Issue Editors

Dr. Janeyuth Chaisakul

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Guest Editor
Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Interests: venom; toxins; snake envenoming; pharmacology
Dr. Zuhair Sami Amr

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Guest Editor
Department of Biology, Jordan University of Science & Technology, Irbid 22110, Jordan
Interests: venomous animals; venoms; snakebite; toxins
Dr. Muhamad Rusdi Bin Ahmad Rusmili

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Guest Editor
Department of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Kuantan 25200, Pahang, Malaysia
Interests: venom, natural toxins; proteomic; pharmacology
Dr. Ahmad Khaldun Ismail

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Guest Editor
Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
Interests: clinical toxinology; pre-hospital care; special events medical services

Special Issue Information

Dear Colleagues,

Animal venom and poison are products of evolutionary adaption that function as tools for capturing prey and defending against predators. The toxicity profiles of the venom and poison can vary due to compositional variations, which depend on the species, geographical location, habitat, season, sex, and diet of an animal. Envenoming and poisoning by venomous animals and poisonous animals, respectively, are hazard risks and public health problems in many countries, particularly underdeveloped and developing countries, throughout the world. Animal envenoming or poisoning can be fatal without proper initial medical intervention and, if available in the case of envenoming, the early administration of the correct and sufficient dose of antivenom. Moreover, the underlying mechanisms for pathological events seen following some instances of animal envenoming and poisoning remain unclear and not well-documented. Therefore, an accessible healthcare system, reliable treatment protocols, and effective public education on these matters, supported by laboratories and epidemiological findings, are necessary in reducing the morbidity and mortality caused by animal envenoming and poisoning. In this Special Issue of the Journal of Tropical Medicine and Infectious Disease, we welcome articles addressing areas of biochemical, pharmacological, pathophysiological, epidemiology, and therapeutic research (either pre-clinical or clinical aspects) on animal venoms, envenomation, animal poison, and poisoning caused by animals. This Special Issue will hopefully be of significant benefit to readers, with insights into diagnostic and therapeutic strategies for animal envenoming and poisoning.

Dr. Janeyuth Chaisakul
Dr. Zuhair Sami Amr
Dr. Muhamad Rusdi Bin Ahmad Rusmili
Dr. Ahmad Khaldun Ismail
Guest Editors

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Keywords

  • envenoming
  • snake
  • insect
  • jellyfish
  • spider
  • treatment
  • amphibian
  • marine creatures

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Published Papers (5 papers)

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Research

13 pages, 826 KiB  
Article
Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand
by Sethapong Lertsakulbunlue, Ratchakarn Suebtuam, Theethach Eamchotchawalit, Wittawat Chantkran and Janeyuth Chaisakul
Trop. Med. Infect. Dis. 2023, 8(7), 346; https://doi.org/10.3390/tropicalmed8070346 - 29 Jun 2023
Cited by 4 | Viewed by 2967
Abstract
Snakebite envenoming is an occupational hazard in remote rural areas of South Thailand, where the highest incidence of snakebites is reported. In this work, a hospital-based retrospective study of snakebite patients from 2012 to 2022 at Fort Wachirawut Hospital and Fort Thepsatrisrisunthon Hospital, [...] Read more.
Snakebite envenoming is an occupational hazard in remote rural areas of South Thailand, where the highest incidence of snakebites is reported. In this work, a hospital-based retrospective study of snakebite patients from 2012 to 2022 at Fort Wachirawut Hospital and Fort Thepsatrisrisunthon Hospital, located in Nakhon Si Thammarat province, Thailand was conducted. Data from the laboratory investigation, physical examinations of snakebite victims, and clinical management, including pharmacological and non-pharmacological treatments, were evaluated. A total of 54 snakebite victims were included. The median age of patients was 49 years (IQR, 28 to 63). Males accounted for 74.1% of all participants. The majority of patients were bitten by Malayan pit vipers (68.5%), followed by unidentified snakes (18.5%), other non-venomous snakes (7.4%), and cobras (5.6%). The most common clinical manifestations were swelling (90.2%) and local pain (73.2%). One patient experienced respiratory failure following an envenoming by an unidentified venomous snake. No deaths were observed in this study. In total, 24 patients received antivenom administration (44.4%), most of whom were from Fort Wachirawut Hospital. Patients who were administered antivenom showed a median admission duration of three days (IQR, 3 to 4), compared with two days (IQR, one to three) for those who did not receive antivenom treatment (p < 0.001). In addition, paracetamol and prophylactic antibiotics, namely, amoxicillin-clavulanate and dicloxacillin, were the most common pharmacotherapies following snakebites. Overall, it was observed that these two community hospitals undertook appropriate clinical management under the standard guidelines for snakebite patients. This might be due to the effective emergency management, facilities, and clinical consultations. Finally, the management process in the medical teams also plays a crucial role in minimizing the severity of snakebite outcomes. Full article
(This article belongs to the Special Issue Treatment Strategies for Toxicity Caused by Venomous Animals)
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23 pages, 19341 KiB  
Article
Assessing the Efficacy of Monovalent and Commercialized Antivenoms for Neutralizing Moroccan Cobra Naja haje Venom: A Comparative Study
by Soukaina Khourcha, Ines Hilal, Iatimad Elbejjaj, Mehdi Karkouri, Amal Safi, Abdelaziz Hmyene and Naoual Oukkache
Trop. Med. Infect. Dis. 2023, 8(6), 304; https://doi.org/10.3390/tropicalmed8060304 - 2 Jun 2023
Cited by 6 | Viewed by 2820
Abstract
In Morocco, eight species of venomous snakes belonging to the Viperidae and Elapidae families are responsible for severe envenomation cases. The species from the Elapidae family is only represented by the medically relevant cobra Naja haje, which is widely distributed in North [...] Read more.
In Morocco, eight species of venomous snakes belonging to the Viperidae and Elapidae families are responsible for severe envenomation cases. The species from the Elapidae family is only represented by the medically relevant cobra Naja haje, which is widely distributed in North Africa. However, there is little information on the systemic effects of Moroccan cobra venom on vital organs due to regional variations. It has been demonstrated that the venom of Naja haje from Egypt causes hemorrhage, while the venom of the Moroccan cobra is neurotoxic and devoid of systemic bleeding. This variability is known to significantly influence treatment efficacy against Naja haje cobra bites in the Middle East. In this study, we examined the pathophysiological mechanisms responsible for the lethality induced by Naja haje venom, as well as the evaluation of the neutralizing capacity of two antivenoms; the monospecific antivenom made for Naja haje only and the antivenom marketed in the Middle East and North Africa. We first determined the toxicity of Naja haje venom by LD50 test, then compared the neutralizing capacity of the two antivenoms studied by determining the ED50. We also performed histological analysis on Swiss mice envenomed and treated with these antivenoms to observe signs of cobra venom envenomation and the degree of reduction of induced systemic alterations. The results showed significant differences between both antivenoms in terms of neutralization. The monospecific antivenom was four times more effective than the marketed antivenom. These results were confirmed by a histological study, which showed that monospecific antivenoms neutralized severe signs of mortality, such as congestion of blood vessels in the heart and kidneys, pulmonary and renal edema, cytoplasmic vacuolization of hepatocytes in the liver, and infiltration of inflammatory cells in the brain and spleen. However, the polyvalent antivenom failed to protect all severe lesions induced by Naja haje venom in mice. These findings highlight the negative impact of geographic variation on the effectiveness of conventional antivenom therapy and confirm the need for a specific Naja haje antivenom for the effective treatment of cobra envenomation in Morocco. Full article
(This article belongs to the Special Issue Treatment Strategies for Toxicity Caused by Venomous Animals)
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21 pages, 5164 KiB  
Article
Insight into the Toxicological and Pathophysiological Effects of Moroccan Vipers’ Venom: Assessing the Efficacy of Commercial Antivenom for Neutralization
by Soukaina Khourcha, Ines Hilal, Iatimad Elbejjaj, Mehdi Karkouri, Amal Safi, Abdelaziz Hmyene and Naoual Oukkache
Trop. Med. Infect. Dis. 2023, 8(6), 302; https://doi.org/10.3390/tropicalmed8060302 - 31 May 2023
Cited by 1 | Viewed by 2678
Abstract
Morocco is one of the richest countries in biodiversity in the Mediterranean region, especially in its ophidian fauna. In total, there are eight species of venomous snakes, with seven belonging to the Viperidae family, responsible for 67.2% of severe envenomation cases in the [...] Read more.
Morocco is one of the richest countries in biodiversity in the Mediterranean region, especially in its ophidian fauna. In total, there are eight species of venomous snakes, with seven belonging to the Viperidae family, responsible for 67.2% of severe envenomation cases in the country. Cerastes cerastes, Daboia mauritanica and Bitis arietans are considered among the most venomous vipers whose bites cause high levels of morbidity, disability or mortality. Despite their wide distribution in the kingdom, the incidence of these snakebites remains poorly understood and largely underestimated. Moreover, intraspecific variations in the venom composition significantly affect the effectiveness of antivenoms. Due to the unavailability of locally produced antivenoms, we evaluated the efficacy of Inoserp-MENA, the only available antivenom in Morocco, against C. cerastes, D. mauritanica and B. arietans. First, we conducted a comprehensive characterization of these venoms, including an LD50 test to examine their toxicity and SDS-PAGE as a technique to analyze the enzymes responsible for biological activities, such as hemorrhagic and edematous activities and myotoxicity, which generate physiopathological effects in the skin, paws and muscles of envenomed mice. Then, we assessed the ability of Inoserp-MENA antivenom to neutralize the toxic activities of Moroccan vipers. Our results indicate that the venom of C. cerastes, D. mauritanica and B. arietans are toxic, causing severe alterations such as edema, myotoxicity, myonecrosis and significant hemorrhages with the formation of hemorrhagic foci. C. cerastes venom is more dangerous in terms of lethality and hemorrhages, while B. arietans venom is more edematous. The effects of C. cerastes venom were effectively neutralized, but Inoserp-MENA antivenom failed to protect mice against the toxic effects induced by B. arietans and D. mauritanica venom. The study reveals alarming shortcomings in the effectiveness of the current commercially available antivenom’s dosage and neutralization capabilities, highlighting the urgent need to develop a region-specific viper envenomation therapy. Full article
(This article belongs to the Special Issue Treatment Strategies for Toxicity Caused by Venomous Animals)
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13 pages, 1875 KiB  
Article
Application of Sonographic Assessments of the Rate of Proximal Progression to Monitor Protobothrops mucrosquamatus Bite-Related Local Envenomation: A Prospective Observational Study
by Feng-Chen Chen, Ahmad Khaldun Ismail, Yan-Chiao Mao, Chih-Hsiung Hsu, Liao-Chun Chiang, Chang-Chih Shih, Yuan-Sheng Tzeng, Chin-Sheng Lin, Shing-Hwa Liu and Cheng-Hsuan Ho
Trop. Med. Infect. Dis. 2023, 8(5), 246; https://doi.org/10.3390/tropicalmed8050246 - 24 Apr 2023
Cited by 2 | Viewed by 3618
Abstract
Patients bitten by Protobothrops mucrosquamatus typically experience significant pain, substantial swelling, and potentially blister formation. The appropriate dosage and efficacy of FHAV for alleviating local tissue injury remain uncertain. Between 2017 and 2022, 29 snakebite patients were identified as being bitten by P. [...] Read more.
Patients bitten by Protobothrops mucrosquamatus typically experience significant pain, substantial swelling, and potentially blister formation. The appropriate dosage and efficacy of FHAV for alleviating local tissue injury remain uncertain. Between 2017 and 2022, 29 snakebite patients were identified as being bitten by P. mucrosquamatus. These patients underwent point-of-care ultrasound (POCUS) assessments at hourly intervals to measure the extent of edema and evaluate the rate of proximal progression (RPP, cm/hour). Based on Blaylock’s classification, seven patients (24%) were classified as Group I (minimal), while 22 (76%) were classified as Group II (mild to severe). In comparison to Group I patients, Group II patients received more FHAV (median of 9.5 vials vs. two vials, p-value < 0.0001) and experienced longer median complete remission times (10 days vs. 2 days, p-value < 0.001). We divided the Group II patients into two subgroups based on their clinical management. Clinicians opted not to administer antivenom treatment to patients in Group IIA if their RPP decelerated. In contrast, for patients in Group IIB, clinicians increased the volume of antivenom in the hope of reducing the severity of swelling or blister formation. Patients in Group IIB received a significantly higher median volume of antivenom (12 vials vs. six vials; p-value < 0.001) than those in Group IIA. However, there was no significant difference in outcomes (disposition, wound necrosis, and complete remission times) between subgroups IIA and IIB. Our study found that FHAV does not appear to prevent local tissue injuries, such as swelling progression and blister formation, immediately after administration. When administering FHAV to patients bitten by P. mucrosquamatus, the deceleration of RPP may serve as an objective parameter to help clinicians decide whether to withhold FHAV administration. Full article
(This article belongs to the Special Issue Treatment Strategies for Toxicity Caused by Venomous Animals)
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13 pages, 3795 KiB  
Article
Immunoprofiling of Equine Plasma against Deinagkistrodon acutus in Taiwan: Key to Understanding Differential Neutralization Potency in Immunized Horses
by Cho-Ju Wu, Geng-Wang Liaw, Chun-Kuei Chen, Chun-Hsiang Ouyang, Yi-Xiu Yang, Li-Chieh Chu, Yung-Chin Hsiao, Chien-Hsin Liu, Wen-Chin Hsieh, Cyong-Yi Wang, Yu-Syuan Liou, Chien-Chun Liu and Cheng-Hsien Hsieh
Trop. Med. Infect. Dis. 2023, 8(1), 51; https://doi.org/10.3390/tropicalmed8010051 - 9 Jan 2023
Cited by 2 | Viewed by 3556
Abstract
Snakebite envenoming is a public health issue linked to high mortality and morbidity rates worldwide. Although antivenom has been the mainstay treatment for envenomed victims receiving medical care, the diverse therapeutic efficacy of the produced antivenom is a major limitation. Deinagkistrodon acutus is [...] Read more.
Snakebite envenoming is a public health issue linked to high mortality and morbidity rates worldwide. Although antivenom has been the mainstay treatment for envenomed victims receiving medical care, the diverse therapeutic efficacy of the produced antivenom is a major limitation. Deinagkistrodon acutus is a venomous snake that poses significant concern of risks to human life in Taiwan, and successful production of antivenom against D. acutus envenoming remains a considerable challenge. Among groups of horses subjected to immunization schedules, few or none subsequently meet the quality required for further scale-up harvesting. The determinants underlying the variable immune responses of horses to D. acutus venom are currently unknown. In this study, we assessed the immunoprofiles of high-potency and low-potency horse plasma against D. acutus venom and explored the conspicuous differences between these two groups. Based on the results of liquid chromatography with tandem mass spectrometry (LC-MS/MS), acutolysin A was identified as the major component of venom proteins that immunoreacted differentially with the two plasma samples. Our findings indicate underlying differences in antivenoms with variable neutralization efficacies, and may provide valuable insights for improvement of antivenom production in the future. Full article
(This article belongs to the Special Issue Treatment Strategies for Toxicity Caused by Venomous Animals)
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