Life-threatening envenoming by the Saharan horned viper (Cerastes cerastes) causing micro-angiopathic haemolysis, coagulopathy and acute renal failure: clinical cases and review

Background: The desert horned vipers (Cerastes cerastes and C. gasperettii) are the most familiar snakes of the great deserts of North Africa and the Middle East, including the plains of Iraq. They are responsible for many human snake bites. In Western countries, they are popular among exotic-snake keepers. Aim: To investigate mechanisms of life-threatening envenoming and treatment. Design: Clinical investigation. Methods: Clinical and laboratory studies with measurement of serum venom antigen concentrations by enzyme immunoassay. Results: Two men bitten while handling captive Saharan horned vipers (Cerastes cerastes) in Europe developed extensive local swelling and life-threatening systemic envenoming, characterized by coagulopathy, increased fibrinolysis, thrombocytopenia, micro-angiopathic haemolytic anaemia and acute renal failure. The clinical picture is explicable by the presence in C. cerastes venom of several thrombin-like, Factor-X-activating, platelet-aggregating, haemorrhagic and nephrotoxic components. In one case, prophylactic use of subcutaneous epinephrine may have contributed to intracranial haemorrhage. The roles in treatment of heparin (rejected) and specific antivenom (recommended) are discussed. Discussion: Cerastes cerastes is capable of life-threatening envenoming in humans. Optimal treatment of envenoming is by early administration of specific antivenom, and avoidance of ineffective and potentially-dangerous ancillary method

Snake venom metalloproteinases and disintegrins: interactions with cells

Metalloproteinases and disintegrins are important components of most viperid and crotalid venoms. Large metalloproteinases referred to as MDC enzymes are composed of an N-terminal Metalloproteinase domain, a Disintegrin-like domain and a Cys-rich C-terminus. In contrast, disintegrins are small non-enzymatic RGD-containing cysteine-rich polypeptides. However, the disintegrin region of MDC enzymes bears a high degree of structural homology to that of the disintegrins, although it lacks the RGD motif. Despite these differences, both components share the property of being able to recognize integrin cell surface receptors and thereby to inhibit integrin-dependent cell reactions. Recently, several membrane-bound MDC enzymes, closely related to soluble venom MDC enzymes, have been described in mammalian cells. This group of membrane-anchored mammalian enzymes is also called the ADAM family of proteins due to the structure revealing A Disintegrin And Metalloproteinase domains. ADAMs are involved in the shedding of molecules from the cell surface, a property which is also shared by some venom MDC enzymes

Standardization of an enzyme linked immunosorbent assay (ELISA) for detecting circulating toxic venom antigens in patients stung by the scorpion Tityus serrulatus Padronização de um teste imunoenzimático (ELISA) para detectar antígenos tóxicos circulantes do veneno em pacientes picados pelo escorpião Tityus serrulatus

The sensitivity and specificity of an enzyme-linked immunosorbent assay (ELISA) for the detection of circulating antigens from toxic components of Tityus serrulatus scorpion venom was determined in patients stung by T. serrulatus before antivenom administration. Thirty-seven patients were classified as mild cases and 19 as moderate or severe cases. The control absorbance in the venom assay was provided by serum samples from 100 individuals of same socioeconomic group and geographical area who had never been stung by scorpions or treated with horse antisera. The negative cutoff value (mean + 2 SD) corresponded to a venom concentration of 4.8 ng/ml. Three out of the 100 normal sera were positive, resulting in a specificity of 97%. The sensitivity of the ELISA when all cases of scorpion sting were included was 39.3%. When mild cases were excluded, the sensitivity increased to 94.7%. This study showed that this ELISA can be used for the detection of circulating venom toxic antigens in patients with systemic manifestations following. T. serrulatus sting but cannot be used for clinical studies in mild cases of envenoming since the test does not discriminate mild cases from control patients.<br>Neste trabalho foram determinadas a sensibilidade e a especificidade da técnica imunoenzimática (ELISA) desenvolvida por CHAVÉZ-OLORTEGUI et al. para detectar antígenos circulantes de veneno em pacientes picados po Tityus serrulatus. A média mais dois desvios padrão da observância do soro de 100 pacientes controles foi utilizada como limite entre teste positivo e teste negativo ("cutoff"). A especificidade do ELISA foi igual a 97,0%. A sensibilidade do método, quando incluidos pacientes classificados como casos leves, moderados e graves de escorpionismo, foi de 39,3% e aumentou para 94,7% quando considerados apenas os casos moderados e graves. Estes resultados mostram que o ELISA pode ser utilizado para detecção de antígenos tóxicos circulantes em pacientes com manifestações sistêmicas de envenenamento escorpiônico mas não deve ser empregado no estudo de pacientes que apresentam apenas dor no local da picada (casos leves). O tempo necessário para a realização do ELISA é superior a 1 hora. Portanto, o teste tem sua utilização limitada para o diagnóstico de envenenamento, mas pode constituir um instrumento útil para o estudo da cinética de neutralização do veneno pelo antiveneno específico

Traditional treatments for snake bite in a rural African community

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