279. Travel Toxinology: An Illustrative Case of Brown Spotted Pit Viper (Protobothrops...
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surveillance network and consolidation of the information available about mortality and morbidity. Methods: Study design was descriptive and transversal, and data from the period 2007-2011 was collected from the National Surveillance System of Health (Sistema Nacional de Vigilancia de la Salud; SNVS). Analysis was made using Microsoft Office Excel, GeCo C2, Epiinfo 3.5.1 and SIGEpi 1.0 software. Results: Within the study period 45012 cases of enve- nomation by venomous animals (9002 cases/year) were registered in the SNVS. 3692 (8.2%) cases were caused by snakes, 6084 (13.5%) by spiders and 35236 (78.3%) by scorpions, corresponding to an incidence rate of 1.8, 3.0 and 17.6 cases/10.000 inhabitants per year, respectively. 15-24 years old was the most affected age group. During the same period 40 deaths were registered, snake bites accounted for 42.5%, scorpion stings for 35.0% and 22.5% were caused by spider bites. Among snake caused deaths, people older than 65 years old were most affected (47.1%), while spiders caused death preferably to the patients older than 45 years old (62.5%). On the other hand, children of 9 years old or less accounted for the majority of deaths by scorpions (96.4%). Geographic distribution of envenomation inci- dence is not uniform, while scorpions and spiders show the highest incidence in the northwest region (58.5 cases/ 10.000 inhabitants per year and 7.7 cases/10.000 inhabi- tants per year respectively), snakes morbidity is higher in the northeast region (8.6 cases/10.000 inhabitants per year). Besides, Northeast and Northwest regions show the greatest notification for snakes (1591 and 1379 cases respectively), while scorpion and spider notification is highest in the center and northwest regions (14033 and 13757 cases for scorpion; 1718 and 1799 for spiders). Envenomation occurs mainly in the summer season for all three poisonous animals. Conclusions: Envenomation by venomous animals constitutes a significant health problem in some regions of Argentina. These events are always medical emergencies and prevention is made through education. Besides, specific treatment provision and adequate management of patients are necessary to avoid serious damage or death. Keywords: Health surveillance, snakes, spiders, scorpions, epidemiology 10.1016/j.toxicon.2012.04.279 279. Travel Toxinology: An Illustrative Case of Brown Spotted Pit Viper (Protobothrops mucrosquamatus) Bite With Review of Clinical Toxinology Issues in Travel Medicine Julian White 1 , Bart Currie 2 1 Toxinology Dept., Women's & Children's Hospital, North Adelaide, SA, Australia 2 Menzies School of Health Research, Casuarina, NT, Australia E-mail address: [email protected] (J. White). Background: Tourism is emerging as a major economic driver globally and travellers visit ever more exotic places. As a consequence, exposure to Venom Induced Diseases (VIDs) becomes an increasing risk. Lack of resources to adequately diagnose and treat VIDs in many parts of the world increases the risk of suboptimal outcomes. Case Report: A 12 year old girl on holiday with her family in Vietnam was bitten on her ankle by a snake while on a tour boat in Ha Long Bay. Local suction and a tourni- quet were applied as first aid, then she was transferred to the mainland hospital where the tourniquet was removed, but no antivenom given as the snake identity was unknown. The snake had been killed and was brought with the patient. The patient complained of significant local pain which remained untreated, then was transferred to a larger hospital, where again no antivenom was given because of doubt over the snake‘s identity. By this time, many hours later, the foot and leg, extending to the abdomen, was markedly swollen. A mild coagulopathy was present, with thrombocytopenia and anaemia. The patient continued to be managed conservatively, with no antivenom and after a week was transferred to Australia. There a marked foot drop was evident with MRI evidence of deep foot muscle necrosis. Despite this over the following weeks the patient regained full use of the foot. Clear photographs of the killed snake were identified by experts as Protobothrops mucros- quamatus. The only antivenom for this snake, a known inhabitant of northern Vietnam, is made in Taiwan. Discussion: This case illustrates a number of problems for tourists envenomed in another country where communication and health system issues can adversely affect treatment. Early consultation with a clinical tox- inologist might have allowed identification of the snake and sourcing of suitable antivenom. This case is illustrative of a wider problem for “travel toxinology” cases. Local health systems may not have the expected expertise to diagnose and treat envenoming, even by local species. Rapid access to (clinical toxinology) expertise per phone, availability of suitable antivenoms and urgent transfer of stabilised envenomed patients are all required elements in improving patient outcomes. Keywords: Snakebite, Protobothrops mucrosquamatus, envenoming 10.1016/j.toxicon.2012.04.280 Q. Venomous Animal Biology 280. Genetic Regulation of Venom Production during Embryonic Development of the Indochinese Spitting Cobra, Naja siamensis Jessica M. Logan 1 , Peter J. Mirtschin 1, 2 , Anthony E. Woods 1 1 School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia 2 Venom Supplies Pty Ltd, Tanunda, SA, Australia E-mail address: [email protected] (J.M. Logan). Background: Snake venoms are a potential source of pharmacologically active components. Since the initial discovery of the ACE inhibitors which were originally derived from the venom of the Brazilian Arrow Head Viper, several compounds have stimulated pharmacological interest although issues relating to venom yield and vari- ability have hampered efforts to isolate these agents. Abstracts Toxins 2012 / Toxicon 60 (2012) 95–248 239
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Transcript of 279. Travel Toxinology: An Illustrative Case of Brown Spotted Pit Viper (Protobothrops...
Abstracts Toxins 2012 / Toxicon 60 (2012) 95–248 239
surveillance network and consolidation of the informationavailable about mortality and morbidity.
Methods: Study design was descriptive and transversal,and data from the period 2007-2011 was collected from theNational Surveillance System of Health (Sistema Nacionalde Vigilancia de la Salud; SNVS). Analysis was made usingMicrosoft Office Excel, GeCo C2, Epiinfo 3.5.1 and SIGEpi 1.0software.
Results: Within the study period 45012 cases of enve-nomation by venomous animals (9002 cases/year) wereregistered in the SNVS. 3692 (8.2%) cases were caused bysnakes, 6084 (13.5%) by spiders and 35236 (78.3%) byscorpions, corresponding to an incidence rate of 1.8, 3.0 and17.6 cases/10.000 inhabitants per year, respectively. 15-24years old was the most affected age group. During the sameperiod 40 deaths were registered, snake bites accounted for42.5%, scorpion stings for 35.0% and 22.5% were caused byspider bites. Among snake caused deaths, people older than65 years old were most affected (47.1%), while spiderscaused death preferably to the patients older than 45 yearsold (62.5%). On the other hand, children of 9 years old orless accounted for the majority of deaths by scorpions(96.4%). Geographic distribution of envenomation inci-dence is not uniform, while scorpions and spiders show thehighest incidence in the northwest region (58.5 cases/10.000 inhabitants per year and 7.7 cases/10.000 inhabi-tants per year respectively), snakes morbidity is higher inthe northeast region (8.6 cases/10.000 inhabitants peryear). Besides, Northeast and Northwest regions show thegreatest notification for snakes (1591 and 1379 casesrespectively), while scorpion and spider notification ishighest in the center and northwest regions (14033 and13757 cases for scorpion; 1718 and 1799 for spiders).Envenomation occurs mainly in the summer season for allthree poisonous animals.
Conclusions: Envenomation by venomous animalsconstitutes a significant health problem in some regions ofArgentina. These events are always medical emergenciesand prevention is made through education. Besides,specific treatment provision and adequate management ofpatients are necessary to avoid serious damage or death.
Keywords: Health surveillance, snakes, spiders, scorpions, epidemiology10.1016/j.toxicon.2012.04.279
279. Travel Toxinology: An Illustrative Case of BrownSpotted Pit Viper (Protobothrops mucrosquamatus) BiteWith Review of Clinical Toxinology Issues in TravelMedicine
Julian White 1, Bart Currie 2
1 Toxinology Dept., Women's & Children's Hospital, North Adelaide,SA, Australia2Menzies School of Health Research, Casuarina, NT, AustraliaE-mail address: [email protected] (J. White).
Background: Tourism is emerging as a major economicdriver globally and travellers visit ever more exotic places.As a consequence, exposure to Venom Induced Diseases(VIDs) becomes an increasing risk. Lack of resources to
adequately diagnose and treat VIDs in many parts of theworld increases the risk of suboptimal outcomes.
Case Report: A 12 year old girl on holiday with herfamily in Vietnamwas bitten on her ankle by a snake whileon a tour boat in Ha Long Bay. Local suction and a tourni-quet were applied as first aid, then she was transferred tothe mainland hospital where the tourniquet was removed,but no antivenom given as the snake identity wasunknown. The snake had been killed and was brought withthe patient. The patient complained of significant local painwhich remained untreated, thenwas transferred to a largerhospital, where again no antivenom was given because ofdoubt over the snake‘s identity. By this time, many hourslater, the foot and leg, extending to the abdomen, wasmarkedly swollen. A mild coagulopathy was present, withthrombocytopenia and anaemia. The patient continued tobe managed conservatively, with no antivenom and aftera week was transferred to Australia. There a marked footdrop was evident with MRI evidence of deep foot musclenecrosis. Despite this over the following weeks the patientregained full use of the foot. Clear photographs of the killedsnake were identified by experts as Protobothrops mucros-quamatus. The only antivenom for this snake, a knowninhabitant of northern Vietnam, is made in Taiwan.
Discussion: This case illustrates a number of problemsfor tourists envenomed in another country wherecommunication and health system issues can adverselyaffect treatment. Early consultation with a clinical tox-inologist might have allowed identification of the snakeand sourcing of suitable antivenom. This case is illustrativeof a wider problem for “travel toxinology” cases. Localhealth systems may not have the expected expertise todiagnose and treat envenoming, even by local species.Rapid access to (clinical toxinology) expertise per phone,availability of suitable antivenoms and urgent transfer ofstabilised envenomed patients are all required elements inimproving patient outcomes.
Keywords: Snakebite, Protobothrops mucrosquamatus, envenoming10.1016/j.toxicon.2012.04.280
Q. Venomous Animal Biology
280. Genetic Regulation of Venom Production duringEmbryonic Development of the Indochinese SpittingCobra, Naja siamensis
Jessica M. Logan 1, Peter J. Mirtschin 1,2, Anthony E. Woods 1
1 School of Pharmacy and Medical Sciences, University of South Australia,Adelaide, SA, Australia2Venom Supplies Pty Ltd, Tanunda, SA, AustraliaE-mail address: [email protected] (J.M. Logan).
Background: Snake venoms are a potential source ofpharmacologically active components. Since the initialdiscovery of the ACE inhibitors which were originallyderived from the venom of the Brazilian Arrow Head Viper,several compounds have stimulated pharmacologicalinterest although issues relating to venom yield and vari-ability have hampered efforts to isolate these agents.
