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-
1.
World Health Organization , 2018. Global Snakebite Burden: Report by the Director-General. Geneva, Switzerland: World Health Assembly, 71. Available at: https://apps.who.int/iris/handle/10665/276406. Accessed August 18, 2020.
-
2.
Gutiérrez JM , Calvete JJ , Habib AG , Harrison RA , Williams DJ , Warrell DA , 2017. Snakebite envenoming. Nat Rev Dis Primers 3: 17079.
-
3.
Seqirus , 2017. Snake Venom Detection Kit (SVDK). Available at: https://labeling.seqirus.com/SVDK/AU/Snake-Venom-Detection-Kit/EN/Snake-Venom-Detection-Kit.pdf. Accessed August 18, 2020.
-
4.
Maduwage K , O’Leary MA , Isbister GK , 2014. Diagnosis of snake envenomation using a simple phospholipase A2 assay. Sci Rep 4: 4827.
-
5.
Warrell DA , Davidson NMD , Greenwood BM , Ormerod LD , Pope HM , Watkins BJ , Prentice CR , 1977. Poisoning by bites of the saw-scaled or carpet viper (Echis carinatus) in Nigeria. Q J Med 46: 33–62.
-
6.
Hirschmann JV , Raugi GJ , 2012. Lower limb cellulitis and its mimics: part I. Lower limb cellulitis. J Am Acad Dermatol 67: 163.e1–163.e12.
-
7.
Chung O , Juonala M , Mallat Z , Hutri-Kähönen N , Viikari JSA , Raitakari OT , Magnussen CG , 2019. Tracking of secretory phospholipase A2 enzyme activity levels from childhood to adulthood: a 21-year cohort. J Pediatr (Rio J) 95: 247–254.
-
8.
Mallat Z et al. 2005. Circulating secretory phospholipase A2 activity predicts recurrent events in patients with severe acute coronary syndromes. J Am Coll Cardiol 46: 1249–1257.
-
9.
Rivière G , Choumet V , Saliou B , Debray M , Bon C , 1998. Absorption and elimination of viper venom after antivenom administration. J Pharmacol Exp Ther 285: 490–495.
-
10.
Barnes JM , Trueta J , 1941. Absorption of bacteria, toxins and snake venoms from the tissues: importance of the lymphatic circulation. Lancet 237: 623–626.
-
11.
Tasoulis T , Isbister GK , 2017. A review and database of snake venom proteomes. Toxins (Basel) 9: 290.
-
12.
Senji Laxme RR , Khochare S , de Souza HF , Ahuja B , Suranse V , Martin G , Whitaker R , Sunagar K , 2019. Beyond the ‘big four’: venom profiling of the medically important yet neglected Indian snakes reveals disturbing antivenom deficiencies. PLoS Negl Trop Dis 13: e0007899.
-
13.
Tun P , Khin Aung C , 1986. Amount of venom injected by Russell’s viper (Vipera russelli). Toxicon 24: 730–733.
-
14.
Sharma M , Gogoi N , Dhananjaya BL , Menon JC , Doley R , 2014. Geographical variation of Indian Russell’s viper venom and neutralization of its coagulopathy by polyvalent antivenom. Toxin Rev 33: 7–15.
-
15.
Boback SM , 2003. Body size evolution in snakes: evidence from island populations. Copeia 2003: 81–94.
-
16.
Daltry JC , Wüster W , Thorpe RS , 1996. Diet and snake venom evolution. Nature 379: 537–540.
-
17.
Warrell DA , 1989. Snake venoms in science and clinical medicine. 1. Russell’s viper: biology, venom and treatment of bites. Trans R Soc Trop Med Hyg 83: 732–740.
-
18.
Isbister GK , Shahmy S , Mohamed F , Abeysinghe C , Karunathilake H , Ariaratnam A , 2012. A randomised controlled trial of two infusion rates to decrease reactions to antivenom. PLoS One 7: e38739.
-
19.
Rutjes AW , Reitsma JB , Vandenbroucke JP , Glas AS , Bossuyt PM , 2005. Case-control and two-gate designs in diagnostic accuracy studies. Clin Chem 51: 1335–1341.
-
20.
Gutiérrez JM , León G , Lomonte B , 2003. Pharmacokinetic-pharmacodynamic relationships of immunoglobulin therapy for envenomation. Clin Pharmacokinet 42: 721–741.
-
21.
Isbister GK , Halkidis L , O’Leary MA , Whitaker R , Cullen P , Mulcahy R , Bonnin R , Brown SG , 2010. Human anti-snake venom IgG antibodies in a previously bitten snake-handler, but no protection against local envenoming. Toxicon 55: 646–649.
-
22.
Macêdo JKA , Joseph JK , Menon J , Escalante T , Rucavado A , Gutiérrez JM , Fox JW , 2019. Proteomic analysis of human blister fluids following envenomation by three snake species in India: differential markers for venom mechanisms of action. Toxins (Basel) 11: 246.
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| Abstract Views | 1015 | 293 | 45 |
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Circulating Secretory Phospholipase A2 Activity following Snakebites and Its Relationship with Envenomation Status and Progression of Local Swelling
Akinchan Bhardwaj
Akinchan Bhardwaj
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;
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Rajaa Muthu
Rajaa Muthu
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;
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Rajendiran Soundravally
Rajendiran Soundravally
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;
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Agieshkumar Balakrishna Pillai
Agieshkumar Balakrishna Pillai
Central Inter-Disciplinary Research Facility, Sri Balaji Vidyapeeth (Deemed To Be University), Puducherry, India
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Chanaveerappa Bammigatti
Chanaveerappa Bammigatti
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;
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Tamilarasu Kadhiravan
Tamilarasu Kadhiravan
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;
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ABSTRACT
We studied whether circulating secretory phospholipase A2 (sPLA2) activity reliably distinguished patients with snakebite envenomation from those with nonvenomous/dry snakebites, and whether patients with progressive local swelling had persistence of circulating sPLA2 activity despite antivenom treatment. We prospectively enrolled adults presenting to the emergency with a history of snakebite in the past 24 hours. We estimated circulating sPLA2 activity at baseline before antivenom administration and after 48 hours in those with envenomation. We enrolled 52 patients with snakebites (mean age 39.3 ± 12.6 years; 35 [67%] men), and 16 patients with infective cellulitis as controls. Thirty patients had local ± systemic envenomation; 15 were classified as dry/nonvenomous bites; and envenomation status was unclear in seven patients. Baseline sPLA2 activity was significantly higher in snakebite patients than that in those with infective cellulitis (4.64 [3.38–5.91] versus 3.38 [1.69–4.01] nmol/minute/mL; P = 0.005). Among patients with snakebites, sPLA2 activity in the highest quartile was significantly associated with envenomation (12 of 27 versus two of 22; P = 0.010). However, median sPLA2 activity did not differ significantly between patients with envenomation and the rest. Baseline sPLA2 activity was significantly associated with the maximum extent of limb swelling (P = 0.031 for trend). In envenomed patients, circulating sPLA2 activity significantly decreased after 48 hours compared with the baseline (5.49 [3.38–8.86] versus 3.38 [2.53–4.64]; P = 0.003) including those with progressive swelling. Although circulating sPLA2 activity was elevated following snakebites, its sensitivity to diagnose envenomation appears to be limited. Administration of more antivenom after systemic manifestations had reversed might not benefit patients with progressive local swelling.
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Author Notes
Financial support: This work was supported by an intramural research grant from the Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India (Grant no: JIP/Res/Intramural/phs2/2017-18/2).
Authors’ addresses: Akinchan Bhardwaj, Chanaveerappa Bammigatti, and Tamilarasu Kadhiravan, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, E-mails: akinchanbhardwaj@gmail.com, bammigatti@gmail.com, and kadhir@jipmer.edu.in. Rajaa Muthu and Rajendiran Soundravally, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, E-mails: rajaa.jipmer@gmail.com and soundy27@gmail.com. Agieshkumar Balakrishna Pillai, Central Inter-Disciplinary Research Facility, Sri Balaji Vidyapeeth (Deemed To Be University), Puducherry, India, E-mail: agiesh.b@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2018. Global Snakebite Burden: Report by the Director-General. Geneva, Switzerland: World Health Assembly, 71. Available at: https://apps.who.int/iris/handle/10665/276406. Accessed August 18, 2020.
-
2.
Gutiérrez JM , Calvete JJ , Habib AG , Harrison RA , Williams DJ , Warrell DA , 2017. Snakebite envenoming. Nat Rev Dis Primers 3: 17079.
-
3.
Seqirus , 2017. Snake Venom Detection Kit (SVDK). Available at: https://labeling.seqirus.com/SVDK/AU/Snake-Venom-Detection-Kit/EN/Snake-Venom-Detection-Kit.pdf. Accessed August 18, 2020.
-
4.
Maduwage K , O’Leary MA , Isbister GK , 2014. Diagnosis of snake envenomation using a simple phospholipase A2 assay. Sci Rep 4: 4827.
-
5.
Warrell DA , Davidson NMD , Greenwood BM , Ormerod LD , Pope HM , Watkins BJ , Prentice CR , 1977. Poisoning by bites of the saw-scaled or carpet viper (Echis carinatus) in Nigeria. Q J Med 46: 33–62.
-
6.
Hirschmann JV , Raugi GJ , 2012. Lower limb cellulitis and its mimics: part I. Lower limb cellulitis. J Am Acad Dermatol 67: 163.e1–163.e12.
-
7.
Chung O , Juonala M , Mallat Z , Hutri-Kähönen N , Viikari JSA , Raitakari OT , Magnussen CG , 2019. Tracking of secretory phospholipase A2 enzyme activity levels from childhood to adulthood: a 21-year cohort. J Pediatr (Rio J) 95: 247–254.
-
8.
Mallat Z et al. 2005. Circulating secretory phospholipase A2 activity predicts recurrent events in patients with severe acute coronary syndromes. J Am Coll Cardiol 46: 1249–1257.
-
9.
Rivière G , Choumet V , Saliou B , Debray M , Bon C , 1998. Absorption and elimination of viper venom after antivenom administration. J Pharmacol Exp Ther 285: 490–495.
-
10.
Barnes JM , Trueta J , 1941. Absorption of bacteria, toxins and snake venoms from the tissues: importance of the lymphatic circulation. Lancet 237: 623–626.
-
11.
Tasoulis T , Isbister GK , 2017. A review and database of snake venom proteomes. Toxins (Basel) 9: 290.
-
12.
Senji Laxme RR , Khochare S , de Souza HF , Ahuja B , Suranse V , Martin G , Whitaker R , Sunagar K , 2019. Beyond the ‘big four’: venom profiling of the medically important yet neglected Indian snakes reveals disturbing antivenom deficiencies. PLoS Negl Trop Dis 13: e0007899.
-
13.
Tun P , Khin Aung C , 1986. Amount of venom injected by Russell’s viper (Vipera russelli). Toxicon 24: 730–733.
-
14.
Sharma M , Gogoi N , Dhananjaya BL , Menon JC , Doley R , 2014. Geographical variation of Indian Russell’s viper venom and neutralization of its coagulopathy by polyvalent antivenom. Toxin Rev 33: 7–15.
-
15.
Boback SM , 2003. Body size evolution in snakes: evidence from island populations. Copeia 2003: 81–94.
-
16.
Daltry JC , Wüster W , Thorpe RS , 1996. Diet and snake venom evolution. Nature 379: 537–540.
-
17.
Warrell DA , 1989. Snake venoms in science and clinical medicine. 1. Russell’s viper: biology, venom and treatment of bites. Trans R Soc Trop Med Hyg 83: 732–740.
-
18.
Isbister GK , Shahmy S , Mohamed F , Abeysinghe C , Karunathilake H , Ariaratnam A , 2012. A randomised controlled trial of two infusion rates to decrease reactions to antivenom. PLoS One 7: e38739.
-
19.
Rutjes AW , Reitsma JB , Vandenbroucke JP , Glas AS , Bossuyt PM , 2005. Case-control and two-gate designs in diagnostic accuracy studies. Clin Chem 51: 1335–1341.
-
20.
Gutiérrez JM , León G , Lomonte B , 2003. Pharmacokinetic-pharmacodynamic relationships of immunoglobulin therapy for envenomation. Clin Pharmacokinet 42: 721–741.
-
21.
Isbister GK , Halkidis L , O’Leary MA , Whitaker R , Cullen P , Mulcahy R , Bonnin R , Brown SG , 2010. Human anti-snake venom IgG antibodies in a previously bitten snake-handler, but no protection against local envenoming. Toxicon 55: 646–649.
-
22.
Macêdo JKA , Joseph JK , Menon J , Escalante T , Rucavado A , Gutiérrez JM , Fox JW , 2019. Proteomic analysis of human blister fluids following envenomation by three snake species in India: differential markers for venom mechanisms of action. Toxins (Basel) 11: 246.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1015 | 293 | 45 |
| Full Text Views | 558 | 11 | 1 |
| PDF Downloads | 198 | 8 | 1 |