Local Cytotoxic Effects in Cobra Envenoming: A Pilot Study

The cobra (genus Naja (N.)) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms...

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Published inToxins Vol. 14; no. 2; p. 122
Main Authors Lin, Jing-Hua, Sung, Wang-Chou, Mu, Han-Wei, Hung, Dong-Zong
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 07.02.2022
MDPI
Subjects
Aged
Aged, 80 and over
Animals
Antivenins
Antivenom
cobra snakebite
cobra snakebite; dermonecrosis; cytotoxin A3; rapid diagnosis kit-ICT-Cobra
Cytotoxicity
cytotoxin A3
Cytotoxins
Debridement
dermonecrosis
Elapid Venoms
Enzyme-linked immunosorbent assay
Female
Humans
Immunoassay
Injuries
Male
Medicine
Middle Aged
Muscles
Naja naja
Necrosis
Neurotoxins
Paralysis
Pilot Projects
R
rapid diagnosis kit-ICT-Cobra
Snake Bites
Snakes
Tissues
Toxicology
Toxins
Venom
Wound healing
Taiwan
dermonecrosis
cobra snakebite
cytotoxin A3
rapid diagnosis kit-ICT-Cobra
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Abstract The cobra (genus Naja (N.)) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of N. atra snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.
AbstractList The cobra (genus Naja (N.)) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of N. atra snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.
The cobra (genus ( )) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.
The cobra (genus Naja ( N. )) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of N. atra snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.
The cobra (genus Naja (N.)) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of N. atra snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.The cobra (genus Naja (N.)) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of N. atra snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.
Author Jing-Hua Lin
Han-Wei Mu
Wang-Chou Sung
Dong-Zong Hung
AuthorAffiliation 2 National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli 35053, Taiwan; sung23@nhri.edu.tw
1 Division of Toxicology, China Medical University Hospital, Taichung 40447, Taiwan; jh.cooltm@gmail.com (J.-H.L.); gackt0366@hotmail.com (H.-W.M.)
AuthorAffiliation_xml – name: 1 Division of Toxicology, China Medical University Hospital, Taichung 40447, Taiwan; jh.cooltm@gmail.com (J.-H.L.); gackt0366@hotmail.com (H.-W.M.)
– name: 2 National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli 35053, Taiwan; sung23@nhri.edu.tw
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  surname: Lin
  fullname: Lin, Jing-Hua
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Keywords dermonecrosis
cobra snakebite
cytotoxin A3
rapid diagnosis kit-ICT-Cobra
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Snippet The cobra (genus Naja (N.)) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and...
The cobra (genus ( )) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic...
The cobra (genus Naja ( N. )) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and...
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StartPage 122
SubjectTerms Aged
Aged, 80 and over
Animals
Antivenins
Antivenom
cobra snakebite
cobra snakebite; dermonecrosis; cytotoxin A3; rapid diagnosis kit-ICT-Cobra
Cytotoxicity
cytotoxin A3
Cytotoxins
Debridement
dermonecrosis
Elapid Venoms
Enzyme-linked immunosorbent assay
Female
Humans
Immunoassay
Injuries
Male
Medicine
Middle Aged
Muscles
Naja naja
Necrosis
Neurotoxins
Paralysis
Pilot Projects
R
rapid diagnosis kit-ICT-Cobra
Snake Bites
Snakes
Tissues
Toxicology
Toxins
Venom
Wound healing
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Title Local Cytotoxic Effects in Cobra Envenoming: A Pilot Study
URI https://cir.nii.ac.jp/crid/1870865117521869952
https://www.ncbi.nlm.nih.gov/pubmed/35202149
https://www.proquest.com/docview/2661938963
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https://pubmed.ncbi.nlm.nih.gov/PMC8877591
https://doaj.org/article/a163c527998843f9b71b46f8779111d9
Volume 14
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