Bungarus multicinctus multicinctus Snakebite in Taiwan

Abstract

Although specific antivenom is available in Taiwan, respiratory failure and general pain frequently accompany envenomation and there have been few reports on the management of envenomation. We retrospectively analyzed 44 cases of bite admitted to Taichung Veterans General Hospital (VGH) or to Taipei VGH. Demographic data, treatment, and outcome of patients with and without respiratory failure were compared. In this study, 20.5% patients had bites without noticeable signs or symptoms of significant envenoming, 27.3% developed respiratory failure, and 27.3% experienced general pain. Bivalent specific antivenom for and was administered in all envenomed cases. Respiratory failure occurred 1.5-6.5 hours post-bite and general pain occurred 1-12 hours post-bite. Specific antivenom for and at the recommended dose (i.e., 2-4 vials) might not effectively prevent respiratory failure and pain. Respiratory failure, general pain, and autonomic effects after bite were probably caused, at least partly, by β-bungarotoxin. Although general weakness, ptosis, dysarthria, and dilated pupils were significantly associated with respiratory failure, their predictive value could not be accurately determined in such a retrospective study. Due to the rapid onset of respiratory failure, every suspected envenomed case thus should be closely monitored in the first few hours. We recommend the initial administration of four vials of antivenom in all envenomation cases, and a subsequent four vials be considered if the patient's condition is deteriorating. Prospective evaluation of the antivenom dosing regimen is urgently needed to improve envenomation treatment.

Venom Ophthalmia and Ocular Complications Caused by Snake Venom

“…These neurotoxins might explain why ptosis and phobia are reported after snakebite. PLA 2 is also one of the snake venom neurotoxins in Bungarus multicinctus , which causes ptosis, diplopia, and photophobia in patients following snakebite [ 72 ]. Pre-synaptic toxins (β-neurotoxins) inhibit acetylcholine (ACh) release from nerve terminals, which cause motor nerve disorders [ 73 ].…”

In Vitro Neurotoxicity of Chinese Krait (Bungarus multicinctus) Venom and Neutralization by Antivenoms

“…Therefore, the results of our in vitro studies, using the chick biventer cervicis preparation, mirror the clinical effects of B. multicinctus envenoming, where respiratory failure is a key feature in spite of early administration of the B. multicinctus antivenom [ 5 ]. This supports the hypothesis that the antivenom resistant neurotoxicity is most likely due to the action of the PLA 2 β-bungarotoxins [ 10 , 11 , 12 , 13 ].…”

“…Although B. multicinctus bites are ranked as the fifth most common in China, B. multicinctus envenoming is ranked first for case fatality rates, ranging from 26.9–33.3% depending on geographical location [ 2 ]. The hallmark of B. multicinctus envenoming is progressive neuromuscular paralysis requiring prolonged artificial ventilation but with minimal local swelling and pain at the bite site [ 2 , 4 , 5 , 6 ]. B. multicinctus venom contains a large proportion of post-synaptic “three finger” toxins (3-FTx) (i.e., α-bungarotoxins) and pre-synaptic phospholipase A 2 (PLA 2 ) β-bungarotoxins [ 7 , 8 ].…”

“…Patients envenomed by B. multicinctus develop respiratory failure in spite of early (i.e., within 4 h of the bite) administration of the recommended quantities of B. multicinctus antivenom [ 5 ]. It is believed that this clinical manifestation of B. multicinctus envenoming (i.e., antivenom resistant neurotoxicity) is primarily due to rapid fixation and irreversible necrotic degeneration of the nerve terminal boutons by the PLA 2 β-bungarotoxins [ 10 , 11 , 12 , 13 ].…”

Immunoreactivity and neutralization study of Chinese Bungarus multicinctus antivenin and lab-prepared anti-bungarotoxin antisera towards purified bungarotoxins and snake venoms

“…B. multicinctus widely distributed in south China and neighboring countries of Myanmar, Laos, north Vietnam and Thailand globally. The high mortality rate of B. multicinctus envenomation is attributed to presynaptic neurotoxins and postsynaptic neurotoxins contained in the venoms, which can block neurotransmitter at motor nerve terminals and eventually leads to respiratory failure and death [8].…”