Clinical Features and Management of Snakebite Envenoming in French Guiana

Abstract

The management of snakebite (SB) envenoming in French Guiana (FG) is based on symptomatic measures and antivenom (AV) administration (Antivipmyn Tri®; Instituto Bioclon—Mexico). Our study aimed to assess clinical manifestations, the efficacy, and safety of Antivipmyn Tri® in the management of SB. Our study is a prospective observational work. It was conducted in the Intensive Care Unit (ICU) of Cayenne General Hospital between January 1st, 2016 and December 31, 2019. We included all patients hospitalized for SB envenoming. Our study contained three groups (without AV, three vials, and six vials Antivipmyn Tri®). During the study period, 133 patients were included. The main clinical symptoms were edema (98.5%), pain (97.7%), systemic hemorrhage (18%), blister (14.3%), and local hemorrhage (14.3%). AV was prescribed for 83 patients (62.3%), and 17 of them (20%) developed early adverse reactions. Biological parameters at admission showed defibrinogenation in 124 cases (93.2%), International Normalized Ratio (INR) > 2 in 104 cases (78.2%), and partial thromboplastin time (PTT) > 1.5 in 74 cases (55.6%). The time from SB to AV was 9:00 (5:22–20:40). The median time from SB to achieve a normal dosage of fibrinogen was 47:00 vs. 25:30, that of Factor II was 24:55 vs. 15:10, that of Factor V was 31:42 vs. 19:42, and that of Factor VIII was 21:30 vs. 10:20 in patients without and with AV, respectively, (p < 0.001 for all factors). Patients receiving Antivipmyn Tri® showed a reduction in the time to return to normal clotting tests, as compared to those who did not. We suggest assessing other antivenoms available in the region to compare their efficacy and safety with Antivipmyn Tri® in FG.

Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders

“…Blood coagulation is restored most of the time within 6-24 h after antivenom [28,32,48,71,72]. Clotting tests and fibrinolysis parameters return to normal around 48 h after antivenom [28,47,49].…”

“…Envenomed patients present increased prothrombin time (PT) and activated partial thromboplastin time (aPTT), with low level of fibrinogen. Factors II, V, VII, X, XIII also decrease [43,47,48]. Factors involved in the intrinsic pathway (factors VIII, IX, XI, XII) are less frequently reduced [47,48].…”

“…Factors II, V, VII, X, XIII also decrease [43,47,48]. Factors involved in the intrinsic pathway (factors VIII, IX, XI, XII) are less frequently reduced [47,48].…”

Pan-American Lancehead Pit-Vipers: Coagulotoxic Venom Effects and Antivenom Neutralisation of Bothrops asper and B. atrox Geographical Variants

“…Use of non-local antivenom is seen in French Guiana, which, due to their lack of a local antivenom, adopted Mexico’s Antivipmyn-Tri to treat snakebites, including B. atrox snakebites, in the region [ 23 ]. However, the literature on the neutralising ability of Antivipmyn-Tri for French Guiana snakes is scarce [ 23 , 24 , 42 , 43 ], and, therefore, there is a knowledge gap regarding its efficacy in treating critically envenomated patients. Cross-species neutralisation has, however, been noted for other antivenoms, such as SAB from Instituto Butantan, which does not contain B. atrox in the immunising mixture but has been proven to be effective in neutralising the coagulotoxic venoms of some B. atrox populations [ 11 ].…”

Critical care medicine in the French Territories in the Americas: Current situation and prospects

“…Indeed, during the last five years, 450 gunshot injuries were recorded only in Cayenne, French Guiana. Envenoming, mainly snake bites, is frequent in Martinique and French Guiana ( 9 – 11 ), and its treatment requires specific knowledge and a critical care environment ( 11 , 12 ). Moreover, the prevalence of obesity, diabetes, and cardiovascular diseases in the FTA is among the highest in France ( 13 – 15 ).…”