Clinical manifestations and treatments of<i>Protobothrops mucrosquamatus</i>bite and associated factors for wound necrosis and subsequent debridement and finger or toe amputation surgery

Mao, Yan; Liu, Po‐Yu; Chiang, Liao-Chun; Lee, Chi Hsin; Lai, Chih Sheng; Lai, Kuo-Lung; Liu, Wen; Su, Hung Yuan; Ho, Ching‐Hwa; Doan, Uyen Vy; Maharani, Tri; Yang, Yi Yuan; Yang, Chen Chang

doi:10.1080/15563650.2020.1762892

Cited by 22 publications

(41 citation statements)

References 54 publications

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“…and M. morganii are frequently present in the infected bite wound [21]. Mao et al and Chiang et al suggested that first-generation cephalosporin with aminoglycoside or sulfamethoxazole/trimethoprim is the preferable antibiotics in the management of infected Protobothrops mucrosquamatus and Trimeresurus stejnegeri stejnegeri bites [22,23]. These suggestions are based on conventional wound microbial culture without prior determination of antibiotic administration before obtaining cultures, thus rendering these suggestions biased.…”

Section: Discussionmentioning

confidence: 99%

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

et al. 2021

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Naja atra is a major venomous snake found in Taiwan. The bite of this snake causes extensive wound necrosis or necrotizing soft tissue infection. Conventional microbial culture-based techniques may fail to identify potential human pathogens and render antibiotics ineffective in the management of wound infection. Therefore, we evaluated 16S Sanger sequencing and next-generation sequencing (NGS) to identify bacterial species in the oropharynx of N. atra. Using conventional microbial culture methods and the VITEK 2 system, we isolated nine species from snakebite wounds. On the basis of the 16S Sanger sequencing of bacterial clones from agar plates, we identified 18 bacterial species in the oropharynx of N. atra, including Morganella morganii, Proteus vulgaris, and Proteus mirabilis, which were also present in the infected bite wound. Using NGS of 16S metagenomics, we uncovered more than 286 bacterial species in the oropharynx of N. atra. In addition, the bacterial species identified using 16S Sanger sequencing accounted for only 2% of those identified through NGS of 16S metagenomics. The bacterial microbiota of the oropharynx of N. atra were modeled better using NGS of 16S metagenomics compared to microbial culture-based techniques. Stenotrophomonas maltophilia, Acinetobacter baumannii, and Proteus penneri were also identified in the NGS of 16S metagenomics. Understanding the bacterial microbiota that are native to the oropharynx of N. atra, in addition to the bite wound, may have additional therapeutic implications regarding empiric antibiotic selection for managing N. atra bites.

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Section: Discussionmentioning

confidence: 99%

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

et al. 2021

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“…We extracted the following data: sex; age; body part bitten; first aid administered; comorbidities (e.g., diabetes mellitus, liver diseases [i.e., abnormal liver biochemistry, hepatic virus infection, or liver cirrhosis], vascular diseases (i.e., coronary artery disease [CAD] or cerebrovascular accident [CVA]), and malignancies); clinical manifestations; laboratory findings; and management details, including time elapsed between bite and antivenom administration, antivenom dosage, antibiotics administered, indications for surgery, time to initial and last surgery, surgery type, hospital stay length, and follow-up period [ 4 , 14 ]. We used consensus to resolve any disagreement between the authors during the data review and abstraction process.…”

Section: Methodsmentioning

confidence: 99%

The development of surgical risk score and evaluation of necrotizing soft tissue infection in 161 Naja atra envenomed patients

et al. 2022

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Background Naja atra bites cause wound necrosis, secondary infection, and necrotizing soft tissue infection (NSTI) requiring repetitive surgeries. Little information is known about the predictors for surgery after these bites. Materials and methods We retrospectively evaluated 161 patients envenomed by N. atra, 80 of whom underwent surgery because of wound necrosis and infection. We compared the patients’ variables between surgical and non-surgical groups. To construct a surgical risk score, we converted the regression coefficients of the significant factors in the multivariate logistic regression into integers. We also examined the deep tissue cultures and pathological findings of the debrided tissue. Results A lower limb as the bite site, a ≥3 swelling grade, bullae or blister formation, gastrointestinal (GI) effects, and fever were significantly associated with surgery in the multivariate logistic regression analysis. The surgical risk scores for these variables were 1, 1, 2, 1, and 2, respectively. At a ≥3-point cutoff value, the model has 71.8% sensitivity and 88.5% specificity for predicting surgery, with an area under the receiver operating characteristic curve of 0.88. The histopathological examinations of the debrided tissues supported the diagnosis of snakebite-induced NSTI. Twelve bacterial species were isolated during the initial surgery and eleven during subsequent surgeries. Discussion and conclusions From the clinical perspective, swelling, bullae or blister formation, GI effects, and fever appeared quickly after the bite and before surgery. The predictive value of these factors for surgery was acceptable, with a ≥3-point risk score. The common laboratory parameters did not always predict the outcomes of N. atra bites without proper wound examination. Our study supported the diagnosis of NSTI and demonstrated the changes in bacteriology during the surgeries, which can have therapeutic implications for N. atra bites.

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“…Ceftazidime was used in this case because of the high infection rate and susceptibility to pathogens associated with snakebites in Taiwan [9,10]. ere was no severe antivenom reaction in this case; however, allergies occurred 8 days later.…”

Section: Discussionmentioning

confidence: 92%

Personal Experience of Daboia siamensis Envenomation

Tsai

Liu

Chuang

2021

Case Reports in Medicine

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Reports of envenomation induced by Daboia siamensis, a medically important venomous snake in Taiwan, are rare, and species identification might not be definitive. This article reports the complete course of a definite D. siamensis bite. The patient in this report was one of the authors who was bitten on the right palm near the base of the index finger by D. siamensis. The patient experienced local effects, neurological manifestations, and acute kidney injury. The laboratory analysis revealed elevated D-dimer and coagulopathy. The patient was administered 8 vials of antivenom and did not undergo surgical intervention or endotracheal tube intubation, but serum sickness occurred 8 days after antivenom administration. The horse immunoglobulin produced by the Centers for Disease Control, R. O. C. (Taiwan), against D. siamensis was effective and safe in the treatment of the patient. However, the best antivenom administration strategy remains unclear and requires further study.

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Clinical manifestations and treatments ofProtobothrops mucrosquamatusbite and associated factors for wound necrosis and subsequent debridement and finger or toe amputation surgery

Cited by 22 publications

References 54 publications

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

The development of surgical risk score and evaluation of necrotizing soft tissue infection in 161 Naja atra envenomed patients

Personal Experience of Daboia siamensis Envenomation

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