Overlooked Issues of Snakebite Management: Time for Strategic Approach

Abstract

Snakebite is a medical emergency in many parts of the world, particularly in the temperate regions. According to 2007 World Health Organization (WHO) report, there are about 5 million snakebite incidences resulting in 2.5 million envenoming, and 125,000 deaths occur annually. Most affected are the healthy individuals like children and farming populations with resource poor settings and away from health care centers in low-income countries of Africa, Asia and Latin America. In view of this, the WHO has declared snakebite as an ignored health crisis and a tropical disease. Although the death rate has reduced markedly due to anti-venom regiment, several limitations of it offer scope for better understanding of various ignored issues. Currently, snakebite therapeutics facing plethora of scientific, technological and public health challenges, including secondary/long term complications that have not been given importance so far. Because of dearth of knowledge, venom researchers and medical practitioners from affected countries worldwide should join together to accomplish this scenario. In view of this, the present review provides a broader perspective on the possible production and application of highly effective therapeutic master anti-venom, designing master diagnostic kit and also to deal with the inefficacy of anti-venom therapy against local manifestations and secondary complications of snakebite. The review demands thorough understanding of venom pharmacology, inculcating new strategies to handle and to enhance the efficacy of snakebite management and urge the governing systems of affected countries to take steps to curtail accidental debilitation and death rate of healthy individuals due to snakebite.

Snake Venom Phospholipases A2: A Novel Tool Against Bacterial Diseases

“…A number of these enzymes are toxic (molecular weight ranges between 13 -150 kDa) and serve specific functions that include immobilizing, killing, and predigesting prey [4]. Snake venom phospholipases A 2 (svPLA 2 s) are highly abundant toxins having functional diversity and systemic toxicities including myotoxicity, cardiotoxicity, neurotoxicity, nephrotoxicity, hepatotoxicity, neprotoxicity, reprotoxicity, and systemic hemorrhage [5][6][7][8][9]. These proteins induce release of inflammatory mediators [10], vasodilating and vasoconstricting mediators such as prostaglandins, histamine, kinins, eicosanoids, platelet activating factor, catecholamines, dopamine, nitric oxide and endothelins.…”

“…Additionally, PLA 2 from human synovial fluid was named (group IIA), which had a disulfide bond pattern more similar to the rattlesnake group II [15]. A majority of svPLA 2 s are basic proteins consisting of 118-132 amino acids with seven disulfide bonds [7][8][9][10][11][12][13][14][15][16][17][18]. Several PLA 2 s have been isolated from snake venoms, including 12 -21 kDa sized proteins , which are slightly larger than other PLA 2 s [19].…”

Propensity of crocin to offset Vipera russelli venom induced oxidative stress mediated neutrophil apoptosis: a biochemical insight

“…The most severe cases of envenomation are inflicted by the species of Viperidae family. In Asia, Vipera russelli is the major culprit for the clinical complications of severe local and systemic pathology (Girish and Kemparaju 2011;Ushanandini et al 2006).…”

“…The ineffectuality of anti-venom against the local effects has been attributed to the brisk action of venom components and the inability of anti-venom F(ab 0 )2 and F(ab) fragments of IgG to penetrate blood/tissue barrier. Other limitations could be the inability of anti-venoms against the possible venom induced apoptosis of inflammatory cells at the bitten site (Lalloo and Theakston 2003;Girish and Kemparaju 2011;Leon et al 2000).…”

Challenges of managing snakebite envenomation in a deployed setting

“…While there is recent guidance on the management of acute snakebite envenomation outlined in the Clinical Guidelines for Operations (CGOs)2 which are currently under revision, delayed presentation following envenomation is unusual in regions where access to healthcare facilities is readily available3 and this kind of guidance may not cover the clinical scenarios faced in a deployed setting. There are estimated to be about 5 million episodes of snakebite envenomation annually leading to approximately 125 000 deaths 4. The most affected are healthy individuals such as children and farming populations in resource poor settings and away from healthcare centres in low-income countries.…”