Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature

Abstract

The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 °C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3–5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation.

Enzymatic Activity And Brine Shrimp Lethality Of Venom From The Large Brown Spitting Cobra (Naja Ashei) And Its Neutralization By Antivenom

“…Table 2.Discussion svPLA 2 make up to 30% of viperid and elapid venoms[28,29], and the local effects of venomous snakebite in sub-Saharan Africa have been linked to svPLA 2 's[12,[30][31][32][33]. Our results suggest that the Eastern forest cobra had the highest svPLA 2 activity while mamba venoms had the least activity.This observation seems to corroborate clinical reports on venomous snakebite in Sub-Saharan Africa where cobra bites are associated with severe muscle and tissue damage, and painful progressive swelling which are generally absent in mamba bites[30,[34][35][36][37][38][39]. Both antivenoms had poor neutralization capacity against the svPLA 2 activity of N. ashei venom.…”

Um caso clínico inesperado de envenenamento por Dendroaspis Polylepis (Mamba Negra) em Angola

“…As mambas estão extensamente distribuídas na África subsariana e o seu envenenamento resulta em altos níveis morbilidade, deficiência e mortalidade (Erulu et al, 2018;Laustsen et al, 2015). Entre 2011 e 2017 foram reportados casos de envenenamentos na Suíça, Alemanha e República Checa (Erulu et al, 2018;Warrell, 2009).…”

“…As mambas estão extensamente distribuídas na África subsariana e o seu envenenamento resulta em altos níveis morbilidade, deficiência e mortalidade (Erulu et al, 2018;Laustsen et al, 2015). Entre 2011 e 2017 foram reportados casos de envenenamentos na Suíça, Alemanha e República Checa (Erulu et al, 2018;Warrell, 2009). No continente africano, Blaylock (Blaylock, 2003), Naidoo (Naidoo et al, 1987), Hilligan, Crisp, (Erulu et al, 2018) e seus colegas publicaram casos de mordeduras de mamba negra ocorridos no Zimbabwe (1967,1980,1982) África do Sul 1986, 1987, e Suazilândia 1987(Erulu et al, 2018.…”

“…Alguns autores como Laustsen e colegas reportam que o antiveneno polivalente produzido na África do Sul (SAVP) e o VINS Bio são eficazes contra o envenenamento por mamba negra em ratos (Erulu, Okumu, Ochola, & Gikunju, 2018;Laustsen et al, 2015). Por outro lado, Harrison e colegas referem que os antivenenos produzidos pela PAN AFRICA, INOSAN Biopharm, Sanofi Pasteur não são eficazes contra todas as espécies de maior importância médica da África subsariana.…”

“…Por outro lado, Harrison e colegas referem que os antivenenos produzidos pela PAN AFRICA, INOSAN Biopharm, Sanofi Pasteur não são eficazes contra todas as espécies de maior importância médica da África subsariana. Adicionalmente a isto, existem poucos centros de controlo de envenenamento e inexistência de protocolos de manuseio clínico dos envenenamentos (Erulu et al, 2018).…”