Snake Eyes: Coral Snake Neurotoxicity Associated With Ocular Absorption of Venom and Successful Treatment With Exotic Antivenom

Puncture Wound to Right Lower Extremity With Ecchymosis

“…If a patient has a suspected bite from a coral snake, but this cannot be confirmed, admission to the hospital for at least 12 hours should be done because there is a risk for delayed reaction. 6 Special focus with this type of bite is on the neurologic system because necrosis and coagulopathy are not common with this bite (Table 1). These patients should have continuous pulse oximetry evaluation as well as respiratory rate and effort.…”

“…2 The other category is monospecific, which is an antivenom for areas where only 1 type of venomous snake exists. 3 Antivenom options for Elapidae envenomation are limited to North American Coralsnake Antivenom (NAC-SAV; Pfizer), which is a horse-derived immunoglobulin G. 6 However, because coral snake envenomation is so infrequent, NACSAV production ended in 2006. There are still some expired stocks available, which can be administered on approval of the US Food and Drug Administration.…”

“…9 Should neurotoxicity develop and NACSAV is unavailable, a dose of anticholinesterase may be given, in the form of neostigmine. 6 Neostigmine is indicated due to its ability to increase the concentrations of acetylcholine at the neuromuscular junction. 6…”

“…6 Neostigmine is indicated due to its ability to increase the concentrations of acetylcholine at the neuromuscular junction. 6…”

Contribution of endothelial cell and macrophage activation in the alterations induced by the venom of Micrurus tener tener in C57BL/6 mice

“…In the United States, only two species are responsible for all coral snake toxicity, Micrurus fulvius fulvius (Eastern coral snake) and Micrurus tener tener (Texas coral snake), and most of the information available rely on the Eastern coral snakebites. Few studies have described the clinical manifestations of patients bitten by Micrurus tener tener (Mtt), which represents 2.3% of the snakebites in Texas, which include local symptoms including pain, edema, erythema, and long-lasting paresthesia, and, in severe cases, skeletal muscle weakness and cranial nerve dysfunction (McAninch et al, 2019;Morgan et al, 2007). These effects can be attributable to the most abundant protein families shared by all species from the elapids of the New world, which are phospholipases A 2 (PLA 2 ) and three-finger toxins (3FTxs), although, members of other protein families, that are common but not omnipresent, including metalloproteinases, L-amino acid oxidases, Kunitz-type serine protease inhibitors, serine proteinases, and C-type lectin-like proteins can also modulate these effects (Alape-Girón et al, 1996;Bénard-Valle et al, 2014Corrêa-Netto et al, 2011Lomonte et al, 2016a).…”