Case report of a coral snake bite (Micrurus ibiboboca) in the state of Pernambuco, northeast Brazil / Relato de caso de picada de cobra coral (Micrurus ibiboboca) no estado de Pernambuco, nordeste do Brasil / Informe de caso de mordedura de serpiente coral (Micrurus ibiboboca) en el estado de Pernambuco, noreste de Brasil

The Elapidae family comprises 35 snake species in Brazil, with Micrurus ibiboboca being widely distributed in the northeast of the country. Despite the high number of Micrurus species in Brazil, there are few cases of human envenomation in literature. This study describes a clinical report of envenomation due to the bite of M. ibiboboca in the State of Pernambuco, Northeast Brazil, that took place in 2017. The patient presented symptoms of muscle paralysis and sweating. He was admitted to the intensive care unit. A total of 10 ampoules of anti-elapidic serum were administered. The patient complained of local pain that extended through the arm, paresthesia in the lower limbs, headache, and chest pain. Changes in the visual, respiratory, and neurological systems were not observed. This clinical case report on coral snake poisoning is useful for increasing the knowledge on the toxicological action of snake poison and its effect on injured individuals, thereby helping in the clinical evaluation and treatment.(AU)

A família Elapidae compreende 35 espécies de serpentes no Brasil, com Micrurus ibiboboca amplamente distribuída no Nordeste. Apesar do elevado número de espécies de Micrurus no Brasil, são poucos os casos de envenenamento humano na literatura. Descrevemos aqui um relato clínico de envenenamento por picada de M. ibiboboca no Estado de Pernambuco, Nordeste do Brasil, ocorrido em 2017. O paciente apresentava sintomas de paralisia muscular e sudorese. Ele foi internado na Unidade de Terapia Intensiva. Um total de 10 ampolas de soro anti-elapídico foi administrado. O paciente queixava-se de dor local que se estendia pelo braço, parestesia em membros inferiores, cefaleia e dor torácica. Não foram observados alterações nos sistemas de visão, respiratório e neurológico. Este relato de caso clínico de intoxicação por cobra coral é útil para aumentar o conhecimento sobre a ação toxicológica da peçonha da serpente e seu efeito sobre os acidentados, auxiliando na avaliação clínica e no tratamento.(AU)

La familia Elapidae comprende 35 especies de serpientes en Brasil como la Micrurus ibiboboca ampliamente distribuidas en el Noreste. A pesar de lo alto número de especies de Micrurus en Brasil, hay pocos casos de envenenamiento humano en la literatura. Describimos aquí un informe clínico de envenenamiento por mordedura de M. ibiboboca en el estado de Pernambuco, Noreste de Brasil, ocurrido en 2017. El paciente presentaba síntomas de parálisis muscular y sudoración. Fue ingresado en la unidad de cuidados intensivos. Se administraron un total de 10 ampollas de suero antielapídico. El paciente se quejaba de dolor local que se extendía por el brazo, parestesias en las extremidades inferiores, cefalea y dolor torácico. No se observaron cambios en los sistemas visual, respiratorio y neurológico. Este informe de caso clínico sobre la intoxicación por serpiente coral es útil para aumentar el conocimiento sobre la acción toxicológica del veneno de serpientes y su efecto en los individuos lesionados, ayudando así en la evaluación clínica y el tratamiento.(AU)

Neurotoxical activity of Micrurus snake venom and methods for its analysis. A literature review / Actividad neurotóxica del veneno de serpientes del género Micrurus y métodos para su análisis. Revisión de la literatura

Abstract Introduction: Snakes of the genus Micrurus have fossorial habits, passive temperament and scarce production of powerful venom with neurotoxic characteristics that block the synaptic transmission at the neuromuscular junction. Objective: To present an overview of the neurotoxicity of the Micrurus snake venom, and its functional characterization by ex vivo analysis methods. Materials and methods: A literature review was conducted in MedLine and ScienceDirect using specific terms and their combinations. Search strategy: type of studies: articles on the neurotoxicity of Micrurus snake venom and techniques to determine its neurotoxic activity by in vitro, in vivo and ex vivo models; publication period: articles published until June 2018; publication language: English and Spanish. Results: Out of 88 studies identified in the initial search, 28 were excluded because they did not meet the inclusion criteria (based on reading their titles and abstracts). 8 additional articles (books and reports) were included, since, according to the authors' opinion, they complemented the information reported by the selected studies. The studies included in the review (n=68) were original research papers (n=44), review articles (n = 16), and book chapters, reports, guides and online consultations (n=8). Conclusions: Studies performed using ex vivo muscle and nerve preparations to evaluate the effect of neurotoxins provide a good model for the characterization of the pre-synaptic and post-synaptic effect of the venom produced by snakes of the genus Micrurus.

Resumen Introducción. Las serpientes del género Micrurus son animales de hábitos fosoriales, de temperamento pasivo y escasa producción de un potente veneno con características neurotóxicas que bloquean la transmisión sináptica en la placa neuromuscular. Objetivo. Presentar un panorama general de la neurotoxicidad del veneno de las serpientes Micrurus y su caracterización funcional mediante métodos de análisis ex vivo. Materiales y métodos. Se realizó una revisión de la literatura en MedLine y ScienceDirect usando términos específicos y sus combinaciones. Estrategia de búsqueda: tipo de estudios: artículos sobre la neurotoxicidad del veneno de serpientes Micrurus y técnicas para determinar su actividad neurotóxica mediante modelos in vitro, in vivo y ex vivo; periodo de publicación: sin límite inicial a junio de 2018; idiomas: inglés y español. Resultados. De los 88 estudios identificados en la búsqueda inicial, se excluyeron 28 por no cumplir los criterios de inclusión (basándose en la lectura de títulos y resúmenes); además, se incluyeron 8 documentos adicionales (libros e informes), que, a criterio de los autores, complementaban la información reportada por las referencias seleccionadas. Los estudios incluidos en la revisión (n=68) correspondieron a las siguientes tipologías: investigaciones originales (n=44), artículos de revisión (n=16) y capítulos de libros, informes, guías y consultas en internet (n=8). Conclusiones. Los estudios que describen el uso de preparaciones ex vivo de músculo y nervio para evaluar el efecto de neurotoxinas ofrecen un buen modelo para la caracterización del efecto presináptico y postsináptico del veneno producido por las serpientes Micrurus.

Clinical Profile of Snake Envenomation with Complications and Outcome in a Tertiary Health Care Centre, Kalburgi.

Bites by snakes represent an important health problem in the tropical world including India. The true incidence of snakebites is difficult to assess and often is under reported. Though the exact number of snake bites is unknown, an estimated 5.4 million people are bitten each year with up to 2.7 million envenoming. Around 81,000 to 1,38,000 people die each year because of snake bites, and around three times as many amputations and other permanent disabilities are caused by snakebites annually. We wanted to determine frequency of various modes of presentation, complications and management of snakebite.METHODSAll patients presenting to emergency department of Basaveshwara Teaching and General Hospital with history of snakebite and features of envenomation were included in the study. All these patients were given Anti-Snake Venom. Symptomatic treatment of complications was done. Semi-structured questionnaire was filled during hospital stay to analyse various characteristics of snakebite and people’s attitude towards this problem.RESULTS75 cases of snakebite admitted to Basaveshwara Teaching & General Hospital, Gulbarga between January 2018 to November 2019 were studied. Males [50 (62.5%)] were affected more than females [25 (31.5%)] in the ratio of 2:1. Most common age group is 20-40 years [45 (60%)]. Snakebite is a common health hazard in rural areas [55 (73.34%)]. Agricultural labourers (68.6%) are the major sufferers with majority of bites occurring outdoor 60 (80%). 71 (94.66%) bites occurred over limbs, out of which 38 (50.66%) were in lower limbs. Most bites occur between 12 Noon to 12 Midnight 60 patients (81.2%). Out of 75 patients, 60 (80%) were poisonous snakebites, 20 (20%) were non-poisonous snakebites. Among 60 (80%) poisonous bites, 32 (53.34%) had neurotoxic manifestations and 28 (46.66%) had hemotoxic manifestations.CONCLUSIONSSnakebite is common in rural setup, in agricultural labourers. Most common victims are males in the age group between 20-40 years. Poisonous bites were more common than non-poisonous snake bites in this study. In neurotoxic envenomation ptosis was the commonest and earliest symptom while in hemotoxic envenomation, most common symptoms were bleeding from bite site and hematuria. The commonest complications were acute renal failure and respiratory paralysis. Shock, infection and gangrene were also noted in some patients. Maximum mortality was observed in patients who were admitted after 24 hours. Early hospitalization and timely ASV administration were the corner stones in the treatment of snakebite.

A study of snakebite envenomation cases admitted to egyptian national poisoning center

Introduction: Snakebite is an Egyptian health problem since ancient Egypt. Meanwhile, there is still no controlled geographical and medical studies on locally prevalent snake family intoxication. Aim and Methods: The present study aimed to investigate local snakebites presentations, management, prognosis, and the effect of the polyvalent antivenom, locally produced by the Holding Company for Biological Products and Vaccines (VACSERA) through the year 2015. Results: A total of 87 snakebites caused by venomous and nonvenomous species were recorded. Most cases were middle-aged males. Most cases presented in summer and in the evening time. Two major groups of venomous Egyptian snakes were identified, Viperidae and Elapidae species, based on history, characteristic symptoms, and laboratory findings. Most snakebites (56 cases) were reported to be nonvenomous bites (64.4%). Twenty-one cases (24.1%) of snakebites were reported to be venomous bites by Elapidae snakes and 10 cases (11.5%) were reported to be venomous bites by Viperidae snakes. Antivenom was administered before referral to 37 (42.5%) of cases, and 19 only of them were victims of venomous snakes. Thirty-six (41.3%) patients received antivenom during admission including all cases of the venomous bites and 8.9% of nonvenomous bites' cases. Conclusion: Patients who had moderate or severe symptoms were effectively treated with VACSERA's polyvalent antivenom, with doses related to the severity grading and snake species identification. Additional antivenom doses were repeated on the bases of the clinical condition. Many snakebite victims referred from primary health centers received inadequate or nonnecessary doses of antivenom. No cases of anaphylaxis were recorded. There were no mortalities with current National Center for Clinical and Environmental Toxicology's protocol of treatment.

Reconhecimento de frações do veneno de cobras corais brasileiras pelo soro antielapídico / Recognition of venom fractions from Brazilian coral snakes by antielapid serum

Objetivos: Investigar a capacidade do soro antielapídico produzido no Brasil na identificação de frações do veneno de seis espécies, incluindo as que constituem o pool de inoculação: Micrurus brasiliensis, M. corallinus, M. frontalis, M. lemniscatus, M. spixii e M. surinamensis. Métodos: As amostras utilizadas fazem parte do banco de venenos do Centro de Estudos e Pesquisas Biológicas, da Pontifícia Universidade Católica de Goiás. O soro antielapídico foi cedido pela Fundação Ezequiel Dias. As metodologias empregadas foram eletroforese e imunoblotting. Resultados: Foi demonstrada uma variabilidade toxinológica e uma capacidade também variável de reconhecimento desses componentes pelo soro antielapídico. A partir da técnica de western-blotting o soro antielapídico da Fundação Ezequiel Dias foi capaz de reconhecer a maioria, mas não todos os componentes presentes nos venenos analisados. Conclusões: Os resultados sugerem uma eficácia restrita do soro antielapídico já que o mesmo possui limitações quanto as espécies Amazônicas, o que reforça a necessidade de uma revisão dos estudos intra e interespecíficos dos venenos micrúricos.

Aims: To investigate whether the antielapid serum produced in Brazil could identify venom fractions from six species of Micrurus, including those in the inoculation pool: Micrurus brasiliensis, M. corallinus, M. frontalis, M. lemniscatus, M. spixii, and M. surinamensis. Methods: The samples belong to the venom bank of the Center for Biological Studies and Research from the Pontifícia Universidade Católica de Goiás, Brazil. The antielapid serum was granted by the Ezequiel Dias Foundation. Both electrophoresis and immunoblotting methods were used. Results: Variability in venom components and in the ability to recognize such components was demonstrated by the antielapid serum. Based on the western-blotting technique, the antielapid serum from Ezequiel Dias Foundation was able to recognize most, but not all the components present in the analyzed venoms. Conclusions: The results suggest restricted efficacy of the antielapid serum, due to its limitations against species from the Amazon region, reinforcing the need for a review of intraspecific and interspecific studies of Micrurus venoms.

Um estudo do rendimento do veneno de cobras corais brasileiras e seu uso na avaliação do soro antielapídico / A study on venom yield of Brazilian coralsnakes and its use in the evaluation of antielapidic serum

Objetivos: Investigar a correlação entre quantidade de veneno produzido por uma cobra coral verdadeira e o tamanho da mesma, e avaliar a produção e o uso do soro antielapídico, levando em conta tamanho, capacidade inoculatória e variabilidade de espécies dessas cobras nasdiversas regiões do Brasil.Métodos: Para avaliação da diversidade e distribuição geográfica, foi realizada pesquisa bibliográfica e eletrônica no site oficial da SociedadeBrasileira de Herpetologia. Para obtenção de dados sobre epidemiologia dos acidentes elapídicos, foi pesquisado o Sistema de Informação de Agravos a Notificação do Ministério da Saúde. Dados de quantidade de veneno e tamanho das cobras das quais o mesmo foi extraído foram obtidos em trabalho de campo realizado entre os anos de 1986 e 2010, que estavam armazenadas no banco de venenos do Centro de Estudos e Pesquisas Biológicas da Pontifícia Universidade Católica de Goiás.Resultados: A maior diversidade de espécies de cobras corais verdadeiras está na região Norte e a maior casuística de acidentes elapídicos na região Nordeste. A análise de regressão linear mostrou forte correlação entre tamanho corporal e quantidade de veneno extraído. A maioria das espécies de cobras corais apresenta tamanho pequeno ou médio. Foi identificada uma diversidade de 35 táxons de cobras corais no Brasil, enquanto o soro antielapídico em uso no País é produzido a partir de três espécies.Conclusões: Devido ao porte reduzido, que resulta em baixa capacidade inoculatória, a recomendação de altas doses de soro antielapídico na ocorrência de acidentes com cobras corais deveria ser revista. Entretanto, a especificidade do veneno de cada espécie gera preocupação sobre a eficácia do soro antielapídico produzido a partir de um número reduzido de espécies de cobras corais.

Aims: To investigate the correlation between the amount of venom produced by a true coral snake and its size, and to evaluate the production and use of antielapidic serum, taking into account size, innoculatory power, and variability of these species in different regions of Brazil.Methods: To assess the diversity and geographic distribution we conducted a bibliographic review and electronic search in the official site of the Brazilian Herpetological Society. Diseases Report Information System of the Ministry of Health was consulted to obtain data on the epidemiology of elapidic accidents. Data on amount of extracted venom and size of the snakes were obtained from work conducted between 1986 and 2010, which data were stored in the venom database of the Centre for Studies and Biological Research of the Catholic University of Goiás.Results: The greatest diversity of species of coral snakes are in the Northern region and the largest sample of Micrurus accidents in the Northeast region. Linear regression analysis showed a strong correlation between body size and amount of venom extracted. Most species of coral snake have small or medium size. A diversity of 35 taxa of coral snakes in Brazil has been identified, while the antielapidic serum in use in this country is produced from three species.Conclusions: Due to the small size, which results in low innoculatory capacity, recommending high doses of antielapidic serum in accidents with coral snakes should be revised. However, the specificity of the venom of each species raises concerns about the effectiveness of antielapidic serum produced from a small number of species of coral snakes.

CORAL SNAKE ANTIVENOM PRODUCED IN CHICKENS (Gallus domesticus) / Antiveneno de serpiente coral producido en gallinas (Gallus domesticus)

The production of anti-snake venom from large mammal's blood has been found to be low-yielding and arduous, consequently, antivenom immunoglobulins for treatment are achieved regularly as polyvalent serum. We have standardized an undemanding technique for making purified immunoglobulin IgY antivenom consisting of polyclonal antibodies against coral snake venom in the egg yolk of immunized hens. We have adapted a reported process of antibody purification from egg yolks, and achieved 90% antibody purity. The customized technique consisted of the removal of lipids from distilled water-diluted egg yolks by a freeze–thaw sequence. The specific immunoglobulins were present in the egg yolk for up to 180 days postimmunization. Therefore, by means of small venom quantities, a significant amount of immunoglobulins were found in an adequately purified state (The obtained material contained about 90% pure IgY). The antigen binding of the immunoglobulins was detected by a double immunodiffusion test. Titers of antibodies in the yolk were estimated with a serum protection assay (Median effective dose = ED50) (ED50= 477 mg/kg). Given that breeding hens is economically feasible, egg gathering is noninvasive and the purification of IgY antibodies is quick and easy, chicken immunization is an excellent alternative for the production of polyclonal antibodies. To the best of our knowledge, this is the first coral snake antivenom prepared in birds.

La producción de antiveneno de serpiente usando sangre de grandes mamíferos se ha encontrado que es de bajo rendimiento y de trabajo arduo, en consecuencia, las inmunoglobulinas antiveneno para el tratamiento se obtienen generalmente, como suero polivalente. Hemos estandarizado una técnica poco exigente para la fabricación de inmunoglobulina purificada IgY, que consistió en generar anticuerpos policlonales contra el veneno de la serpiente coral en huevos de gallinas inmunizadas. La técnica consistió en la eliminación de lípidos de las yemas del huevo, diluidas en agua y en una secuencia de congelación-descongelación. Las inmunoglobulinas específicas estuvieron presentes en la yema de huevo hasta 180 días después de la inmunización. La unión del antígeno a las inmunoglobulinas se detectó mediante un ensayo de inmunodifusión doble. Los títulos de anticuerpos en la yema fueron estimados con un ensayo de protección (dosis efectiva media = ED50). Dado que las gallinas reproductoras son económicamente viables, la recolección de huevos es no invasiva y la purificación de anticuerpos IgY es rápida y fácil, la inmunización de la gallina es una excelente alternativa para la producción de anticuerpos policlonales. A nuestro entender, esta es el primer anti-veneno contra serpiente de coral preparado en aves.

Characterization of venomous snakes of Thailand.

Background: Envenoming by snakebite is an important public health problem in rural tropics. Venomous snake families such as Elapidae and Viperidae frequently produce severe poisoning. Anti-venoms are not available for all venomous snakes of Thailand and there is need for more development in this field. Objective: We characterized the important venomous snakes’ distribution of Thailand. Method: Venomous snake species are described in details including their identification, range, and extraterritorial distribution. Result: Eighteen snake species of the family Elapidae are summarized in their characteristics and distribution. There are three species of Naja, one species of Ophiophagus, three species of Bungarus, four species of Calliophis, one species of Sinomicrurus, two species of Laticauda, and four species of subfamily Hydrophiinae. Fifteen snake species of the family Viperidae consisting of one species of subfamily Viperinae and fourteen species of subfamily Crotalinae are also discussed. Conclusion: All these snakes are venomous and their venom is potentially fatal since birth.

How many studies are necessary to compare niche-based models for geographic distributions? Inductive reasoning may fail at the end / Quantos estudos ainda serão necessários para avaliar modelos de distribuição geográfica baseados em modelagem do nicho? Um pensamento indutivo pode estar fadado ao fracasso

The use of ecological niche models (ENM) to generate potential geographic distributions of species has rapidly increased in ecology, conservation and evolutionary biology. Many methods are available and the most used are Maximum Entropy Method (MAXENT) and the Genetic Algorithm for Rule Set Production (GARP). Recent studies have shown that MAXENT perform better than GARP. Here we used the statistics methods of ROC - AUC (area under the Receiver Operating Characteristics curve) and bootstrap to evaluate the performance of GARP and MAXENT in generate potential distribution models for 39 species of New World coral snakes. We found that values of AUC for GARP ranged from 0.923 to 0.999, whereas those for MAXENT ranged from 0.877 to 0.999. On the whole, the differences in AUC were very small, but for 10 species GARP outperformed MAXENT. Means and standard deviations for 100 bootstrapped samples with sample sizes ranging from 3 to 30 species did not show any trends towards deviations from a zero difference in AUC values of GARP minus AUC values of MAXENT. Ours results suggest that further studies are still necessary to establish under which circumstances the statistical performance of the methods vary. However, it is also important to consider the possibility that this empirical inductive reasoning may fail in the end, because we almost certainly could not establish all potential scenarios generating variation in the relative performance of models.

A utilização de modelos de nicho ecológico (ENM) para gerar distribuições geográficas potenciais de espécies tem aumentado rapidamente nas áreas de ecologia, biologia da conservação e biologia evolutiva. O Método de Máxima Entropia (MAXENT) e o Algoritmo Genético para Produção de Conjunto de Regras (GARP) estão entre os métodos mais utilizados, e estudos recentes têm atribuído ao MAXENT um melhor desempenho no processo de modelagem com relação ao GARP. Neste trabalho, foram utilizados os métodos estatísticos ROC - AUC (area under the Receiver Operating Characteristics curve) e de reamostragem (bootstrap) para avaliar o desempenho do GARP e MAXENT em gerar modelos de distribuição potencial para 39 espécies de cobras corais do Novo Mundo. Os resultados mostraram que os valores de AUC para o GARP variaram de 0,923 a 0,999, enquanto que para o MAXENT variaram de 0,877 a 0,999. Em geral, as diferenças de AUC entre os dois métodos foram pequenas, embora o GARP tenha apresentado melhor desempenho que o MAXENT para 10 espécies. Valores de média e desvio padrão de 100 amostras variando de 3 a 30 espécies não revelaram qualquer tendência de desvio em relação à diferença zero entre valores de AUC do GARP menos valores de AUC do MAXENT. Estes resultados sugerem que mais estudos serão necessários para determinar sob quais circunstâncias o desempenho estatístico dos modelos varia, embora seja importante considerar também a possibilidade de que argumentações empírico-indutivas em favor de um ou outro método podem falhar, já que é quase impossível estabelecer todos os cenários potenciais causadores de variação no desempenho dos modelos.

Estudo cariotípico de duas espécies brasileiras do gênero Micrurus (Ophidia: Elapidae) / Karyotypic studies of two Brazilian species of the genus Micrurus (Ophidia: Elapidae)

Descrevemos neste trabalho o cariótipo de duas espécies de cobra coral (Ophidia: Elapidae) do Brasil: Micrurus corallinus e M. ibiboboca. Preparações citológicas foram obtidas através da técnica de esmagamento, seguida de coloração convencional com Giemsa. Encontramos para M. corallinus, um número diplóide (2n) de 40 cromossomos, com fórmula cariotípica 40 (4; 16; 20) e constricção secundária no segundo par de macrocromossomos subtelocêntricos. Micrurus ibiboboca apresentou 2n = 42, com fórmula cariotípica 42 (2; 20; 20) e constricção secundária no primeiro par de macrocromossomos telocêntricos. As primeiras descrições dos cariótipos das espécies M. corallinus e M. ibiboboca, apresentadas neste trabalho, mostram aspectos semelhantes aos cariótipos de M. lemniscatus e M. surinamensis, únicas espécies deste gênero da América do Sul analisadas cromossomicamente. As quatro espécies em questão apresentam o mesmo número de microcromossomos (20), os maiores valores de macrocromossomos telocêntricos ou subtelocêntricos e os maiores números diplóides (2n) já encontrados no gênero Micrurus. Tais características diferenciam estas espécies da América do Sul das nove da América Central com cariótipos já estudados.

The karyotypes of two brazilian species of coral snakes (Ophidia: Elapidae): Micrurus corallinus and M. ibiboboca are described for the first time. Cytological preparations were obtained through the technique of squashing, followed by conventional Giemsa staining. The diploid number for Micrurus corallinus was 40 chromosomes with a karyotype formulae 40 (4; 16; 20) with a secondary constriction in the second pair of subtelocentric macrochromosomes. Micrurus ibiboboca is described by the formulae 42 (2; 20; 20) with 2n = 42 with a secondary constriction in the first pair of telocentric macrochromosomes. The karyotypes of M. corallinus and M. ibiboboca present aspects similar to M. lemniscatus and M. surinamensis, the only previously analyzed species of this genus in South America. These four species have the same number of microchromosomes (20), the largest number of telocentric or subtelocentric macrochromosomes and the largest diploid numbers (2n) ever found in the genus Micrurus. These characteristics differ from those of the nine known species of Central America.