Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis
J. venom. anim. toxins incl. trop. dis
;
26: e20200043, 2020. tab
Article
in English
| LILACS, VETINDEX
| ID: biblio-1135129
ABSTRACT
Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results:
A total of 185 patients were evaluated three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant.Conclusions:
The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite.(AU)
Full text:
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Index:
LILACS (Americas)
Main subject:
Thrombocytopenia
/
Bites and Stings
/
Antivenins
/
Risk Factors
/
Trimeresurus
/
Crotalid Venoms
/
Necrosis
Type of study:
Etiology study
/
Prognostic study
/
Risk factors
Limits:
Animals
Language:
English
Journal:
J. venom. anim. toxins incl. trop. dis
Year:
2020
Type:
Article
Institution/Affiliation country:
Cho Ray Hospital/VN
/
Daha Husada Hospital/ID
/
E-Da Hospital/TW
/
National Defense Medical Center/TW
/
National Tsing Hua University/TW
/
Taichung Veterans General Hospital/TW
/
Taichung Wildlife Conservation Group/TW
/
Taipei Medical University/TW
/
Taipei Veterans General Hospital/TW
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