ABSTRACT
We prospectively compared the ability of anti-venom and edrophonium (Tensilon) to improve paralytic symptoms in 8 patients envenomed by the Philippine cobra (Naja naja philippinensis). Twenty, 50 or 100 ml of Philippine cobra antivenom were administered in a double-blind fashion by constant intravenous infusion over 30 min. Even the largest dose of antivenom failed to produce marked improvement within 2 h, though enzyme-linked immunosorbent assays and neutralization tests demonstrated that it possessed high titres of anti-neurotoxin antibodies. Tensilon given at 2 h was significantly more effective than antivenom at increasing the duration of upward gaze (78 +/- 28 vs 43 +/- 26 sec, P less than 0.001), and either completely reversed or markedly decreased paralysis in every patient. The Tensilon test should be given to all patients with paralytic envenoming by cobras, and anticholinesterases administered to those with a positive response.
Subject(s)
Antivenins/therapeutic use , Edrophonium/therapeutic use , Paralysis/drug therapy , Snake Bites/drug therapy , Adolescent , Adult , Cobra Neurotoxin Proteins/antagonists & inhibitors , Double-Blind Method , Female , Humans , Male , Middle Aged , Neutralization Tests , Prospective Studies , Randomized Controlled Trials as Topic , Snake Bites/complicationsABSTRACT
Although human cases of leptospirosis have been reported from the Philippines, there is a lack of data on its prevalence. We therefore surveyed three rice-farming villages for the presence of leptospiral antibody. Out of 155 sera tested, 63 (43.6%) tested positive using the standard microagglutination test. Antibodies were more frequent in men than women (48 vs. 31%, respectively, p less than 0.01), and less common in the elderly. Exposure to leptospires occurs frequently in rice farmers, and leptospirosis is likely to be an underdiagnosed cause of both mild and severe febrile illness in the Philippines.
Subject(s)
Antibodies, Bacterial/analysis , Leptospira interrogans/immunology , Adolescent , Adult , Aged , Agricultural Workers' Diseases/epidemiology , Female , Humans , Male , Middle Aged , Oryza , Philippines , Weil Disease/epidemiologyABSTRACT
The effects of tourniquet application were prospectively studied in 36 hospitalized patients who developed neurotoxic symptoms after bites by the Philippine cobra (Naja naja philippinensis). Tourniquets had been applied in 94% of cases and delayed the onset of symptoms. Four patients were asymptomatic prior to the release of their tourniquet and in 11 patients symptoms worsened precipitously. Most importantly, 4 patients developed complete respiratory paralysis requiring artificial ventilation on its removal. Medical personnel seeing patients after a possible cobra bite should remove any tourniquet very gradually with both specific therapy and ventilatory support at hand. We recommend tourniquet application in the Philippines only after the bite of a definitely identified cobra and when removal can take place under controlled hospital conditions.
Subject(s)
Cobra Neurotoxin Proteins/poisoning , Elapid Venoms/poisoning , Snake Bites/therapy , Tourniquets , Adolescent , Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Prospective Studies , Time FactorsSubject(s)
Leptospirosis/diagnosis , Agglutination Tests , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Serologic Tests , Time FactorsABSTRACT
The effect of a 7-day course of intravenous penicillin (6 million units/day) on severe, advanced leptospirosis was examined in a randomised, placebo-controlled, double-blind trial involving 42 patients. Every measurable aspect of the disease was favourably affected by penicillin. Fever lasted more than twice as long in the placebo group (11.6 [SD 8.34] days vs 4.7 [4.19] days, p less than 0.005), and by the fourth day after starting penicillin more than half the treatment group, but only 1 of 19 in the placebo group, were afebrile (p less than 0.005). Creatinine rises persisted more than thrice as long in the patients receiving only placebo (8.3 [8.46] days vs 2.7 [1.90] days; p less than 0.01). Penicillin also shortened the hospital stay and prevented leptospiruria. Intravenous penicillin should be given to patients with severe leptospirosis, even if therapy can be begun only late in the course of their disease.
Subject(s)
Penicillin G/therapeutic use , Weil Disease/drug therapy , Adolescent , Adult , Agglutination Tests , Clinical Trials as Topic , Double-Blind Method , Enzyme-Linked Immunosorbent Assay , Female , Humans , Immunoglobulin M/analysis , Infusions, Intravenous , Male , Penicillin G/administration & dosage , Random Allocation , Weil Disease/immunologyABSTRACT
We investigated mortality from cobra (Naja naja philippinensis) bite among Filipino rice farmers. Village records in one area were examined and we conducted a careful survey in this and two additional areas among inhabitants at varying risk for snakebite. The death rate from cobra bite was estimated to be as high as 107.1 deaths per 100,000 population per year at one site. Most victims were young (median age 17) and 98% were males. Only 8% of the victims studied reached a hospital. The confirmed death rate averaged 53.8/100,000 for the three populations.
