Jelinek George A, Tweed Charles, Lynch Dania, Celenza Tony, Bush Brian, Michalopoulos Nick
Discipline of Emergency Medicine, School of Primary, Aboriginal, and Rural Health Care, University of Western Australia, Australia.
Emerg Med Australas. 2004 Oct-Dec;16(5-6):459-64. doi: 10.1111/j.1742-6723.2004.00650.x.
Studies have noted the relatively common occurrence of positive urine results with the Commonwealth Serum Laboratories Venom Detection Kit (VDK) when testing patients with suspected snakebite who are not envenomed. Possible explanations have been false positive test results or subclinical envenoming. We investigated a third possibility, that there is potential for the venom (or saliva) from mildly venomous and non-venomous snakes to give a positive reading with the VDK.
Venoms/saliva from three non-venomous and seven mildly venomous snake species were tested in the laboratory with the VDK, along with control venoms from four of the five major snake genera (Brown snake, Tiger snake, Death adder and Black snake).
Two of the venom/saliva samples, from Gould's hooded snake (Parasuta gouldii), a mildly venomous snake, and the Black-headed python (Aspidites melanocephalus), a non-venomous snake, caused a positive test for the tiger snake genus. There was also cross-reactivity between black snake venoms and the tiger snake well of the VDK.
This study provides a further possible explanation for 'false positive' VDK results, that is venom/saliva presence or absorption from mildly or non-venomous snakes and cross reactivity with venomous snakes on VDK testing. It has implications for antivenom use should it ever be required for more severe envenoming syndromes from mildly or moderately venomous snakes, and for further research. It reinforces the practice of only using VDK testing in patients who show definite evidence of envenoming.
研究指出,在对未中毒的疑似蛇咬伤患者进行检测时,英联邦血清实验室毒液检测试剂盒(VDK)的尿液检测结果呈阳性的情况相对常见。可能的解释是假阳性检测结果或亚临床中毒。我们研究了第三种可能性,即轻度有毒和无毒蛇的毒液(或唾液)有可能使VDK检测结果呈阳性。
在实验室中,使用VDK对三种无毒蛇和七种轻度有毒蛇的毒液/唾液进行检测,并与五种主要蛇属(棕蛇、虎蛇、死亡蝮蛇和黑蛇)中的四种的对照毒液一起检测。
来自轻度有毒的古尔德氏盔头蛇(Parasuta gouldii)和无毒的黑头蟒(Aspidites melanocephalus)的两种毒液/唾液样本,对虎蛇属检测呈阳性。黑蛇毒液与VDK的虎蛇检测孔之间也存在交叉反应。
本研究为VDK检测结果“假阳性”提供了另一种可能的解释,即轻度或无毒蛇的毒液/唾液存在或被吸收,以及在VDK检测中与有毒蛇的交叉反应。这对于在轻度或中度有毒蛇导致更严重中毒综合征时可能需要使用抗蛇毒血清的情况以及进一步研究具有启示意义。它强化了仅对显示明确中毒证据的患者使用VDK检测的做法。