Thomas L, Chausson N, Uzan J, Kaidomar S, Vignes R, Plumelle Y, Bucher B, Smadja D
Service des Urgencies, Centre Hospitalier Universitaire, Hôpital Pierre Zobda-Quitman, F-97200, Fort-de-France, Martinique.
Toxicon. 2006 Jul;48(1):23-8. doi: 10.1016/j.toxicon.2006.04.007. Epub 2006 Apr 28.
The severity of envenoming from Bothrops lanceolatus is determined by the development of cerebral, myocardial or pulmonary infarctions, and occasionnaly by serious local envenoming. Introduction of specific antivenom has resulted in a dramatic improvement in the prognosis of this envenoming. Against this background, we report 3 recent cases of patients bitten by B. lanceolatus who developed cerebral infarctions despite early administration of antivenom.
In 1991 a protocol was designed to apply the same evaluation and treatment to all envenomed patients. The clinical results have been continuously monitored.
Between April 1993 and July 2003, 128 envenomed patients (age 6-83 (mean 45) years) were treated. No coagulopathy, thrombotic complication or death occurred in patients who were given early antivenom therapy--up to 6h following the bite--and 126 patients recovered. Between August 2003 and October 2004, 10 additional patients (18-66 (mean 46) years) were given antivenom at the time of admission at hospital. Of these, 3 developed cerebral infarctions within 24h. Effectiveness of antivenom was tested on mouse, and found to be lower than specified by the manufacturer.
Our data shows that recently the antivenom may have lost some of its efficacy. Possible mechanisms include variability in venom composition or loss of activity of the antibodies produced more than 15 years ago. The question is whether we should attempt to produce improved antivenom. This could include activity against the venom of Bothrops caribbaeus from the neighbouring island of St Lucia, which shares a monophyletic group with B. lanceolatus and whose venom produces a similar thrombotic syndrome.
Prevention of systemic vessels thrombosis remains the main therapeutic challenge of B. lanceolatus envenoming in Martinique.
矛头蝮蛇咬伤中毒的严重程度取决于脑、心肌或肺梗死的发生情况，偶尔也取决于严重的局部中毒。特异性抗蛇毒血清的应用使这种中毒的预后有了显著改善。在此背景下，我们报告了3例近期被矛头蝮蛇咬伤的患者，尽管早期使用了抗蛇毒血清，但仍发生了脑梗死。
1991年设计了一项方案，对所有中毒患者采用相同的评估和治疗方法，并持续监测临床结果。
1993年4月至2003年7月，共治疗了128例中毒患者（年龄6 - 83岁，平均45岁）。在咬伤后6小时内接受早期抗蛇毒血清治疗的患者未出现凝血障碍、血栓并发症或死亡，126例患者康复。2003年8月至2004年10月，又有10例患者（年龄18 - 66岁，平均46岁）在入院时接受了抗蛇毒血清治疗。其中，3例在24小时内发生了脑梗死。对小鼠进行抗蛇毒血清有效性测试，发现其效果低于制造商规定的标准。
我们的数据表明，近期抗蛇毒血清可能已丧失了部分疗效。可能的机制包括毒液成分的变异性或15年多前产生的抗体活性丧失。问题是我们是否应尝试生产改良的抗蛇毒血清。这可能包括针对来自邻近圣卢西亚岛的加勒比矛头蝮蛇毒液的活性，该蛇与矛头蝮蛇同属一个单系群，其毒液会产生类似的血栓综合征。
预防全身血管血栓形成仍然是马提尼克岛矛头蝮蛇咬伤中毒的主要治疗挑战。
