Gan Melissa, O'Leary Margaret A, Brown Simon G A, Jacoby Tamara, Spain David, Tankel Alan, Gavaghan Chris, Garrett Peter, Isbister Geoffrey K
Emergency Department, Gold Coast Hospital, Gold Coast, QLD, Australia.
Med J Aust. 2009 Aug 3;191(3):183-6. doi: 10.5694/j.1326-5377.2009.tb02736.x.
To describe demographic, geographical and clinical features of envenoming by the rough-scaled snake (RSS) (Tropidechis carinatus).
DESIGN, SETTING AND PARTICIPANTS: Prospective cohort study of RSS snakebite victims, recruited between January 2004 and December 2008, as part of the Australian Snakebite Project. RSS envenoming cases were confirmed by snake identification and/or venom-specific enzyme immunoassay.
Clinical and laboratory features of envenoming.
There were 24 confirmed cases of RSS envenoming, nearly all occurring in coastal areas between northern New South Wales and south-eastern Queensland. Twenty-three patients had local bite-site effects and 17 had at least three non-specific systemic effects (eg, nausea, headache). All 24 had venom-induced consumption coagulopathy (VICC), and 19 had an international normalised ratio>3.0. Six had bleeding from the bite site or intravenous cannula site, 10 had blood detected on urinalysis, and one had a major intra-abdominal haemorrhage. Mild neurotoxicity developed in two patients, and one patient developed myotoxicity with generalised myalgia, myoglobinuria and a peak creatine kinase level of 59 700 IU/L. Twenty-three patients were treated with antivenom (21 with tiger snake antivenom, two with polyvalent antivenom). Free venom was undetectable in 19 of 20 blood samples taken after antivenom administration.
RSS envenoming occurs predominantly in coastal areas of northern NSW and southern Queensland, and within this range, most envenoming is due to the RSS rather than tiger snakes. Clinically it is characterised by VICC, with mild neurotoxicity and myotoxicity in some cases. Tiger snake antivenom appears to be effective against RSS envenoming.
描述糙鳞蛇（RSS）（Tropidechis carinatus）致伤的人口统计学、地理分布及临床特征。
设计、地点和参与者：作为澳大利亚蛇咬伤项目的一部分，对2004年1月至2008年12月期间招募的RSS蛇咬伤受害者进行前瞻性队列研究。通过蛇种鉴定和/或毒液特异性酶免疫测定确诊RSS致伤病例。
致伤的临床和实验室特征。
确诊24例RSS致伤病例，几乎均发生在新南威尔士州北部和昆士兰州东南部的沿海地区。23例患者有局部咬伤部位症状，17例至少有三种非特异性全身症状（如恶心、头痛）。24例均出现毒液诱导的消耗性凝血病（VICC），19例国际标准化比值>3.0。6例咬伤部位或静脉插管部位出血，10例尿液分析检测到血液，1例发生严重腹腔内出血。2例患者出现轻度神经毒性，1例患者出现肌毒性，伴有全身肌痛、肌红蛋白尿，肌酸激酶峰值水平达59700 IU/L。23例患者接受了抗蛇毒血清治疗（21例用虎蛇抗蛇毒血清，2例用多价抗蛇毒血清）。给予抗蛇毒血清后采集的20份血样中，19份未检测到游离毒液。
RSS致伤主要发生在新南威尔士州北部和昆士兰州南部沿海地区，在此范围内，大多数致伤是由RSS而非虎蛇所致。临床上以VICC为特征，部分病例伴有轻度神经毒性和肌毒性。虎蛇抗蛇毒血清似乎对RSS致伤有效。
