Razavi Shahab, Weinstein Scott A, Bates David J, Alfred Sam, White Julian
Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia; Medical School, University of Bristol, Bristol BS8 1TH, UK.
Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia.
Toxicon. 2014 Jul;85:17-26. doi: 10.1016/j.toxicon.2014.04.003. Epub 2014 Apr 13.
The mulga snake (Pseudechis australis) is the largest terrestrial venomous snake in Australia. It is capable of inflicting severe and occasionally fatal envenoming, but there have been few studies of P. australis bites.
To highlight and reinforce the main features of P. australis envenoming and to provide a clearer picture of the epidemiology of bites from this species.
Selected case records kept by the Toxinology Dept. (Women's and Children's Hospital, Adelaide, Australia) were reviewed retrospectively to determine definite P. australis bites.
definite cases where the snake was identified by a competent person and/or lab specimens (bite site/urine) tested positive for "black snake" using CSL snake venom detection kit in a locality within the known range of P. australis, but without sympatry with other Pseudechis spp.
where the snake could not be clearly identified under criteria above. Epidemiological and clinical information was recorded and analysed for the definite cases.
A total of 27 cases were identified as definite P. australis bites; there were no fatalities. The median age was 35.5 years (IQR 51-23) and 80% of bites occurred in males. More bites occurred in the warmer months (Dec-March) and in those handling/interfering with snakes. Seven people were bitten whilst asleep at night. 21/27 patients developed systemic envenoming (based on signs, symptoms and laboratory results) and 17 cases received antivenom. Local bite site pain (18) and swelling (17) were common as were non-specific generalised symptoms such as nausea, vomiting and headache. Myotoxicity (11) and anticoagulant coagulopathy (10) occurred frequently; haemolysis was seen in fewer cases (3). Two patients developed local tissue injury around the bite site requiring further treatment.
This study confirms previous reports about P. australis bites with respect to high rates of envenoming, commonly associated with pain and swelling and systemic effects of rhabdomyolysis and anticoagulant coagulopathy. Systemic envenoming, even severe cases, responds well to antivenom therapy. Compared to other Australian snakes, a high proportion of bites occur in people asleep at night. Medically significant local tissue injury around the bite site may occur and may be associated with inappropriate first-aid, particularly the vascular occlusive type.
穆拉蛇（澳洲伪眼镜蛇）是澳大利亚最大的陆生毒蛇。它能够造成严重且偶尔致命的中毒，但对澳洲伪眼镜蛇咬伤的研究较少。
强调并强化澳洲伪眼镜蛇中毒的主要特征，更清晰地呈现该物种咬伤的流行病学情况。
回顾性分析澳大利亚阿德莱德妇女儿童医院毒素学部门保存的选定病例记录，以确定明确的澳洲伪眼镜蛇咬伤病例。
在澳洲伪眼镜蛇已知分布范围内的地区，由专业人员鉴定出蛇种和/或实验室标本（咬伤部位/尿液）使用CSL蛇毒检测试剂盒检测“黑蛇”呈阳性的明确病例，且该地区不存在与其他伪眼镜蛇属物种同域分布的情况。
不符合上述标准且无法明确鉴定蛇种的病例。记录并分析明确病例的流行病学和临床信息。
共鉴定出27例明确的澳洲伪眼镜蛇咬伤病例；无死亡病例。中位年龄为35.5岁（四分位间距51 - 23），80%的咬伤发生在男性身上。更多咬伤事件发生在温暖月份（12月至次年3月）以及那些处理/干扰蛇的人身上。7人在夜间睡觉时被咬伤。21/27例患者出现全身中毒（基于体征、症状和实验室检查结果），17例患者接受了抗蛇毒血清治疗。局部咬伤部位疼痛（18例）和肿胀（17例）较为常见，恶心、呕吐和头痛等非特异性全身症状也很常见。肌毒性（11例）和抗凝性凝血障碍（10例）频繁发生；溶血病例较少（3例）。两名患者咬伤部位周围出现局部组织损伤，需要进一步治疗。
本研究证实了先前关于澳洲伪眼镜蛇咬伤的报道，即中毒发生率高，通常伴有疼痛、肿胀以及横纹肌溶解和抗凝性凝血障碍的全身影响。全身中毒，即使是严重病例，对抗蛇毒血清治疗反应良好。与其他澳大利亚蛇类相比，较高比例的咬伤发生在夜间入睡的人身上。咬伤部位周围可能会出现具有医学意义的局部组织损伤，这可能与不适当的急救措施有关，尤其是血管闭塞型急救措施。
