Bamford N J, Sprinkle S B, Cudmore L A, Cullimore A M, van Eps A W, Verdegaal E J M M, Tennent-Brown B S
Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, Australia.
Scone Equine Hospital, Scone, New South Wales, Australia.
Equine Vet J. 2018 Mar;50(2):196-201. doi: 10.1111/evj.12735. Epub 2017 Sep 6.
Snake envenomation is a cause of morbidity and mortality in domestic animals worldwide. The clinical features of crotalid snake (pit viper) envenomation are widely reported and well described in horses but elapid snake envenomation is poorly characterised.
To describe the presentation, clinical and laboratory findings, treatment and outcome of horses with a diagnosis of elapid snake envenomation in Australia.
Retrospective case series.
Medical records of horses with a diagnosis of elapid snake envenomation (2006-2016) at several university and private veterinary practices were reviewed. Inclusion criteria comprised one or more of the following: 1) observed snakebite, 2) positive snake venom detection kit (SVDK) result, 3) appropriate clinical response to treatment with antivenom or 4) supportive post-mortem findings.
Fifty-two cases met the inclusion criteria. Most cases (94%) demonstrated clinical signs of neurotoxicity, characterised by generalised neuromuscular weakness. Associated neurologic signs included staggering gait, muscle fasciculations, recumbency, mydriasis, ptosis and tongue paresis. Concurrent clinically important conditions included rhabdomyolysis (50%) and haemolysis (19%). Of 18 urine samples evaluated with a SVDK, only three (17%) were positive. Overall survival was favourable (86%) among 49 horses who received antivenom. Eighteen surviving horses (43%) required more than one vial of antivenom.
Possible cases within the searchable database were not included if horses died acutely or responded to symptomatic treatment without receiving antivenom.
Elapid snake envenomation is primarily a syndrome of neuromuscular weakness. Supportive anamnesis or an obvious bite site is rarely encountered. In endemic areas, this diagnosis should be considered for horses with generalised neuromuscular weakness, altered mentation, rhabdomyolysis and/or haemolysis; especially during spring and summer months. Diagnostic suspicion is best confirmed by response to treatment with antivenom.
蛇咬伤是全球家畜发病和死亡的一个原因。响尾蛇（蝰蛇）咬伤的临床特征在马匹中有广泛报道且描述详尽，但眼镜蛇科蛇咬伤的特征描述较少。
描述澳大利亚诊断为眼镜蛇科蛇咬伤的马匹的临床表现、临床和实验室检查结果、治疗及预后。
回顾性病例系列研究。
回顾了几家大学和私人兽医诊所诊断为眼镜蛇科蛇咬伤（2006 - 2016年）的马匹的病历。纳入标准包括以下一项或多项：1）观察到蛇咬，2）蛇毒检测试剂盒（SVDK）结果呈阳性，3）对抗蛇毒血清治疗有适当的临床反应，或4）尸检结果支持。
52例符合纳入标准。大多数病例（94%）表现出神经毒性的临床症状，其特征为全身性神经肌肉无力。相关的神经学症状包括蹒跚步态、肌肉震颤、卧地不起、瞳孔散大、上睑下垂和舌麻痹。同时存在的具有临床重要性的情况包括横纹肌溶解（50%）和溶血（19%）。在18份用SVDK评估的尿液样本中，只有3份（17%）呈阳性。在接受抗蛇毒血清治疗的49匹马中，总体存活率良好（86%）。18匹存活的马（43%）需要不止一剂抗蛇毒血清。
如果马匹急性死亡或在未接受抗蛇毒血清的情况下对对症治疗有反应，则可搜索数据库中的可能病例未被纳入。
眼镜蛇科蛇咬伤主要是一种神经肌肉无力综合征。很少遇到支持性的既往史或明显的咬伤部位。在流行地区，对于出现全身性神经肌肉无力、精神状态改变、横纹肌溶解和/或溶血的马匹应考虑这一诊断；尤其是在春季和夏季。对治疗的反应最能证实诊断怀疑。
