Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Wilderness Environ Med. 2021 Jun;32(2):221-225. doi: 10.1016/j.wem.2021.01.004. Epub 2021 Mar 26.
Snakebite envenoming is a serious and life-threatening but neglected problem in the tropics. The focus in the Indian subcontinent is usually on the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell's viper (Daboia russelii), and Indian saw-scaled viper (Echis carinatus). The Indian polyvalent antivenom contains hyperimmunized horse antibodies against only these 4 species. However, regional intraspecific variations are important in viper envenomings, leading to marked differences in clinical presentation and response to the available polyvalent antivenom. Echis carinatus sochureki, a subspecies of Echis carinatus, has been linked to serious morbidity in the Thar Desert regions of Rajasthan, although consistent reports are lacking. We report a patient with prolonged venom-induced consumption coagulopathy owing to Echis carinatus sochureki envenoming who did not respond to Indian polyvalent antivenom in Jodhpur, India. Features of local and hemotoxic envenoming resolved after a week with supportive care. Echis sochureki venom has been shown to be different from Echis carinatus in terms of composition and in vitro neutralization by antivenom. Clinicians in the tropical desert regions must suspect Echis sochureki envenoming in the setting of nonresponsiveness to Indian polyvalent antivenom. This will help optimize antivenom use in these patients, preventing potentially life-threatening antivenom associated reactions. Because the usefulness of Indian polyvalent antivenom appears to be limited in this setting, there is an urgent need to advocate for region-specific antivenom or monovalent antivenom for this area.
蛇咬伤中毒是热带地区一种严重且危及生命但被忽视的问题。在印度次大陆，通常关注的是印度眼镜蛇（Naja naja）、常见的金环蛇（Bungarus caeruleus）、罗素的蝰蛇（Daboia russelii）和印度锯鳞蝰（Echis carinatus）。印度多价抗蛇毒血清含有针对这 4 种蛇的高度免疫马抗体。然而，在毒蛇中毒中，区域种内变异很重要，导致临床表现和对现有多价抗蛇毒血清的反应存在显著差异。Echis carinatus sochureki 是 Echis carinatus 的一个亚种，与拉贾斯坦邦塔尔沙漠地区的严重发病率有关，尽管缺乏一致的报告。我们报告了一名患者，因 Echis carinatus sochureki 中毒而导致长时间的毒液诱导消耗性凝血病，在印度焦特布尔对印度多价抗蛇毒血清没有反应。局部和血液中毒的特征在一周的支持性治疗后得到缓解。Echis sochureki 毒液在组成和抗蛇毒血清的体外中和方面与 Echis carinatus 不同。在对印度多价抗蛇毒血清无反应的情况下，热带沙漠地区的临床医生必须怀疑存在 Echis sochureki 中毒。这将有助于优化这些患者对抗蛇毒血清的使用，防止潜在危及生命的抗蛇毒血清相关反应。由于印度多价抗蛇毒血清在这种情况下似乎效果有限，因此迫切需要倡导为该地区提供特定于区域的抗蛇毒血清或单价抗蛇毒血清。
