Division of Toxicology, China Medical University Hospital, Taichung 40447, Taiwan.
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli 35053, Taiwan.
Toxins (Basel). 2022 Feb 7;14(2):122. doi: 10.3390/toxins14020122.
The cobra (genus ()) is one of the most common venomous snakes. Due to its frequency and deadly complications of muscle paralysis, local necrosis, and chronic musculoskeletal disability, it should not be ignored. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear. Here, we attempted to dig in envenomed tissues to study the clinical toxicology of cobra venom. Four cases of snake envenomation, in which the subjects developed advanced tissue injury, were involved in this study. We used enzyme-ligand sandwich immunoassay (ELISA) to assay the whole venom, cytotoxin A3 and short-chain neurotoxin (sNTX) in blood, bullae, wound discharge, and debrided tissue. We found that persistently high concentrations of venom and toxins, especially cytotoxin A3, were detected in bullae, wound discharge fluid and necrotic tissue of these patients even after large doses of specific antivenom treatment, and wide excision and advanced debridement could largely remove these toxins, lessen the size of necrosis, and promote wound healing. We also found that the point-of-care apparatus, ICT-Cobra kit, might be used to promptly monitor the wound condition and as one of the indicators of surgical intervention in cases of cobra envenomation in Taiwan.
眼镜蛇（属）是最常见的毒蛇之一。由于其频繁发生且可导致肌肉瘫痪、局部坏死和慢性肌肉骨骼残疾等严重并发症，不应被忽视。尽管存在特定的抗蛇毒血清，但破坏性组织损伤的病理机制仍不完全清楚。在此，我们尝试深入研究中毒组织，以研究眼镜蛇毒液的临床毒理学。本研究纳入了 4 例因蛇咬伤而出现严重组织损伤的病例。我们使用酶联免疫吸附试验（ELISA）检测血液、水疱、伤口分泌物和清创组织中的全毒液、细胞毒素 A3 和短链神经毒素（sNTX）。我们发现，即使在大剂量使用特定抗蛇毒血清治疗后，这些患者的水疱、伤口分泌物和坏死组织中仍持续存在高浓度的毒液和毒素，特别是细胞毒素 A3。广泛切除和先进的清创术可以大量去除这些毒素，减少坏死面积，并促进伤口愈合。我们还发现，床边即时检验（ICT）设备——ICT-Cobra 试剂盒，可用于及时监测伤口状况，并作为台湾地区眼镜蛇咬伤手术干预的指标之一。
