Johnston Christopher I, Tasoulis Theo, Isbister Geoffrey K
Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia.
National Poison Centre Network, Westmead Children's Hospital, Sydney, NSW, Australia.
Front Pharmacol. 2022 Mar 21;13:816795. doi: 10.3389/fphar.2022.816795. eCollection 2022.
Sea snakes are venomous snakes found in the warm parts of the Indo-Pacific, including around Australia. Most sea snake envenoming causes myotoxicity, but previous Australian case reports describe neurotoxicity. We aimed to describe the epidemiology and clinical presentation of Australian sea snake envenoming and the effectiveness of antivenom. Patients were recruited to the Australian Snakebite Project (ASP), an Australia-wide prospective observational study recruiting all patients with suspected or confirmed snakebite >2 years. Information about demographics, bite circumstances, species involved, clinical and laboratory features of envenoming, and treatment is collected and entered into a purpose-built database. Between January 2002 and August 2020, 13 patients with suspected sea snake bite were recruited to ASP, 11 were male; median age was 30 years. Bites occurred in Queensland and Western Australia. All patients were in or around, coastal waters at the time of bite. The species involved was identified in two cases (both ) Local effects occurred in 9 patients: pain (5), swelling (5), bleeding (2), bruising (1). Envenoming occurred in eight patients and was characterised by non-specific systemic features (6) and myotoxicity (2). Myotoxicity was severe (peak CK 28200 and 48100 U/L) and rapid in onset (time to peak CK 13.5 and 15.1 h) in these two patients. Non-specific systemic features included nausea (6), headache (6), abdominal pain (3), and diaphoresis (2). Leukocytosis, neutrophilia, and lymphopenia occurred in both patients with myotoxicity and was evident on the first blood test. No patients developed neurotoxicity or coagulopathy. Early Seqirus antivenom therapy was associated with a lower peak creatine kinase. While relatively rare, sea snake envenoming is associated with significant morbidity and risk of mortality. Early antivenom appears to have a role in preventing severe myotoxicity and should be a goal of therapy.
海蛇是一种毒蛇，分布于印度-太平洋地区的温暖海域，包括澳大利亚周边海域。大多数海蛇咬伤会导致肌毒性，但此前澳大利亚的病例报告描述的是神经毒性。我们旨在描述澳大利亚海蛇咬伤的流行病学、临床表现以及抗蛇毒血清的有效性。患者被纳入澳大利亚蛇咬伤项目（ASP），这是一项在澳大利亚范围内开展的前瞻性观察性研究，招募所有疑似或确诊蛇咬伤超过2年的患者。收集有关人口统计学、咬伤情况、涉及的蛇种、咬伤的临床和实验室特征以及治疗的信息，并录入一个专门构建的数据库。2002年1月至2020年8月期间，13名疑似海蛇咬伤的患者被纳入ASP，其中11名男性；中位年龄为30岁。咬伤发生在昆士兰州和西澳大利亚州。所有患者在咬伤时都处于沿海水域或其附近。有两例确定了涉及的蛇种（均为……）。9名患者出现局部症状：疼痛（5例）、肿胀（5例）、出血（2例）、瘀伤（1例）。8名患者发生咬伤中毒，其特征为非特异性全身症状（6例）和肌毒性（2例）。这两名患者的肌毒性严重（肌酸激酶峰值分别为28200和48100 U/L）且起病迅速（肌酸激酶达到峰值的时间分别为13.5和15.1小时）。非特异性全身症状包括恶心（6例）、头痛（6例）、腹痛（3例）和出汗（2例）。两名肌毒性患者均出现白细胞增多、中性粒细胞增多和淋巴细胞减少，且在首次血液检查时就很明显。没有患者出现神经毒性或凝血病。早期使用赛奇鲁斯抗蛇毒血清治疗与较低的肌酸激酶峰值相关。虽然相对罕见，但海蛇咬伤中毒会导致严重发病和死亡风险。早期使用抗蛇毒血清似乎在预防严重肌毒性方面有作用，应作为治疗目标。
