Rajarata Tropical Disease Research Group, Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Clin Toxicol (Phila). 2023 Jul;61(7):518-523. doi: 10.1080/15563650.2023.2229007. Epub 2023 Jul 24.
Serum sickness is a poorly reported delayed adverse reaction following snake antivenom therapy. We aimed to assess the frequency of serum sickness associated with administering Indian polyvalent antivenom in Sri Lanka.
We recruited patients from the Anuradhapura snakebite cohort who were admitted to a rural tertiary care hospital in Sri Lanka over one year period. Patients were interviewed over the phone 21 to 28 days post-envenoming to collect data on clinical effects: fever/chills, arthralgia/myalgia, rash, malaise, headache, abdominal pain, and nausea/vomiting. The presence of three or more symptoms between the 5th to 20th days after snake envenoming was defined as serum sickness.
We were able to contact 98/122 (80%) patients who received antivenom and 423/588 (72%) who did not receive antivenom during the study period. The treated patients received a median dose of 20 vials (interquartile range: 20-30) of Indian polyvalent antivenom and of them, 92 (92%) received premedication. However, 67/98 (68%) developed acute adverse reactions to antivenom, including 19/98 (19%) developing anaphylaxis. Only 4/98 (4%) who received antivenom met the criteria for serum sickness, compared to none who did not receive antivenom therapy. All patients who developed serum sickness were envenomed by Russell's vipers, were premedicated, and received VINS Bioproducts antivenom. Three of them were treated with hydrocortisone in the acute stage, as premedication or as a treatment for acute adverse reactions of antivenom. Although all four patients sought medical advice for their symptoms, only one was clinically suspected to be serum sickness and treated, while the others were treated for infections.
We confirmed that Indian polyvalent antivenom use in Sri Lanka is associated with high rates of acute adverse reactions. In contrast to studies of other antivenoms only a small proportion of patients developed serum sickness.
血清病是一种少见的蛇毒抗血清治疗后迟发性不良反应。我们旨在评估在斯里兰卡使用印度多价蛇毒抗血清与血清病相关的频率。
我们招募了在斯里兰卡一家农村三级保健医院住院的阿努拉达普拉蛇咬伤队列的患者。在被蛇咬伤后 21 至 28 天，通过电话对患者进行访谈，以收集以下临床影响的数据：发热/寒战、关节痛/肌痛、皮疹、不适、头痛、腹痛和恶心/呕吐。在蛇咬伤后第 5 至 20 天出现 3 个或更多症状定义为血清病。
我们能够联系到 122 名接受抗血清治疗的患者中的 98 名（80%）和研究期间未接受抗血清治疗的 588 名患者中的 423 名（72%）。接受治疗的患者接受了中位数为 20 瓶（四分位间距：20-30）的印度多价蛇毒抗血清，其中 92 名（92%）接受了预处理。然而，67/98（68%）出现了抗血清的急性不良反应，包括 19/98（19%）发生过敏反应。只有 4/98（4%）接受抗血清治疗的患者符合血清病的标准，而未接受抗血清治疗的患者则没有。所有发生血清病的患者均被罗素蝰蛇咬伤，接受了预处理，并接受了 VINS Bioproducts 抗血清治疗。其中 3 名患者在急性期接受了氢化可的松治疗，作为预处理或治疗抗血清的急性不良反应。尽管所有 4 名患者都因症状寻求医疗建议，但只有 1 名患者被临床怀疑为血清病并接受治疗，而其他患者则被治疗感染。
我们证实，在斯里兰卡使用印度多价蛇毒抗血清与急性不良反应发生率高有关。与其他抗血清的研究不同，只有少数患者发生血清病。
