Antivenom cross neutralisation in a suspected Asian pit viper envenoming causing severe coagulopathy

Isbister, G. K., Maduwage, K. and Page, C. B. (2014) Antivenom cross neutralisation in a suspected Asian pit viper envenoming causing severe coagulopathy. Toxicon, 90 286-290. doi:10.1016/j.toxicon.2014.08.071


Author Isbister, G. K.
Maduwage, K.
Page, C. B.
Title Antivenom cross neutralisation in a suspected Asian pit viper envenoming causing severe coagulopathy
Journal name Toxicon   Check publisher's open access policy
ISSN 0041-0101
1879-3150
Publication date 2014-11
Sub-type Article (original research)
DOI 10.1016/j.toxicon.2014.08.071
Open Access Status
Volume 90
Start page 286
End page 290
Total pages 5
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon Press
Collection year 2015
Language eng
Subject 3005 Toxicology
Formatted abstract
There is evidence of cross-neutralisation between common toxin groups in snake venoms and therefore the potential for antivenoms to be effective against species they are not raised against. Here we present a 49 year old female bitten by an unknown pit-viper in Nepal. She developed a venom induced consumption coagulopathy with an unrecordable international normalised ratio and undetectable fibrinogen. On return to Australia 5 days post-bite she was treated successfully with one antivenom raised against Malayan pit viper and green pit viper venoms (Haemato-polvalent antivenom from Thailand) and then subsequently with another antivenom raised against American pit-viper venoms (Antivipmyn). Presumed pit viper venom was detected in patient sera with an enzyme immunoassay against Hypnale hypnale venom. There was increased absorbance before antivenom compared to non-envenomed control samples, which then decreased after the administration of each antivenom. The recurrence of venom detected by enzyme immunoassay between antivenom doses was accompanied by a recurrence of the coagulopathy. Cross reactivity between the unknown venom and both antivenoms was supported by the fact that no venom was detected in the pre-antivenom samples after they were incubated in vitro with both antivenoms. This case and investigation of the venom and antivenoms suggest cross-neutralisation between pit vipers, including pit vipers from different continents.
Keyword Antivenom
Cross-neutralisation
Venom
Pit viper
Snake envenoming
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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