Dry bite of Snake venom

 

Dry bite Snake venom	Comment	Country	References
Definition	Failure to inject venom while biting	Denmark and Brazil.	1
Cause	[1] viral infections, [2] physical agents, [3] traumas during defense,  [4] excessive pressure on the venom glands (i.e., during manual extraction in captivity) [5] any other inflammatory response. [6] venom gland tissue damage will result in empty venom glands and, consequently, in dry bites.  [7]. Calcification of fangs and obstruction of the secondary venom ducts. [8]. Aged snakes often present these alterations	Denmark and Brazil.	1
Rate	18%	India	2
	Viperids (14.7%)    Elapids (14.5%)	Denmark and Brazil.	1
	19%	Turkey	3
	Rattlesnake 42.9%	Brazil.	4
	25—50%	Denmark and Brazil.	1
Diagnosis	The diagnosis of a dry bite is generally made retrospectively, once it has been confirmed that the bite was sustained from a venomous snake and that no envenoming occurred.	Denmark and Brazil.	1
Observe	Some toxins may exert their effects within minutes, while others may require several hours to take effect. Therefore, it is crucial to observe the patient long enough to enable differentiation between delayed onset of toxicity and a dry bite. Usually, clinical manifestations present within 12–24 h (or less) of the bite incident	Costa Rica; Spain, UK, Papua New Guinea, and Australia.	5

 

1.      https://pubmed.ncbi.nlm.nih.gov/33105644/

2.      https://pubmed.ncbi.nlm.nih.gov/33311806/

3.      https://pubmed.ncbi.nlm.nih.gov/17978913/

4.      https://pubmed.ncbi.nlm.nih.gov/8592769/

5.      https://pubmed.ncbi.nlm.nih.gov/28905944/

 Edited by Yu-Jang Su   Feb, 7, 2023

Bee Venom Poisoning

 

SUBSTANCE

   -Melittin and phospholipase A2, hyaluronidase, apamin, [1, 2, 3]

-           peptide 401 [3].

 

Common name or Trade name 

- Bees/wasps sting venom poisoning.

 

Involving SYSTEM

- Skin. 

-   Kidney:  Acute kidney injury: related to melittin attacking renal tubular epithelial cells (RTECs) [4, 5, 6, 7]

- acute respiratory failure, acute liver failure, rhabdomyolysis.

- 24.1% of hospitalized patients: Rhabdomyolysis [8]

-19.2% of hospitalized patients: hemolysis [8]

- liver injury in 30.1% of hospitalized patients [8].

- coagulopathy in 22.5% of hospitalized patients. [6, 8]

Presentation

-          Skin itching, painful. Systemic symptoms and signs when > 20 stings. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083164]

-          Anaphylaxis. [9]

-          Skin necrosis. [10]

-          Angioedema [2]

-          Bronchospasm [2]

-          Shock [2]

-          wheezing

-          Gastrointestinal bleeding. [11]

-          DIC [2]

-          Coma [11]

 

Antidote and Treatment 

-          no antidote.

-Epinephrine 0.3 mg SC when anaphylactic shock. Bosmin 1 amp in N/S IV pump keep 30 c.c./hr.

- Tetanus toxoid [2].

- Ice packing, steroid ointment [2]

-Antihistamine [2]

- Steroid [2]

-Antibiotics when secondary infection. [2]

 

Disposition

 -76.9% of the hospitalized cases attacked 10 or > 10 stings with a mortality of 5.1%. [8]

-          4.4 % of hospitalized cases died of multi-organ injury [8]

-          1% of hospitalized cases died who were attacked less than 10 stings. [8]

-          Poor outcome when high creatinine level, shock, oliguria, and anemia [8].

REFERENCES

1.      Pillur Tamilarasu K, Shankar T, Kabi A. Unusual case of recurrent hypoglycaemia in multiple bee sting envenomation. BMJ Case Rep. 2021 Jul 26;14(7):e242440. doi: 10.1136/bcr-2021-242440. PMID: 34312127; PMCID: PMC8314743.

2.      急診醫學會. 急性中毒救命術.三版 p.191—197

3.      Silva GBD Junior, Vasconcelos AG Junior, Rocha AMT, Vasconcelos VR, Barros J Neto, Fujishima JS, Ferreira NB, Barros EJG, Daher EF. Acute kidney injury complicating bee stings - a review. Rev Inst Med Trop Sao Paulo. 2017 Jun 1;59:e25. doi: 10.1590/S1678-9946201759025. PMID: 28591253; PMCID: PMC5459532.

4.      Kim H, Hong JY, Jeon WJ, Baek SH, Ha IH. Bee Venom Melittin Protects against Cisplatin-Induced Acute Kidney Injury in Mice via the Regulation of M2 Macrophage Activation. Toxins (Basel). 2020 Sep 6;12(9):574. doi: 10.3390/toxins12090574. PMID: 32899913; PMCID: PMC7551791.

5.      Shu Y, Yang Y, Zhao Y, Ma L, Fu P, Wei T, Zhang L. Melittin Inducing the Apoptosis of Renal Tubule Epithelial Cells through Upregulation of Bax/Bcl-2 Expression and Activation of TNF-α Signaling Pathway. Biomed Res Int. 2019 May 29;2019:9450368. doi: 10.1155/2019/9450368. PMID: 31772938; PMCID: PMC6854966.

6.      Chen TH, Liao WT, Chen CS, Lin PC, Wu MY. An Envenoming Syndrome from Massive Vespa Stings Induces Multiple Organ Failure. Insects. 2020 Apr 2;11(4):219. doi: 10.3390/insects11040219. PMID: 32252275; PMCID: PMC7240471.

7.      Grisotto LS, Mendes GE, Castro I, Baptista MA, Alves VA, Yu L, Burdmann EA. Mechanisms of bee venom-induced acute renal failure. Toxicon. 2006 Jul;48(1):44-54. doi: 10.1016/j.toxicon.2006.04.016. Epub 2006 May 6. PMID: 16774771.

8.      Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases. PLoS One. 2013 Dec 31;8(12):e83164. doi: 10.1371/journal.pone.0083164. PMID: 24391743; PMCID: PMC3877022.

9.      Hughes RL. A Fatal Case of Acute Renal Failure From Envenoming Syndrome After Massive Bee Attack: A Case Report and Literature Review. Am J Forensic Med Pathol. 2019 Mar;40(1):52-57. doi: 10.1097/PAF.0000000000000451. PMID: 30531211.

10.  Toledo LFM, Moore DCBC, Caixeta DMDL, Salú MDS, Farias CVB, Azevedo ZMA. Multiple bee stings, multiple organs involved: a case report. Rev Soc Bras Med Trop. 2018 Jul-Aug;51(4):560-562.

11.  Iliev YT, Tufkova SG, Prancheva MG. A rare case of severe intoxication from multiple bee stings with a favorable outcome. Folia Med (Plovdiv). 2010 Jul-Sep;52(3):74-7. doi: 10.2478/v10153-010-0010-5. PMID: 21053677.

edited by Yu-Jang Su    Oct 30th, 2021.