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Wilderness & environmental medicine2021; 32(2); 221-225; doi: 10.1016/j.wem.2021.01.004

Venom-Induced Consumption Coagulopathy Unresponsive to Antivenom After Echis carinatus sochureki Envenoming.

Abstract: Snakebite envenoming is a serious and life-threatening but neglected problem in the tropics. The focus in the Indian subcontinent is usually on the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell's viper (Daboia russelii), and Indian saw-scaled viper (Echis carinatus). The Indian polyvalent antivenom contains hyperimmunized horse antibodies against only these 4 species. However, regional intraspecific variations are important in viper envenomings, leading to marked differences in clinical presentation and response to the available polyvalent antivenom. Echis carinatus sochureki, a subspecies of Echis carinatus, has been linked to serious morbidity in the Thar Desert regions of Rajasthan, although consistent reports are lacking. We report a patient with prolonged venom-induced consumption coagulopathy owing to Echis carinatus sochureki envenoming who did not respond to Indian polyvalent antivenom in Jodhpur, India. Features of local and hemotoxic envenoming resolved after a week with supportive care. Echis sochureki venom has been shown to be different from Echis carinatus in terms of composition and in vitro neutralization by antivenom. Clinicians in the tropical desert regions must suspect Echis sochureki envenoming in the setting of nonresponsiveness to Indian polyvalent antivenom. This will help optimize antivenom use in these patients, preventing potentially life-threatening antivenom associated reactions. Because the usefulness of Indian polyvalent antivenom appears to be limited in this setting, there is an urgent need to advocate for region-specific antivenom or monovalent antivenom for this area.
Copyright © 2021 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
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Publication Date: 2021-03-26 PubMed ID: 33781663DOI: 10.1016/j.wem.2021.01.004Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article investigates the complications of snakebite poisoning in the Indian subcontinent, focusing specifically on the Echis carinatus sochureki snake. The study examines a case where the existing Indian polyvalent antivenom was ineffective in treating venom-induced consumption coagulopathy, proposing the necessity of region-specific treatments.

Overview of Snakebite Envenoming and Antivenom in India

  • The Indian subcontinent suffers significantly from snakebite envenoming, a hazard that is often overlooked compared to other health problems.
  • The common venomous snakes in the region include the Indian cobra, common krait, Russell’s viper, and the Indian saw-scaled viper.
  • The Indian polyvalent antivenom, used commonly to treat snakebite victims, is derived from hyperimmunized horse antibodies and works against the major four types of snakes.

Case of Echis carinatus sochureki Envenoming

  • In the Thar Desert regions of Rajasthan, a subspecies of the Indian saw-scaled viper, Echis carinatus sochureki, has been linked to serious health issues.
  • A case is presented where a patient suffered from venom-induced consumption coagulopathy following a bite from this snake. Coagulopathy is a disturbance in the blood’s ability to clot – the venom typically causes a drastic drop in clotting factors leading to risk of severe bleeding.
  • Despite treatment with the Indian polyvalent antivenom, the patient did not show improvement, and only started recovering after a week of supportive care.

Implications and Recommendations

  • Research indicates that the venom of Echis carinatus sochureki contains different components in comparison to Echis carinatus, and hence cannot be neutralized effectively by the Indian polyvalent antivenom.
  • Healthcare professionals working in areas with a high occurrence of Echis carinatus sochureki bites should be aware of the potential ineffectiveness of the standard treatment and consider this possibility when dealing with non-responsive patients.
  • The study advocates for region-specific antivenom or monovalent antivenom (an antivenom designed to counteract the venom of a specific snake) for regions like the Thar Desert, given the ineffectiveness of Indian polyvalent antivenom against Echis carinatus sochureki bites.

Cite This Article

APA
Gopalakrishnan M, Yadav P, Mathur R, Midha N, Garg MK. (2021). Venom-Induced Consumption Coagulopathy Unresponsive to Antivenom After Echis carinatus sochureki Envenoming. Wilderness Environ Med, 32(2), 221-225. https://doi.org/10.1016/j.wem.2021.01.004

Publication

Wilderness & environmental medicine
ISSN: 1545-1534
NlmUniqueID: 9505185
Country: United States
Language: English
Volume: 32
Issue: 2
Pages: 221-225
PII: S1080-6032(21)00009-0

Researcher Affiliations

Gopalakrishnan, Maya
  • Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India. Electronic address: maya.gopalakrishnan@gmail.com.
Yadav, Prakrati
  • Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Mathur, Rohit
  • Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Midha, Naresh
  • Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Garg, Mahendra Kumar
  • Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.

MeSH Terms

  • Animals
  • Antivenins / therapeutic use
  • Disseminated Intravascular Coagulation
  • Horses
  • Humans
  • India
  • Snake Bites / drug therapy
  • Viper Venoms / toxicity
  • Viperidae

Citations

This article has been cited 10 times.
  1. Vanuopadath M, Rajan K, Alangode A, Nair SS, Nair BG. The Need for Next-Generation Antivenom for Snakebite Envenomation in India. Toxins (Basel) 2023 Aug 18;15(8).
    doi: 10.3390/toxins15080510pubmed: 37624267google scholar: lookup
  2. Lim ASS, Tan KY, Quraishi NH, Farooque S, Khoso ZA, Ratanabanangkoon K, Tan CH. Proteomic Analysis, Immuno-Specificity and Neutralization Efficacy of Pakistani Viper Antivenom (PVAV), a Bivalent Anti-Viperid Antivenom Produced in Pakistan. Toxins (Basel) 2023 Apr 3;15(4).
    doi: 10.3390/toxins15040265pubmed: 37104203google scholar: lookup
  3. Rijal P, Singh AP, Panwar P, Pathania M, Kant R. Prolonged asymptomatic venom induced consumption coagulopathy: Caused by hemotoxic snake bite. J Family Med Prim Care 2022 Nov;11(11):7448-7451.
    doi: 10.4103/jfmpc.jfmpc_1126_22pubmed: 36993133google scholar: lookup
  4. Gopalakrishnan M, Saurabh S, Sagar P, Bammigatti C, Dutta TK. A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study. PLoS Negl Trop Dis 2022 Feb;16(2):e0010183.
    doi: 10.1371/journal.pntd.0010183pubmed: 35192642google scholar: lookup
  5. Kumar A, Gopalakrishnan M, Kuri HR, Bajpayee A, Kothari N, Garg MK. Case Report: Delayed Diffuse Alveolar Hemorrhage in Echis sochureki Envenoming, Jodhpur, India. Am J Trop Med Hyg 2022 Jan 31;106(3):967-969.
    doi: 10.4269/ajtmh.21-1187pubmed: 35100564google scholar: lookup
  6. Kumar A, Sahu A, Gopalakrishnan M, Blotra A, Rout VK, Kuttalam S, Muralidar S, Malhotra A, Vasudevan K. The Venom Proteome and Immunorecognition Profile of Clinically Important Echis carinatus sochureki from Northwestern India Underscores the Need for Regionally Specific Antivenoms. Toxins (Basel) 2026 Jan 21;18(1).
    doi: 10.3390/toxins18010054pubmed: 41591200google scholar: lookup
  7. Rao S, Reghu N, Nair BG, Vanuopadath M. The Role of Snake Venom Proteins in Inducing Inflammation Post-Envenomation: An Overview on Mechanistic Insights and Treatment Strategies. Toxins (Basel) 2024 Dec 2;16(12).
    doi: 10.3390/toxins16120519pubmed: 39728777google scholar: lookup
  8. Lath V, Shekhawat D, Sirur FM. Strikes and stripes of the Saw-scaled Viper in the Western Ghats-A case series. Toxicol Rep 2024 Dec;13:101721.
    doi: 10.1016/j.toxrep.2024.101721pubmed: 39295951google scholar: lookup
  9. Senji Laxme RR, Khochare S, Bhatia S, Martin G, Sunagar K. From birth to bite: the evolutionary ecology of India's medically most important snake venoms. BMC Biol 2024 Jul 29;22(1):161.
    doi: 10.1186/s12915-024-01960-8pubmed: 39075553google scholar: lookup
  10. Bava D, Kumar PHA, Gupta A, Mandal S, Bajpayee A, Gopalakrishnan M, Khan MA. Redefining the role of therapeutic plasma exchange in complications of Echis carinatus sochureki envenomation refractory to anti-snake venom: A case series. Asian J Transfus Sci 2023 Jul-Dec;17(2):295-300.
    doi: 10.4103/ajts.ajts_49_22pubmed: 38274951google scholar: lookup
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