Exotic snake-bite
A brief synopsis of the presentation “Exotic snake-bite and its treatment”Dr Ken Winkel, Director, Australian Venom Research UnitTrade globalisation and internet-based transactions mean that practically any dangerous venomous snake can now be sold, delivered to, and found in, any major city anywhere in the world. The recent seizure of illegally held dangerous exotic venomous snakes in Melbourne1 provides a local example of a global phenomena2. Alarmingly, in most instances the “underground zoo” keepers have little or no specific snake antivenom. Fortunately, to date, this kind of snakebite has been rare in Australia. However, currently held exotic antivenom stocks in Australia represent only seven of the 44 manufacturers in the world3. Where available information on such potentially lifesaving products is necessarily out of date and many of the antivenoms themselves are actually expired. This reflects the fact that the continued production of some of these products is under threat or has already been replaced by scarce and extremely expensive alternatives4 and follows the low priority given to antivenom research and development internationally. Given Australia’s isolation, the expense of antivenoms to individual institutions and their infrequent use, the establishment of a comprehensive national stock of antivenom is of paramount importance. Alternative models for antivenom provisioning were discussed. They include: (i) a strategically located specialist centre or centres, funded by the national government and providing ’world cover’ similar to the UK system5, (ii) regional antivenom banks funded by both hospitals, zoos and herpetologists along the lines of the Florida antivenom bank6 and (iii) fragmented but loosely interconnected institution based holdings such as in continental Europe7. Several recent cases of exotic snakebite from the USA8,9, UK7 and Europe10,11 were used to illustrate the issues involved in exotic snakebite diagnosis and management. Such issues include: (i) difficulty in snake identification, (ii) lack of expertise in the management of exotic snake bite, (iii) uncertainty regarding the appropriate antivenom in cases of uncommon or taxonomically disputed exotic snake species, (iv) the absolute and relative lack of antivenoms, (v) the difficulty in accessing such antivenoms, (vi) and the absence of comprehensive experimental and clinical data on antivenom cross-neutralisation. Table 1 presents an overview of the major venomous snakes of the world by region, those species in the collected seized in Melbourne that come from that region (as a real example of those species from that region that have been found in Australia) together with a list of the major antivenoms available to neutralise the snake venoms from that region (not a comprehensive list) and those products currently represented in Australia. This demonstrates the limitations of the existing ’exotic’ antivenom holdings in this country. References 1. Butler M. Drug squad stumbles on a poisonous plot. The Age 2001; March 7. 2. Trestrail JH. The “underground zoo”. The problem of exotic venomous snakes in private possession in the United States. Vet Hum Toxicol 1982; 24S: 141-149. 3. Sutherland SK, Tibballs J. Treatment of Snakebite. Chapter 17 In: Australian Animal Toxins, Oxford University Press, Melbourne, 2001, p. 324. 4. Cheng A, Winkel KD. Snakebite and antivenoms in the Asia-Pacific: Wokabaut wantaim – raka hebou – walking together. Med J Aust 2001; 175: 648-651. 5. Reid HA. Bites by foreign venomous snakes in Britain. Br Med J 1978; 1: 1598-1600. 6. Antivenom Index, 1999 revision. Donal M Boyer, AZA Antivenom index Editor. The American Zoo and The American Association of Poison Control Centers. 7. Warrell DA. Bites by exotic snakes in Europe: illegally held venomous animals and the “macho pet” phenomenon. 14th European Symposium on Animal, Plant and Microbial Toxins Program and Abstracts, 4-6 October, 2001, Stockholm, Sweden, p.25. 8. Jasper EH, Miller M, Neuburger KJ, Widder PC, Snyder JW and Lopez BL: Venomous snakebites in an urban area: what are the possibilities? Wild Envr Med 2000; 11: 168-171. 9. Wetzel WW, Christy NP. A King Cobra bite in New York. Toxicon 1989; 27: 393-395. 10. De Haro L, Hayek-Lanthois, Arditti J, Valli M. Exotic venomous pets envenomations: experience of the poison centre of Marseille during 2000. European Symposium on Animal, Plant and Microbial Toxins Program and Abstracts, 4-6 October, 2001, Stockholm, Sweden, p.23. 11. Gillissen A, et al. Neurotoxicity, haemostatic disturbances and haemolytic anaemia after a bite by a tunisian saw-scaled or carpet viper (Echis ’pyramidum’- complex): failure of antivenom treament. Toxicon 1994;32:937-944.
Table 1. Illegally held exotic snake species seized by Environment Australia in Melbourne March 2001, antivenom requirements and current stocks. Return to conference overview « home |
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