geographical area, including Asia and Africa. Envenomation is characterized by muscle paralysis, local necrosis, and chronic musculoskeletal disability. The pathology of devastating tissue destruction, even though specific antivenoms exist, is not fully clear and continues to challenge healthcare providers. Cytotoxins, one of the main groups of toxins in cobra venom, are thought to play a significant role with evidence in animals, but not human, studies. Here, we present a case of severe Naja atra (Chinese cobra) snakebite, identify the toxic components and highlight the possible role of toxins that remain in tissues around the bite site after a cobra snake bite. Case report: A 68-year-old female was bitten by a Naja atra snake and presented to hospital 8 hours later. Her clinical course was complicated by severe tissue necrosis even after treatment with 10 vials of specific antivenom. We collected her blood and wound discharge to determine the concentration of whole venom or toxins, cytotoxin A3 and a short-chain neurotoxin using an enzyme-linked immunosorbent assay (ELISA). We found high concentrations of venom and cytotoxin A3 remained present in the wound discharge fluid until complete decontamination of the bite site by wide and advanced debridement to remove these toxins and promote wound healing. Conclusion: The toxic compounds in the venom, especially cytotoxin A3, persisted in local tissue, and might play a key role in the pathology of dermonecrosis in cobra envenomation. Advanced debridement as early as possible may minimize the extent of tissue destruction in cobra envenomation.
日期:
2022-05-12
關聯:
Clinical Toxicology. 2022 May 12;60(Suppl. 1):50-51.
