NEUROTOXICITY, HEMOSTATIC DISTURBANCES AND HEMOLYTIC-ANEMIA AFTER A BITE BY A TUNISIAN SAW-SCALED OR CARPET VIPER (ECHIS PYRAMIDUM-COMPLEX) - FAILURE OF ANTIVENOM TREATMENT
NEUROTOXICITY, HEMOSTATIC DISTURBANCES AND HEMOLYTIC-ANEMIA AFTER A BITE BY A TUNISIAN SAW-SCALED OR CARPET VIPER (ECHIS PYRAMIDUM-COMPLEX) - FAILURE OF ANTIVENOM TREATMENT
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DOI：
10.1016/0041-0101(94)90372-7
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发表时间：
1994-08-01
期刊：
影响因子：
2.8
通讯作者：
WARRELL, DA
中科院分区：
文献类型：
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作者：
GILLISSEN, A;THEAKSTON, RDG;WARRELL, DA
德国的一名年轻男子被一条突尼斯血统的大型锯鳞毒蛇（Echis vagium '-complex）咬伤。在咬伤后的最初几个小时内，他出现了弥散性血管内凝血和纤维蛋白溶解的迹象，并自发流血的。尽管总共给予了310毫升三种不同的Echis特异性抗蛇毒血清（以及大量新鲜冷冻血浆和浓缩凝血因子），毒液抗原血症（通过酶免疫测定法测量）和凝血病持续了10多天，他出现了溶血性贫血和轻度肾功能障碍。暂时性双侧上睑下垂归因于毒液中毒。在免疫学上，造成咬伤的蛇的毒液与尼日利亚E。眼斑蛇毒血清中的抗蛇毒血清，并且显然没有被已经施用的三种单特异性抗蛇毒血清中和。这一案例再次说明了蛇毒的地理差异，以及在制备抗蛇毒血清时需要汇集来自不同地理区域的蛇毒。北非Echis物种的毒刺可能无法通过现有的抗蛇毒血清逆转。
A young man in Germany was bitten by a large captive saw-scaled viper (Echis pyramidum'-complex) of Tunisian origin. During the first few hours after the bite he developed evidence of disseminated intravascular coagulation and fibrinolysis, and bled spontaneously. Despite being given a total of 310 ml of three different Echis-specific antivenoms (together with large amounts of fresh frozen plasma and concentrated clotting factors), venom antigenaemia (measured by enzyme immunoassay) and coagulopathy persisted for more than 10 days, and he developed a haemolytic anaemia and mild renal dysfunction. Transient bilateral ptosis was attributed to envenoming. The venom of the snake responsible for the bite was immunologically distinct from that of Nigerian E. ocellatus and was clearly not neutralised by the three monospecific antivenoms which had been administered. This case is another illustration of the geographical variation in snake venoms and the need for pooling venoms from snakes from different parts of the geographical range in the preparation of antivenoms. Envenoming by North African Echis species may not be reversible by available antivenoms.