Neurotoxic envenoming by South American coral snake (Micrurus lemniscatus helleri): case report from eastern Ecuador and review
Neurotoxic envenoming by South American coral snake (Micrurus lemniscatus helleri): case report from eastern Ecuador and review
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DOI：
10.1016/j.trstmh.2008.03.026
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发表时间：
2008-11-01
影响因子：
2.2
通讯作者：
Warrell, David A.
中科院分区：
文献类型：
--
作者：
Manock, Stephen R.;Suarez, German;Warrell, David A.
在厄瓜多尔亚马逊河流域，一名男子被一条大珊瑚蛇（Micrurus lemniscatus helleri）咬伤，被咬伤的手臂出现持续的剧痛，入院不到30分钟后，他出现多形核白细胞增多症、血小板减少症和轻度延长的凝血酶原时间/部分凝血活酶时间。直到咬伤后14小时，他才出现神经毒性的第一个迹象。尽管在咬伤后50小时用特异性抗蛇毒血清治疗，但在咬伤后60小时他需要氧气治疗呼吸衰竭，并在72小时后进行6小时机械通气。在接下来的38小时内，他需要两次插管和辅助通气，然后被空运到三级转诊医院。并发症包括细菌性肺炎、气胸、粘液栓阻塞支气管和轻度横纹肌溶解。他在咬伤后15天出院，持续肢体无力和尿失禁，但最终康复。有趣的和不寻常的功能，这种情况下（严重的局部疼痛，非常缓慢的神经毒性envenoming，持续性血小板减少症和轻度凝血功能障碍的演变）的背景下，什么是已知的Micrurus毒液的组成和小的临床文献envenoming从他们的叮咬进行了讨论。(C)2008年皇家热带医学和卫生学会。由爱思唯尔有限公司出版。保留所有权利。
A man bitten by a large coral snake (Micrurus lemniscatus helleri) in the Amazon basin of Ecuador developed persistent excruciating pain in the bitten arm. On admission to hospital less than 30 min later, he had a polymorphonuclear leucocytosis, thrombocytopenia and mildly prolonged prothrombin time/partial thromboplastin time. Not until 14 h after the bite did he develop the first signs of neurotoxicity. Despite treatment with specific antivenom 50 h after the bite, he required oxygen for respiratory failure 60 h, and 6 h of mechanical ventilation 72 h, after the bite. Over the next 38 h, he required two further intubations and periods of assisted ventilation before being airlifted to a tertiary referral hospital. Complications included bacterial pneumonia, pneumothorax, bronchial obstruction by mucus plugs and mild rhabdomyolysis. He was discharged from hospital 15 days after the bite with persistent limb weakness and urinary incontinence but eventually recovered. The interesting and unusual features of this case (severe local pain, very slow evolution of neurotoxic envenoming, persistent thrombocytopenia and mild coagulopathy) are discussed in the context of what is known of the composition of Micrurus venoms and the small clinical literature on envenoming from their bites. (C) 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.