1921
Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

A total of 112 cases of envenomation were examined at two referring hospitals: Taichung Veterans General Hospital in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan. Overall, 77% (86/112) of cases developed clinically suspected wound infections and 54% (61/112) required surgery secondary to tissue necrosis, finger or toe gangrene, and/or necrotizing fasciitis. was the most abundant gram-negative bacterial strain isolated from bite wounds, followed by spp., , , and spp. in descending order; spp. were the most common gram-positive bacteria and spp. were the only anaerobic bacteria. A few episodes of bacteremia were caused by and spp. There were no significant variations in the distribution of bacterial species between these two hospitals except for a higher incidence of , spp., and polymicrobial infection observed at VGH-TP, which may have been related to variations in the fecal flora of prey and oral flora of individual snakes in different geographic areas in Taiwan. According to the susceptibility test involving various pathogens, first-line drug options for the management of snakebite wound infections may include monotherapy with ureidopenicillin or combination therapy with aminopenicillin and a third-generation cephalosporin or fluoroquinolone. A prospective evaluation of empiric antibiotic therapy for the management of snakebite should be considered.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.15-0667
2016-05-04
2017-09-21
Loading full text...

Full text loading...

/deliver/fulltext/14761645/94/5/1129.html?itemId=/content/journals/10.4269/ajtmh.15-0667&mimeType=html&fmt=ahah

References

  1. Uetz P, Hošek J, , eds., 2014. The Reptile Database. Available at: http://wwwreptile-databaseorg/. Accessed December 8, 2014.
  2. Mao YC, Hung DZ, Gopalakrishnakone P, Faiz MA, Fernando R, Gnanathasan CA, Habib AG, Yang C-C, , 2015. Epidemiology of snake envenomation in Taiwan. , eds. Clinical Toxinology in Asia Pacific and Africa. Singapore: Springer, 420.
  3. Mao YC, Hung DZ, Gopalakrishnakone P, Faiz MA, Fernando R, Gnanathasan CA, Habib AG, Yang C-C, , 2015. Management of snake envenomation in Taiwan. , eds. Clinical Toxinology in Asia Pacific and Africa. Singapore: Springer, 2448.
  4. Chen CM, Wu KG, Chen CJ, Wang CM, , 2011. Bacterial infection in association with snakebite: a 10-year experience in a northern Taiwan medical center. J Microbiol Immunol Infect 44: 456460.[Crossref]
  5. Huang LW, Wang JD, Huang JA, Hu SY, Wang LM, Tsan YT, , 2012. Wound infections secondary to snakebites in central Taiwan. J Venom Anim Toxins Incl Trop Dis 18: 272276.[Crossref]
  6. Liao WB, Lee CW, Tsai YS, Liu BM, Chung KJ, , 2000. Influential factors affecting prognosis of snakebite patients management: Kaohsiung Chang Gung Memorial Hospital experience. Chang Gung Med J 23: 577583.
  7. Shek KC, Tsui KL, Lam KK, Crow P, Ng KH, Ades G, Yip KT, Grioni A, Tan KS, Lung DC, Lam TS, Fung HT, Que TL, Kam CW, , 2009. Oral bacterial flora of the Chinese cobra (Naja atra) and bamboo pit viper (Trimeresurus albolabris) in Hong Kong SAR, China. Hong Kong Med J 15: 183190.
  8. Lam KK, Crow P, Ng KH, Shek KC, Fung HT, Ades G, Grioni A, Tan KS, Yip KT, Lung DC, Que TL, Lam TS, Simpson ID, Tsui KL, Kam CW, , 2011. A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China. Emerg Med J 28: 107114.[Crossref]
  9. Theakston RD, Phillips RE, Looareesuwan S, Echeverria P, Makin T, Warrell DA, , 1990. Bacteriological studies of the venom and mouth cavities of wild Malayan pit vipers (Calloselasma rhodostoma) in southern Thailand. Trans R Soc Trop Med Hyg 84: 875879.[Crossref]
  10. Garg A, Sujatha S, Garg J, Acharya NS, Chandra Parija S, , 2009. Wound infections secondary to snakebite. J Infect Dev Ctries 3: 221223.[Crossref]
  11. Wong OF, Lam TS, Fung HT, Choy CH, , 2010. Five-year experience with Chinese cobra (Naja atra)–related injuries in two acute hospitals in Hong Kong. Hong Kong Med J 16: 3643.
  12. Huang YP, Yu YJ, Hung DZ, , 2002. Sandwich enzyme-linked immunosorbent assay for Taiwan cobra venom. Vet Hum Toxicol 44: 200204.
  13. Hung DZ, Liau MY, Lin-Shiau SY, , 2003. The clinical significance of venom detection in patients of cobra snakebite. Toxicon 41: 409415.[Crossref]
  14. Hung DZ, Lin JH, Mo JF, Huang CF, Liau MY, , 2014. Rapid diagnosis of Naja atra snakebites. Clin Toxicol (Phila) 52: 187191.[Crossref]
  15. Warrell DA, , 2010. Guidelines for the Clinical Management of Snake-Bites, 2nd edition. New Delhi, India: WHO Regional Office for South-East Asia, 1151.
  16. Gardner SE, Frantz RA, Doebbeling BN, , 2001. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair Regen 9: 178186.[Crossref]
  17. Cutting KF, White R, , 2004. Defined and refined: criteria for identifying wound infection revisited. Br J Community Nurs 9: S6S15.[Crossref]
  18. World Union of Wound Healing Societies, 2008. Wound Infection in Clinical Practice: An International Consensus. London, United Kingdom: Medical Education Partnership Ltd.
  19. Clark RF, Selden BS, Furbee B, , 1993. The incidence of wound infection following crotalid envenomation. J Emerg Med 11: 583586.[Crossref]
  20. Bowler PG, Duerden BI, Armstrong DG, , 2001. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 14: 244269.[Crossref]
  21. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E, Infectious Diseases Society of America, , 2012. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 54: e132e173.[Crossref]
  22. Kerrigan KR, , 1992. Bacteriology of snakebite abscess. Trop Doct 22: 158160.[Crossref]
  23. Goldstein EJ, Citron DM, Gonzalez H, Russell FE, Finegold SM, , 1979. Bacteriology of rattlesnake venom and implications for therapy. J Infect Dis 140: 818821.[Crossref]
  24. Chen LW, Kao PH, Fu YS, Lin SR, Chang LS, , 2011. Membrane-damaging activity of Taiwan cobra cardiotoxin 3 is responsible for its bactericidal activity. Toxicon 58: 4653.[Crossref]
  25. Ledbetter EO, Kutscher AE, , 1969. The aerobic and anaerobic flora of rattlesnake fangs and venom: therapeutic implications. Arch Environ Health 19: 770778.[Crossref]
  26. Cheng CW, Lin HS, Ye JJ, Yang CC, Chiang PC, Wu TS, Lee MH, , 2009. Clinical significance of and outcomes for Bacteroides fragilis bacteremia. J Microbiol Immunol Infect 42: 243250.
  27. Liu PY, Lin CF, Tung KC, Shyu CL, Wu MJ, Liu JW, Chang CS, Chan KW, Huang JA, Shi ZY, , 2013. Clinical and microbiological features of Shewanella bacteremia in patients with hepatobiliary disease. Intern Med 52: 431438.[Crossref]
  28. Jorge MT, Ribeiro LA, da Silva ML, Kusano EJ, de Mendonca JS, , 1994. Microbiological studies of abscesses complicating Bothrops snakebite in humans: a prospective study. Toxicon 32: 743748.[Crossref]
  29. LoVecchio F, Klemens J, Welch S, Rodriguez R, , 2002. Antibiotics after rattlesnake envenomation. J Emerg Med 23: 327328.[Crossref]
  30. Jorge MT, Malaque C, Ribeiro LA, Fan HW, Cardoso JL, Nishioka SA, Sano-Martins IS, Franca FO, Kamiguti AS, Theakston RD, Warrell DA, , 2004. Failure of chloramphenicol prophylaxis to reduce the frequency of abscess formation as a complication of envenoming by Bothrops snakes in Brazil: a double-blind randomized controlled trial. Trans R Soc Trop Med Hyg 98: 529534.[Crossref]
  31. Kerrigan KR, Mertz BL, Nelson SJ, Dye JD, , 1997. Antibiotic prophylaxis for pit viper envenomation: prospective, controlled trial. World J Surg 21: 369372; discussion 372–363.[Crossref]
  32. Chen YW, Chen MH, Chen YC, Hung DZ, Chen CK, Yen DH, Huang CI, Lee CH, Wang LM, Yang CC, , 2009. Differences in clinical profiles of patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri envenoming in Taiwan. Am J Trop Med Hyg 80: 2832.
  33. Wu PL, Chiu CR, Huang WN, Wu WG, , 2012. The role of sulfatide lipid domains in the membrane pore-forming activity of cobra cardiotoxin. Biochim Biophys Acta 1818: 13781385.[Crossref]
  34. Wang W, Chen QF, Yin RX, Zhu JJ, Li QB, Chang HH, Wu YB, Michelson E, , 2014. Clinical features and treatment experience: a review of 292 Chinese cobra snakebites. Environ Toxicol Pharmacol 37: 648655.[Crossref]
  35. Blaylock RS, , 1999. Antibiotic use and infection in snakebite victims. S Afr Med J 89: 874876.
  36. Blokhuis-Arkes MH, Haalboom M, van der Palen J, Heinzle A, Sigl E, Guebitz G, Beuk R, , 2015. Rapid enzyme analysis as a diagnostic tool for wound infection: comparison between clinical judgment, microbiological analysis and enzyme analysis. Wound Repair Regen 23: 345352.[Crossref]
  37. Abrahamian FM, Goldstein EJ, , 2011. Microbiology of animal bite wound infections. Clin Microbiol Rev 24: 231246.[Crossref]
  38. Stock I, Wiedemann B, , 1998. Identification and natural antibiotic susceptibility of Morganella morganii . Diagn Microbiol Infect Dis 30: 153165.[Crossref]
  39. Sheng WH, Chen YC, Wang JT, Chang SC, Luh KT, Hsieh WC, , 2002. Emerging fluoroquinolone-resistance for common clinically important gram-negative bacteria in Taiwan. Diagn Microbiol Infect Dis 43: 141147.[Crossref]
  40. Wang JT, Chang SC, Wang HY, Chen PC, Shiau YR, Lauderdale TL, Hospitals T, , 2013. High rates of multidrug resistance in Enterococcus faecalis and E. faecium isolated from inpatients and outpatients in Taiwan. Diagn Microbiol Infect Dis 75: 406411.[Crossref]
  41. Nishioka S de A, Silveira PV, , 1992. Bacteriology of abscesses complicating bites of lance-headed vipers. Ann Trop Med Parasitol 86: 8991.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.15-0667
Loading
/content/journals/10.4269/ajtmh.15-0667
Loading

Data & Media loading...

  • Received : 13 Sep 2015
  • Accepted : 29 Jan 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error