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TropicalMed
Special Issues
Snakebite Envenoming: Prioritizing a Neglected Tropical Disease
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Snakebite Envenoming: Prioritizing a Neglected Tropical Disease

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Neglected and Emerging Tropical Diseases".

Deadline for manuscript submissions: closed (30 June 2018) | Viewed by 35168

Special Issue Editors

Dr. David Williams

E-Mail
Guest Editor
Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia
Interests: antivenom design, development and production; clinical toxinology of animal; clinical trials; first aid for snake bites; health worker training and education
Dr. Timothy Jackson

E-Mail Website
Guest Editor
Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia
Interests: evolutionary biology; herpetology; toxinology; antivenomics; snakebite; venomous bites and stings

Special Issue Information

Dear Colleagues,

In June 2017, the World Health Organization added snakebite envenoming to the category A list of Neglected Tropical Diseases, recognising the need to catalyse global action against this disease, which at worst estimates may claim as many as 138,000 lives and causes great suffering to between 1.8−2.7 million people around the world each year.

Renewed focus on snakebite envenoming is the result of concerted efforts by the global toxinology community, civil society and concerned nations, but advocacy alone is insufficient to bring about sustained reductions in the burden of morbidity, disability and death. There is an urgent need to develop a range of strategies and tools to capture a higher resolution understanding of the disease and how it can be effectively controlled and contained. One of the consequences of neglect is limited investment in research that can overcome the practical socioeconomic, clinical and logistical barriers to improved surveillance, diagnosis, treatment and rehabilitation.

Conventional antivenom treatment for snakebite envenoming has long been the victim of this reduced investment, and while antivenoms are often disparaged over issues of safety, stability and clinical effectiveness, fresh investment in innovation and modernisation offer great potential to extend their usefulness and save millions of lives. The same goes for emerging fields of research such as the quest for specific inhibitors of toxin activity and the development of recombinant and MAb approaches to the neutralization of snake venoms.

Many other practical problems need to be solved. How, for example, to we effectively reach out to communities and positively change their health-seeking behaviours, improve their approaches to snakebite prevention and reduce the direct and indirect socioeconomic impacts of snakebite envenoming on victims and their families? What technologies can we bring to bear to improve the reporting of snake bites in countries with fragile health systems? Despite the enormity of the problem no universal first aid intervention that could prolong life has been validated. Is this simply an impossible undertaking? What are the real costs of snakebite envenoming in different regions of the world and can we demonstrate that investment required to sustain realistic targets for control will deliver measurably greater returns in terms of these costs? How do we define effective treatment? How can we better manage snake bites that produce necrosis to reduce tissue loss and improve rehabilitation?

In this Special Issue, we will focus on where to go next in assembling an arsenal or resources, tools and strategies with which to launch a concerted effort to confront the problems standing in the way of effective snakebite control. Your contributions through reports or discussions of basic, applied and clinical research that have real potential for practical translation into real-world solutions would be very welcome.

Dr. David John Williams
Dr. Timothy Jackson
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tropical Medicine and Infectious Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • snakebite envenoming
  • antivenoms
  • health systems strengthening
  • disease surveillance
  • research translation
  • biotherapeutics

Published Papers (5 papers)

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Research

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17 pages, 1667 KiB  
Article
Translational Venomics: Third-Generation Antivenomics of Anti-Siamese Russell’s Viper, Daboia siamensis, Antivenom Manufactured in Taiwan CDC’s Vaccine Center
by Libia Sanz, Sarai Quesada-Bernat, Pei Yu Chen, Cheng Dow Lee, Jen Ron Chiang and Juan J. Calvete
Trop. Med. Infect. Dis. 2018, 3(2), 66; https://doi.org/10.3390/tropicalmed3020066 - 15 Jun 2018
Cited by 25 | Viewed by 4883
Abstract
The venom proteome of Siamese Russell’s viper from Taiwan, alongside complementary in vivo lethality neutralization assay and in vitro third-generation antivenomics assessment of the preclinical efficacy of the homologous antivenom manufactured in Taiwan CDC’s Vaccine Center, are here reported. Taiwanese Russell’s viper venom [...] Read more.
The venom proteome of Siamese Russell’s viper from Taiwan, alongside complementary in vivo lethality neutralization assay and in vitro third-generation antivenomics assessment of the preclinical efficacy of the homologous antivenom manufactured in Taiwan CDC’s Vaccine Center, are here reported. Taiwanese Russell’s viper venom proteome comprised 25 distinct gene products, with the heterodimeric PLA2 viperotoxin-F representing the most abundant toxin (47.5% of total venom proteome). Coagulation FV-activating serine proteinase (RVV-V, 14%), the PIV-SVMP activator of FX (RVV-FX, 8.5%), and less abundant toxins from nine protein families, make up its venom proteome. Venom composition-pathology correlations of D. siamensis envenomings in Taiwan are discussed. The lethal effect of Taiwanese D. siamensis venom was 0.47 mg/g mouse. Antivenomics-guided assessment of the toxin recognition landscape of the Taiwanese Russell’s viper antivenom, in conjunction with complementary in vivo neutralization analysis, informed the antivenom’s maximal toxin immunorecognition ability (14 mg total venom proteins/vial), neutralization capacity (6.5 mg venom/vial), and relative content of lethality neutralizing antibodies (46.5% of the toxin-binding F(ab’)2 antibodies). The antivenomics analysis also revealed suboptimal aspects of the CDC-Taiwan antivenom. Strategies to improve them are suggested. Full article
(This article belongs to the Special Issue Snakebite Envenoming: Prioritizing a Neglected Tropical Disease)
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Review

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12 pages, 2415 KiB  
Review
First Aid and Pre-Hospital Management of Venomous Snakebites
by Jennifer Parker-Cote and William J. Meggs
Trop. Med. Infect. Dis. 2018, 3(2), 45; https://doi.org/10.3390/tropicalmed3020045 - 24 Apr 2018
Cited by 24 | Viewed by 8361
Abstract
Background: Antivenom is the definitive treatment for venomous snakebites, but is expensive and not available in many rural and poorly developed regions. Timely transportation to facilities that stock and administer antivenom may not be available in rural areas with poorly developed emergency medical [...] Read more.
Background: Antivenom is the definitive treatment for venomous snakebites, but is expensive and not available in many rural and poorly developed regions. Timely transportation to facilities that stock and administer antivenom may not be available in rural areas with poorly developed emergency medical services. These factors have led to consideration of measures to delay onset of toxicity or alternatives to antivenom therapy. Methods: PubMed searches were conducted for articles on snakebite treatment, or that contained first aid, emergency medical services, tourniquets, pressure immobilization bandages, suction devices, and lymphatic flow inhibitors. Results: The reviewed articles describe how venoms spread after a venomous snakebite on an extremity, list the proposed first aid measures for delaying the spread of venoms, and evaluate the scientific studies that support or refute methods of snakebite first aid. The recommendations for field treatment of venomous snakebites will be discussed. Conclusions: The evidence suggests that pressure immobilization bandages and related strategies are the best interventions to delay onset of systemic toxicity from venomous snakebites but may increase local toxicity for venoms that destroy tissue at the site of the bite, so their use should be individualized to the circumstances and nature of the venom. Full article
(This article belongs to the Special Issue Snakebite Envenoming: Prioritizing a Neglected Tropical Disease)
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13 pages, 5524 KiB  
Review
Recent Advances in Next Generation Snakebite Antivenoms
by Cecilie Knudsen and Andreas H. Laustsen
Trop. Med. Infect. Dis. 2018, 3(2), 42; https://doi.org/10.3390/tropicalmed3020042 - 15 Apr 2018
Cited by 54 | Viewed by 7567
Abstract
With the inclusion of snakebite envenoming on the World Health Organization’s list of Neglected Tropical Diseases, an incentive has been established to promote research and development effort in novel snakebite antivenom therapies. Various technological approaches are being pursued by different research groups, including [...] Read more.
With the inclusion of snakebite envenoming on the World Health Organization’s list of Neglected Tropical Diseases, an incentive has been established to promote research and development effort in novel snakebite antivenom therapies. Various technological approaches are being pursued by different research groups, including the use of small molecule inhibitors against enzymatic toxins as well as peptide- and oligonucleotide-based aptamers and antibody-based biotherapeutics against both enzymatic and non-enzymatic toxins. In this article, the most recent advances in these fields are presented, and the advantages, disadvantages, and feasibility of using different toxin-neutralizing molecules are reviewed. Particular focus within small molecules is directed towards the inhibitors varespladib, batimastat, and marimastat, while in the field of antibody-based therapies, novel recombinant polyclonal plantivenom technology is discussed. Full article
(This article belongs to the Special Issue Snakebite Envenoming: Prioritizing a Neglected Tropical Disease)
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Other

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8 pages, 2087 KiB  
Case Report
Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
by Valentine Eugene Erulu, Mitchel Otieno Okumu, Francis Okumu Ochola and Joseph Kangangi Gikunju
Trop. Med. Infect. Dis. 2018, 3(3), 104; https://doi.org/10.3390/tropicalmed3030104 - 19 Sep 2018
Cited by 4 | Viewed by 5617
Abstract
The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of [...] Read more.
The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 °C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3–5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation. Full article
(This article belongs to the Special Issue Snakebite Envenoming: Prioritizing a Neglected Tropical Disease)
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4 pages, 447 KiB  
Case Report
First Case Report of a Near Lethal Envenomation by a Salomonelaps par (Solomons Coral Snake) in the Solomon Islands
by Sarah Luthy, Damian Rake, Tanya Buchanan and Christine Schultze
Trop. Med. Infect. Dis. 2018, 3(3), 90; https://doi.org/10.3390/tropicalmed3030090 - 21 Aug 2018
Cited by 2 | Viewed by 6931
Abstract
Venomous snake bites in the Solomon Islands can be very dangerous due to lack of access to health care. There are no documented case reports of envenomation by snake bites in the Solomon Islands. This case report highlights the management of a patient [...] Read more.
Venomous snake bites in the Solomon Islands can be very dangerous due to lack of access to health care. There are no documented case reports of envenomation by snake bites in the Solomon Islands. This case report highlights the management of a patient with potentially lethal neurotoxicity secondary to a Solomonelaps par (Solomons coral snake) in a low resource setting. This case identifies the potential benefit of further research to determine the incidence of lethal envenomation as well as analysing the venom to determine if any commercially available antivenom would be useful in the treatment of envenomation by Salomonelaps par and other venomous snakes. There should be consideration given to providing education on first aid for people living in remote areas as well as education for health workers. Full article
(This article belongs to the Special Issue Snakebite Envenoming: Prioritizing a Neglected Tropical Disease)
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