Clinical and laboratory features distinguishing between Deinagkistrodon acutus and Daboia siamensis envenomation View Full Text


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Article Info

DATE

2018-12-27

AUTHORS

Hung-Yuan Su, Shih-Wei Huang, Yan-Chiao Mao, Ming-Wen Liu, Kuo-Hsin Lee, Pei-Fang Lai, Ming-Jen Tsai

ABSTRACT

BackgroundThere are 6 species of venomous snakes in Taiwan. Two of them, Deinagkistrodon acutus (D. acutus) and Daboia siamensis (D. siamensis), can cause significant coagulopathy. However, a significant proportion of patients with snakebites cannot identify the correct snake species after envenomation, which hampers the application of antivenom. Hence, the differential diagnosis between the two snakebites by clinical presentations is important. This study aims to compare their clinical and laboratory features for the purpose of differential diagnosis between the two snakebites.MethodsWe retrospectively reviewed the medical records of patients who arrived at the emergency department due to D. acutus or D. siamensis envenomation, between 2003 and 2016, in one medical center in eastern Taiwan. Since these snakebites are rare, we also included 3 cases reported from another hospital in central Taiwan.ResultsIn total, 15 patients bitten by D. acutus and 12 patients by D. siamensis were analyzed. Hemorrhagic bulla formation and the need for surgical intervention only presented for D. acutus envenomation cases (Both 53.3% vs. 0.0%, P = 0.003). As to laboratory features, lower platelet counts (20.0 × 103/μL [interquartile range, 14–66 × 103/μL] vs. 149.0 × 103/μL [102.3–274.3 × 103/μL], P = 0.001), lower D-dimer level (1423.4 μg/L [713.4–4212.3 μg/L] vs. 12,500.0 μg/L [2351.4–200,000 μg/L], P = 0.008), higher proportion of patients with moderate-to-severe thrombocytopenia (platelet count < 100 × 103/μL) (80% vs. 16.7%, odds ratio (OR) = 20.0, 95% CI, 2.77–144.31; P = 0.002), and lower proportion of patients with extremely high D-dimer (> 5000 ng/mL) (16.7% vs. 66.7%, adjusted OR = 0.1 (95% CI, 0.01–0.69; P = 0.036) were found among cases of D. acutus envenomation compared to D. siamensis envenomation. The combination of hemorrhagic bulla, thrombocytopenia, and a lack of extremely high D-dimer had good discriminatory power (area under the curve (AUC) = 0.965; 95% CI, 0.904–1.00) for distinguishing D. acutus from D. siamensis envenomation.ConclusionsThe presentation of moderate to severe thrombocytopenia (platelet count < 100 × 103/μL) and hemorrhagic bulla formation may indicate D. acutus envenomation. However, the envenomed patient with extremely high D-dimer levels may indicate a D. siamensis envenomation. These findings may help diagnose and select the right antivenom in patients with unknown snakebites who present significant coagulopathy. More... »

PAGES

43

References to SciGraph publications

  • 2015-01-30. Epidemiology of Snake Envenomation in Taiwan in CLINICAL TOXINOLOGY IN ASIA PACIFIC AND AFRICA
  • 2017-08-08. Snakebite envenomation turns again into a neglected tropical disease! in JOURNAL OF VENOMOUS ANIMALS AND TOXINS INCLUDING TROPICAL DISEASES
  • 2016-10-04. Aspirin plus tirofiban inhibit the thrombosis induced by Russell’s viper venom in THROMBOSIS JOURNAL
  • 2016-03-16. The 6th international conference on envenomation by Snakebites and Scorpion Stings in Africa: a crucial step for the management of envenomation in JOURNAL OF VENOMOUS ANIMALS AND TOXINS INCLUDING TROPICAL DISEASES
  • 2018-02-28. Antivenom therapy: efficacy of premedication for the prevention of adverse reactions in JOURNAL OF VENOMOUS ANIMALS AND TOXINS INCLUDING TROPICAL DISEASES
  • 2017-03-23. Deinagkistrodon acutus envenomation: a report of three cases in JOURNAL OF VENOMOUS ANIMALS AND TOXINS INCLUDING TROPICAL DISEASES
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    http://scigraph.springernature.com/pub.10.1186/s40409-018-0179-2

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    http://dx.doi.org/10.1186/s40409-018-0179-2

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30607144


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