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Observational Study
. 2020 Oct 19;12(10):662.
doi: 10.3390/toxins12100662.

Clinical Features and Management of Snakebite Envenoming in French Guiana

Dabor Resiere  1   2 , Stéphanie Houcke  1 , Jean Marc Pujo  3 , Claire Mayence  1 , Cyrille Mathien  1 , Flaubert NkontCho  4 , Nicaise Blaise  4 , Magalie Pierre Demar  5 , Didier Hommel  1 , Hatem Kallel  1
Affiliations
Observational Study

Clinical Features and Management of Snakebite Envenoming in French Guiana

Dabor Resiere et al. Toxins (Basel). .

Abstract

The management of snakebite (SB) envenoming in French Guiana (FG) is based on symptomatic measures and antivenom (AV) administration (Antivipmyn Tri®; Instituto Bioclon-Mexico). Our study aimed to assess clinical manifestations, the efficacy, and safety of Antivipmyn Tri® in the management of SB. Our study is a prospective observational work. It was conducted in the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 December 2019. We included all patients hospitalized for SB envenoming. Our study contained three groups (without AV, three vials, and six vials Antivipmyn Tri®). During the study period, 133 patients were included. The main clinical symptoms were edema (98.5%), pain (97.7%), systemic hemorrhage (18%), blister (14.3%), and local hemorrhage (14.3%). AV was prescribed for 83 patients (62.3%), and 17 of them (20%) developed early adverse reactions. Biological parameters at admission showed defibrinogenation in 124 cases (93.2%), International Normalized Ratio (INR) > 2 in 104 cases (78.2%), and partial thromboplastin time (PTT) > 1.5 in 74 cases (55.6%). The time from SB to AV was 9:00 (5:22-20:40). The median time from SB to achieve a normal dosage of fibrinogen was 47:00 vs. 25:30, that of Factor II was 24:55 vs. 15:10, that of Factor V was 31:42 vs. 19:42, and that of Factor VIII was 21:30 vs. 10:20 in patients without and with AV, respectively, (p < 0.001 for all factors). Patients receiving Antivipmyn Tri® showed a reduction in the time to return to normal clotting tests, as compared to those who did not. We suggest assessing other antivenoms available in the region to compare their efficacy and safety with Antivipmyn Tri® in FG.

Keywords: Antivipmyn Tri®; Bothrops atrox; French Guiana; clinical manifestations; snakebite envenoming.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart showing the distribution of patients according to antivenom dosage. (AV: Antivenom).
Figure 2
Figure 2
The mean and 95% CI of the elapsed time from snakebite to the time of normal dosages of fibrinogen, factor II, factor V, and factor VIII according to the antivenom use. p < 0.001 for all factors. (results are expressed in means ± SD).
See this image and copyright information in PMC

References

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