Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 29;8(11):459.
doi: 10.3390/biomedicines8110459.

Phospholipase A2 (PLA2) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27)

Geoffrey K Isbister  1 , Nandita Mirajkar  1 , Kellie Fakes  1 , Simon G A Brown  2 , Punnam Chander Veerati  1
Affiliations

Phospholipase A2 (PLA2) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27)

Geoffrey K Isbister et al. Biomedicines. .

Abstract

Early diagnosis of snake envenomation is essential, especially neurotoxicity and myotoxicity. We investigated the diagnostic value of serum phospholipase (PLA2) in Australian snakebites. In total, 115 envenomated and 80 non-envenomated patients were recruited over 2 years, in which an early blood sample was available pre-antivenom. Serum samples were analyzed for secretory PLA2 activity using a Cayman sPLA2 assay kit (#765001 Cayman Chemical Company, Ann Arbor MI, USA). Venom concentrations were measured for snake identification using venom-specific enzyme immunoassay. The most common snakes were Pseudonaja spp. (33), Notechis scutatus (24), Pseudechis porphyriacus (19) and Tropidechis carinatus (17). There was a significant difference in median PLA2 activity between non-envenomated (9 nmol/min/mL; IQR: 7-11) and envenomated patients (19 nmol/min/mL; IQR: 10-66, p < 0.0001) but Pseudonaja spp. were not different to non-envenomated. There was a significant correlation between venom concentrations and PLA2 activity (r = 0.71; p < 0.0001). PLA2 activity was predictive for envenomation; area under the receiver-operating-characteristic curve (AUC-ROC), 0.79 (95% confidence intervals [95%CI]: 0.72-0.85), which improved with brown snakes excluded, AUC-ROC, 0.88 (95%CI: 0.82-0.94). A cut-point of 16 nmol/min/mL gives a sensitivity of 72% and specificity of 100% for Australian snakes, excluding Pseudonaja. PLA2 activity was a good early predictor of envenomation in most Australian elapid bites. A bedside PLA2 activity test has potential utility for early case identification but may not be useful for excluding envenomation.

Keywords: antivenom; diagnosis; envenomation; phospholipase; snakebite; venom.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart showing the excluded patients (red) and the envenomated (green) and non-envenomated (blue) patients. Minor venomous snakes include two whip snake (Demansia spp.) bites and one bite by a De Vi’s Banded snake (Denisonia devisi).
Figure 2
Figure 2
Box and whisker plots of the secretory phospholipase A2 concentrations for envenomated versus non-envenomated patients (A) and for non-envenomated patients and the different species of snakes (B). Scatter plots for the less common species. The boxes are medians and interquartile ranges. The gray dotted line represents the cut-off of 16 nmol/min/mL.
Figure 3
Figure 3
Plots of secretory phospholipase A2 concentrations versus venom concentration on double logarithmic axes (A) and secretory phospholipase A2 concentrations versus time on a logarithmic axis (B). The red dotted line represents the cut-off of 16 nmol/min/mL.
Figure 4
Figure 4
Area under the curve of the receiver operating curve for secretory phospholipase A2 concentrations for envenomated versus non-envenomated patients and non-envenomated patients versus envenomated patients (excluding brown snake).
Figure 5
Figure 5
Plots of the peak creatine kinase (CK) versus secretory phospholipase A2 in patients with myotoxicity, including Mulga snake bites (P. australis), red-bellied black snake (P. porphyriacus, RBBS) bites, rough-scaled snake (T. carinatus; RSS) bites, taipan (O. scutellatus) bites and tiger snake (Notechis spp.) bites.
See this image and copyright information in PMC

References

    1. Longbottom J., Shearer F.M., Devine M., Alcoba G., Chappuis F., Weiss D.J., Ray S.E., Ray N., Warrell D.A., de Castañeda R.R., et al. Vulnerability to snakebite envenoming: A global mapping of hotspots. Lancet. 2018;392:673–684. doi: 10.1016/S0140-6736(18)31224-8. - DOI - PMC - PubMed
    1. Kasturiratne A., Wickremasinghe A.R., de Silva N., Gunawardena N.K., Pathmeswaran A., Premaratna R., Savioli L., Lalloo D.G., de Silva H.J. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218. doi: 10.1371/journal.pmed.0050218. - DOI - PMC - PubMed
    1. Isbister G.K. Antivenom efficacy or effectiveness: The Australian experience. Toxicology. 2010;268:148–154. doi: 10.1016/j.tox.2009.09.013. - DOI - PubMed
    1. Johnston C.I., Ryan N.M., O’Leary M.A., Brown S.G., Isbister G.K. Australian taipan (Oxyuranus spp.) envenoming: Clinical effects and potential benefits of early antivenom therapy—Australian Snakebite Project (ASP-25) Clin. Toxicol. 2017;55:115–122. doi: 10.1080/15563650.2016.1250903. - DOI - PubMed
    1. Churchman A., O’Leary M.A., Buckley N.A., Page C.B., Tankel A., Gavaghan C., Holdgate A., Brown S.G., Isbister G.K. Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11) Med. J. Aust. 2010;193:696–700. doi: 10.5694/j.1326-5377.2010.tb04108.x. - DOI - PubMed

LinkOut - more resources