The emerging syndrome of envenoming by the New Guinea small-eyed snake Micropechis ikaheka |
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Authors: | Warrell DA; Hudson BJ; Lalloo DG; Trevett AJ; Whitehead P; Bamler PR; Ranaivoson M; Wiyono A; Richie TL; Fryauff DJ; O'Shea MT; Richards AM; Theakston RD |
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Affiliation: | Centre for Tropical Medicine, University of Oxford, UK; Royal North Shore Hospital, St Leonards, NSW, Australia; Department of Medicine, University of Papua New Guinea, PNG; Bulollo Health Centre, PNG; Gaubin Lutheran Mission Hospital, Kar Kar Island, PNG; Intensive Care Unit, Provincial Hospital, Jayapura, Irian Jaya, Indonesia; US Naval Medical Research Unit No 2, Jakarta, Indonesia; Christensen Research Institute, Madang, PNG; Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, UK; Correspondence to: Prof DA Warrell, Centre for Tropical Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; Present address: Public Health Dept, Nottingham Health Authority, Forest Rise, Berkeley Avenue, Nottingham, UK |
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Abstract: | The New Guinea small-eyed or Ikaheka snake, <it>Micropechis
ikaheka</it>, which occurs throughout New Guinea and some adjacent
islands, is feared by the indigenes. The first proven human fatality was in
the 1950s and this species has since been implicated in many other cases of
severe and fatal envenoming. Reliable attribution of envenoming to this
species in victims unable to capture or kill the snake recently became
possible by the use of enzyme immunoassay. Eleven cases of proven
envenoming by <it>M. ikaheka</it>, with two fatalities, were
identified in Papua New Guinea and Irian Jaya. Five patients showed no
clinical signs of envenoming by other Australasian elapids: mild local
swelling, local lymphadenopathy, neurotoxicity, general myalgia,
spontaneous systemic bleeding, incoagulable blood and passage of dark urine
(haemoglobinuria or myoglobinuria). Two patients developed hypotension and
two died of respiratory paralysis 19 and 38 h after being bitten.
<it>In vitro</it> studies indicate that the venom is rich in
phospholipase A2, is indirectly haemolytic, anticoagulant and inhibits
platelets, but is not procoagulant or fibrinolytic. It shows predominantly
post-synaptic neurotoxic and myotoxic activity. Anecdotally, Commonwealth
Serum Laboratories' (CSL) death adder antivenom has proved ineffective
whereas CSL polyvalent antivenom may be beneficial. Anticholinesterase
drugs might prove effective in improving neuromuscular transmission and
should be tested in patients with neurotoxic envenoming.
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