The Clinical Usefulness of Taiwan Bivalent Freeze-Dried Hemorrhagic Antivenom in Protobothrops mucrosquamatus- and Viridovipera stejnegeri-Envenomed Patients

Chih-Chuan Lin; Chia-Pang Shih; Chia-Cheng Wang; Chun-Hsiang Ouyang; Chien-Chun Liu; Jau-Song Yu; Chih-Hong Lo

doi:10.3390/toxins14110794

The Clinical Usefulness of Taiwan Bivalent Freeze-Dried Hemorrhagic Antivenom in Protobothrops mucrosquamatus- and Viridovipera stejnegeri-Envenomed Patients

Toxins (Basel). 2022 Nov 15;14(11):794. doi: 10.3390/toxins14110794.

Authors

Chih-Chuan Lin^{1

2}, Chia-Pang Shih³, Chia-Cheng Wang⁴, Chun-Hsiang Ouyang⁴, Chien-Chun Liu⁵, Jau-Song Yu^{5

6

7}, Chih-Hong Lo⁸

Affiliations

¹ Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
³ Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan.
⁴ Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
⁵ Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan.
⁶ Department of Cell and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
⁷ Liver Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan.
⁸ Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.

Abstract

Snakebites from Protobothrops mucrosquamatus (Taiwan habus) and Viridovipera stejnegeri (green bamboo vipers) account for the most venomous snakebites in Taiwan. The bivalent freeze-dried hemorrhagic (FH) antivenom is employed to treat these two snakebite patients without a strict clinical trial. We evaluated the clinical usefulness of Taiwan bivalent freeze-dried hemorrhagic (FH) antivenom in Taiwan habu- and green bamboo viper-envenomed patients. We checked ELISA- based serum venom antigen levels before and after FH antivenom to evaluate FH's ability to neutralize patients' serum snake venom and its usefulness in reducing limb swelling after snakebites. Patients who had higher serum venom antigen levels had more severe limb swelling. Of the 33 enrolled patients, most of their snake venom antigen levels were undetected after the appliance of antivenom. Most enrolled patients (25/33) had their limb swelling subside within 12 h after antivenom treatment. The failure to reduce limb swelling was probably due to an inadequate antivenom dose applied in more severely envenomated patients. Our data indicate the feasibility of the FH antivenom in effectively eliminating venom and resolving the affected limb swelling caused by Taiwan habu and green bamboo viper bites.

Keywords: Protobothrops mucrosquamatus; Viridovipera stejnegeri; snake antivenom; snake venom.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Antivenins* / therapeutic use
Edema / drug therapy
Hemorrhage / drug therapy
Humans
Snake Bites* / drug therapy
Snake Venoms
Trimeresurus*

Substances

Antivenins
Snake Venoms

Grants and funding

This work was funded by the Ministry of Science and Technology, Taiwan (grants MOST 108-2314-B-182A-081- to C.-C.L.). The funders had no role in the study design, data collection, analysis, publication decision, or manuscript preparation. The A.P.C. was funded by the Chang Gung Memorial Hospital in Taiwan.