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Bites in Australian snake handlers--Australian snakebite project (ASP-15).
QJM 2012; 105(11):1089-95QJM

Abstract

BACKGROUND

Snakebites in snake handlers are an important clinical problem that may differ to bites in the general population.

AIM

To investigate the epidemiology and clinical presentation of bites in snake handlers.

DESIGN

Prospective observational study.

METHODS

Bites in snake handlers recruited as part of the Australian Snakebite Project (ASP) from 2004 to 2011 were included in the study. Data were extracted from the ASP database, which included demographic and clinical information, laboratory tests and antivenom treatment.

RESULTS

From 1089 snake bites recruited to ASP, there were 106 (9.7%) bites in snake handlers. The median age was 40 years (range: 16-81 years) and 104 (98%) were males. The commonest circumstances of the bites were handling snakes (47), catching snakes (22), feeding snakes (18) and cleaning cages (11). Bites were to the upper limb in 103 cases. Bites were most commonly by Red-bellied black snakes (20), Brown snakes (17), Taipan (15), Tiger snakes (14) and Death adders (14). Envenoming occurred in 77 patients: venom-induced consumption coagulopathy in 45 patients (58%), neurotoxicity in 10 (13%) and myotoxicity in 13 (17%). Systemic hypersensitivity reactions (SHSRs) to venom occurred in eight, satisfying clinical criteria for anaphylaxis in five, of which three were hypotensive. Antivenom was administered in 60 envenomed patients. SHSRs to antivenom occurred in 15 (25%; 95% CI:15-38%), including 2 (3%:1-13%) with severe (hypotensive) reactions.

CONCLUSION

Bites in snake handlers remain a common, important problem involving a broad range of snakes. Neurotoxicity and myotoxicity are relatively common, consistent with the snakes involved. Venom anaphylaxis occured, despite previously being a poorly recognized problem in snake handlers. The incidence of SHSRs to antivenoms, including anaphylaxis, was not higher than that observed in non-snake handlers.

Authors+Show Affiliations

Discipline of Clinical Pharmacology, University of Newcastle, Calvary Mater Newcastle, Waratah NSW 2298, Australia. geoff.isbister@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22875778

Citation

Isbister, Geoffrey K., et al. "Bites in Australian Snake handlers--Australian Snakebite Project (ASP-15)." QJM : Monthly Journal of the Association of Physicians, vol. 105, no. 11, 2012, pp. 1089-95.
Isbister GK, Brown SG, ASP Investigators. Bites in Australian snake handlers--Australian snakebite project (ASP-15). QJM. 2012;105(11):1089-95.
Isbister, G. K., & Brown, S. G. (2012). Bites in Australian snake handlers--Australian snakebite project (ASP-15). QJM : Monthly Journal of the Association of Physicians, 105(11), pp. 1089-95. doi:10.1093/qjmed/hcs132.
Isbister GK, Brown SG, ASP Investigators. Bites in Australian Snake handlers--Australian Snakebite Project (ASP-15). QJM. 2012;105(11):1089-95. PubMed PMID: 22875778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bites in Australian snake handlers--Australian snakebite project (ASP-15). AU - Isbister,Geoffrey K, AU - Brown,S G A, AU - ,, Y1 - 2012/08/08/ PY - 2012/8/10/entrez PY - 2012/8/10/pubmed PY - 2013/5/7/medline SP - 1089 EP - 95 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 105 IS - 11 N2 - BACKGROUND: Snakebites in snake handlers are an important clinical problem that may differ to bites in the general population. AIM: To investigate the epidemiology and clinical presentation of bites in snake handlers. DESIGN: Prospective observational study. METHODS: Bites in snake handlers recruited as part of the Australian Snakebite Project (ASP) from 2004 to 2011 were included in the study. Data were extracted from the ASP database, which included demographic and clinical information, laboratory tests and antivenom treatment. RESULTS: From 1089 snake bites recruited to ASP, there were 106 (9.7%) bites in snake handlers. The median age was 40 years (range: 16-81 years) and 104 (98%) were males. The commonest circumstances of the bites were handling snakes (47), catching snakes (22), feeding snakes (18) and cleaning cages (11). Bites were to the upper limb in 103 cases. Bites were most commonly by Red-bellied black snakes (20), Brown snakes (17), Taipan (15), Tiger snakes (14) and Death adders (14). Envenoming occurred in 77 patients: venom-induced consumption coagulopathy in 45 patients (58%), neurotoxicity in 10 (13%) and myotoxicity in 13 (17%). Systemic hypersensitivity reactions (SHSRs) to venom occurred in eight, satisfying clinical criteria for anaphylaxis in five, of which three were hypotensive. Antivenom was administered in 60 envenomed patients. SHSRs to antivenom occurred in 15 (25%; 95% CI:15-38%), including 2 (3%:1-13%) with severe (hypotensive) reactions. CONCLUSION: Bites in snake handlers remain a common, important problem involving a broad range of snakes. Neurotoxicity and myotoxicity are relatively common, consistent with the snakes involved. Venom anaphylaxis occured, despite previously being a poorly recognized problem in snake handlers. The incidence of SHSRs to antivenoms, including anaphylaxis, was not higher than that observed in non-snake handlers. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/22875778/Bites_in_Australian_snake_handlers__Australian_snakebite_project__ASP_15__ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcs132 DB - PRIME DP - Unbound Medicine ER -