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Neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan (Oxyuranus microlepidotus, Elapidae) in remote outback South Australia.
Toxicon 2017; 137:15-18T

Abstract

INTRODUCTION

A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus, is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity.

CASE REPORT

The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling "drowsiness" and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole blood clotting test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury.

DISCUSSION

Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome.

Authors+Show Affiliations

Toxinology Department, Women's and Children's Hospital, 72 King William Street, North Adelaide, South Australia, 5006, Australia; Department of Paediatrics and Reproductive Medicine, University of Adelaide School of Medicine, 30 Frome Street, Adelaide, South Australia, 5005, Australia. Electronic address: herptoxmed@msn.com.Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia; MedSTAR Retrieval Service, South Australian Ambulance Service, 20 James Schofield Drive, Adelaide Airport, South Australia, 5950, Australia.Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia.Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia.MedSTAR Retrieval Service, South Australian Ambulance Service, 20 James Schofield Drive, Adelaide Airport, South Australia, 5950, Australia.Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia.Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia.Royal Flying Doctor Service, Central Operations, 1 Tower Road, Adelaide Airport, South Australia, 5950, Australia.MedSTAR Retrieval Service, South Australian Ambulance Service, 20 James Schofield Drive, Adelaide Airport, South Australia, 5950, Australia.Toxinology Department, Women's and Children's Hospital, 72 King William Street, North Adelaide, South Australia, 5006, Australia; Department of Paediatrics and Reproductive Medicine, University of Adelaide School of Medicine, 30 Frome Street, Adelaide, South Australia, 5005, Australia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28694006

Citation

Weinstein, Scott A., et al. "Neurotoxicity With Persistent Unilateral Ophthalmoplegia From Envenoming By a Wild Inland Taipan (Oxyuranus Microlepidotus, Elapidae) in Remote Outback South Australia." Toxicon : Official Journal of the International Society On Toxinology, vol. 137, 2017, pp. 15-18.
Weinstein SA, Everest E, Purdell-Lewis J, et al. Neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan (Oxyuranus microlepidotus, Elapidae) in remote outback South Australia. Toxicon. 2017;137:15-18.
Weinstein, S. A., Everest, E., Purdell-Lewis, J., Harrison, M., Tavender, F., Alfred, S., ... White, J. (2017). Neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan (Oxyuranus microlepidotus, Elapidae) in remote outback South Australia. Toxicon : Official Journal of the International Society On Toxinology, 137, pp. 15-18. doi:10.1016/j.toxicon.2017.07.006.
Weinstein SA, et al. Neurotoxicity With Persistent Unilateral Ophthalmoplegia From Envenoming By a Wild Inland Taipan (Oxyuranus Microlepidotus, Elapidae) in Remote Outback South Australia. Toxicon. 2017;137:15-18. PubMed PMID: 28694006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan (Oxyuranus microlepidotus, Elapidae) in remote outback South Australia. AU - Weinstein,Scott A, AU - Everest,Evan, AU - Purdell-Lewis,Jeremy, AU - Harrison,Michael, AU - Tavender,Fiona, AU - Alfred,Sam, AU - Marrack,Liz, AU - Davenport-Klunder,Chris, AU - Wearn,Neralie, AU - White,Julian, Y1 - 2017/07/08/ PY - 2017/06/11/received PY - 2017/07/03/revised PY - 2017/07/05/accepted PY - 2017/7/12/pubmed PY - 2018/12/21/medline PY - 2017/7/12/entrez KW - Antivenom KW - Envenoming KW - Inland taipan KW - Neurotoxicity KW - Oxyuranus microlepidotus KW - Persistent ophthalmoplegia KW - Remote retrieval SP - 15 EP - 18 JF - Toxicon : official journal of the International Society on Toxinology JO - Toxicon VL - 137 N2 - INTRODUCTION: A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus, is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. CASE REPORT: The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling "drowsiness" and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole blood clotting test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury. DISCUSSION: Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome. SN - 1879-3150 UR - https://www.unboundmedicine.com/medline/citation/28694006/Neurotoxicity_with_persistent_unilateral_ophthalmoplegia_from_envenoming_by_a_wild_inland_taipan_(Oxyuranus_microlepidotus,_Elapidae)_in_remote_outback_South_Australia L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-0101(17)30211-8 DB - PRIME DP - Unbound Medicine ER -