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The emerging syndrome of envenoming by the New Guinea small-eyed snake Micropechis ikaheka.
QJM. 1996 Jul; 89(7):523-30.QJM

Abstract

The New Guinea small-eyed or ikaheka snake, Micropechis ikaheka, 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 M. ikaheka, with two fatalities, were identified in Papua New Guinea and Irian Jaya. Five patients showed no clinical signs of envenoming. The other six patients showed symptoms typical of envenoming by other Australasian elapids: mild local swelling, local lymphadenopathy, neurotoxicity, generalized 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. In vitro 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.

Authors+Show Affiliations

Centre for Tropical Medicine, University of Oxford, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

8759493

Citation

Warrell, D A., et al. "The Emerging Syndrome of Envenoming By the New Guinea Small-eyed Snake Micropechis Ikaheka." QJM : Monthly Journal of the Association of Physicians, vol. 89, no. 7, 1996, pp. 523-30.
Warrell DA, Hudson BJ, Lalloo DG, et al. The emerging syndrome of envenoming by the New Guinea small-eyed snake Micropechis ikaheka. QJM. 1996;89(7):523-30.
Warrell, D. A., Hudson, B. J., Lalloo, D. G., Trevett, A. J., Whitehead, P., Bamler, P. R., Ranaivoson, M., Wiyono, A., Richie, T. L., Fryauff, D. J., O'Shea, M. T., Richards, A. M., & Theakston, R. D. (1996). The emerging syndrome of envenoming by the New Guinea small-eyed snake Micropechis ikaheka. QJM : Monthly Journal of the Association of Physicians, 89(7), 523-30.
Warrell DA, et al. The Emerging Syndrome of Envenoming By the New Guinea Small-eyed Snake Micropechis Ikaheka. QJM. 1996;89(7):523-30. PubMed PMID: 8759493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The emerging syndrome of envenoming by the New Guinea small-eyed snake Micropechis ikaheka. AU - Warrell,D A, AU - Hudson,B J, AU - Lalloo,D G, AU - Trevett,A J, AU - Whitehead,P, AU - Bamler,P R, AU - Ranaivoson,M, AU - Wiyono,A, AU - Richie,T L, AU - Fryauff,D J, AU - O'Shea,M T, AU - Richards,A M, AU - Theakston,R D, PY - 1996/7/1/pubmed PY - 1996/7/1/medline PY - 1996/7/1/entrez SP - 523 EP - 30 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 89 IS - 7 N2 - The New Guinea small-eyed or ikaheka snake, Micropechis ikaheka, 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 M. ikaheka, with two fatalities, were identified in Papua New Guinea and Irian Jaya. Five patients showed no clinical signs of envenoming. The other six patients showed symptoms typical of envenoming by other Australasian elapids: mild local swelling, local lymphadenopathy, neurotoxicity, generalized 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. In vitro 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. SN - 1460-2725 UR - https://www.unboundmedicine.com/medline/citation/8759493/The_emerging_syndrome_of_envenoming_by_the_New_Guinea_small_eyed_snake_Micropechis_ikaheka_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/89.7.523 DB - PRIME DP - Unbound Medicine ER -