LECTURE 22: BITES AND STINGS

SNAKE BITES

SNAKE BITES
In Australia 500 to 3000 snake bites/year (difficult to estimate accurately)
Anti-venom required 200 500 cases
Potentially life threatening condition if envenomation occurs
Australian Elapid snakes are one of the most deadly species in the world
5 main types to worry about

SNAKE TYPES
Type Bite Clinical symptoms
Brown snakes Wide spread habitat in Australia Minimal local effects/non-specific
Fast moving and biting (striking) effects
Repeated biting Major clinical feature is consumption
Aggressive coagulopathy clotting all the fibre
High rate of dry bites (no venom) from blood so blood is no longer able
want to save venom for animals to clot, death due to cerebral stroke
they want to eat Paralysis is rarely seen
Bite almost painless fangs are
skinny, needle-like and not very
long

Tiger snakes Southern and Eastern Australia Consumption coagulopathy

Anti-venom is used for many snakes Presynaptic neurotoxicity
Can treat rough scaled snake, Rhabdomyolysis muscle
copperhead, broad-headed, breakdown
Stephens, red bellied and blue
bellied black
Vary in the way they look. Could be
black or brown as well

Mulga and Black snakes
Mulga also called King brown
Very large snake (>2.5m possible)
Anti-venom often not necessary
with Red Bellied Black snakes
Treatment with Tiger snake venom
Risk of injecting anti-venom
because the patient may have an
allergic reaction to it
Anticoagulant coagulopathy
exception, not defibrination
Rhabdomyolysis
Collett snakes have similar clinical
picture
Taipans Regions of Northern Australia only Consumptive coagulopathy
Powerful venom large amounts Presynaptic neurotoxicity
High mortality if untreated Mild rhabdomyolysis
Intubation may be necessary within
1-2 hours bite
Anti-venom may be warranted
before systemic envenomation
established risk of anti-venom is
lower because risk of death is higher
Death possible emergency
situation

Death adders Rather hide than bite? might No defibrination coagulopathy

not want to blow its camouflage No myolysis
Painful bite Powerful post-synaptic
Treatment via IV AChE (raise neurotoxin
atropine at nicotinic Ach
receptors)

CHARACTERISTICS OF BITES/VENOMS
Venom will paralyse the prey so it has to act very quickly evolutionary advantage
Often only local effects insufficient venom or non-venomous
Local venom-derived tissue damage effects non-reversible
Non-specific effects include: nausea/vomiting, headache, abdominal pain, diarrhoea, dizziness, collapse
o Time of collapse is characteristic of different snakes but little data

Coagulopathy

Major clinical effect in many snake bites

Major haemorrhage/intracranial bleed possible
Usually pro-coagulant coagulopathy
Prothrombin activators get defibrination in <30 minutes BOOM runny blood
Mulga and Colletts snake venom produces anti-coagulant coagulopathy
o Both respond to anti-venom treatment

Neurotoxicity

Pre & post synaptic

o Pre-synaptic: days to resolve, no response to anti-venom
o Post synaptic: reversed by anti-venom
Progressive descending flaccid paralysis
Ptosis first sign
o Droopy eyelids
o
Death by respiratory failure
 Neurotoxins
o -neurotoxins
Post-synaptic inhibition (competitive antagonist for ACh)
More than 100 isolated
All share 3-finger shape
Short chain type (60-62 amino acid)
4 conserved S-S bridges
Long chain type (66-75 aa)
5 conserved S-S bridges
More structural integrity
But also have longer tail which enables it to bind to Nic-ACh receptor for longer
Long chain harder to overcome than short chain
o -neurotoxins
Pre-synaptic inhibition
Australian Elapids may have both toxins

Myotoxicity

Often phospholipases
Breakdown muscle cells rhabdomyolysis myoglobinuria (myoglobin coming out of cells) renal failure
(because clogging up kidneys with myoglobin)
Muscle pain/weakness, red colour urine
Anti-venom seems to work (resolution of muscle pain)
Secondary renal failure and hyperkalaemia (can be lethal)

TREATMENT
First Aid

Do not wash bite site

o At the hospital need to know what snake bit the person
o May be venom left on surface of skin
Do not catch snake
Keep patient calm
Lie still and hope for the best
Pressure immobilisation
o 15cm bandage from bite site up entire limb
o Keep patient still
o Bandage only removed by hospital staff
o Some argument about whether it actually works though
Basic resuscitation may be necessary

Hospital

Examine bite site

Watch for signs of
o Paralysis (ptosis, respiratory effort musculature failing)
o Coagulopathy (persistent ooze from bite site, cranial irritation, bleeding)
o Rhabdomyolysis (muscle weakness/tenderness)
Coagulation studies
o Prick patients finger and put their blood on glass
o Then do the same with your finger
o Compare how long it takes for each blood sample to clot
o If your blood clots quicker than their blood then there are signs of coagulopathy
Urine analysis
Snake venom detection kit
o Eliza based assay
 o Determines which antivenom is required

Antivenom

It is an immunoglobulin with specific toxins within the venom of a creature

Created by injecting animal with venom
o But not enough to kill them
o You only want to give them enough to start an immune system
Animal produces antibodies to components
Blood extracted from animal
Antibodies purified and modified to reduce foreign protein load on patient
o Dont want to give someone too much foreign protein
Horses most common animal but dogs, rabbits and chicken eggs used
Intact IgG used, MW = 150 000 Da
o Eliminate Fc region Fab which is 50 000 Da
o Fab fragmenting allows for renal excretion and decreases half-life form 50 hours to 17 hours
Type 1 immediate hypersensitivity
o IgG or Fab, animal derived proteins
o Antigen cross-linking on endogenous IgE bound to mast cells and basophils histamine release
Anaphylactoid reactions
o Aggregation of protein antiserum activation of complement cascade
o Unlike anaphylactic reactions
o Dose dependent, can be halted
Type 3 hypersensitivity serum sickness
o Days to develop
o Antibody complexes cause immune responses in body, skin, joints, kidneys rarely serious

SPIDER BITES

SPIDER BITES
Most bites minor effects only
2 spider groups to worry about:
o Red back spiders
Cause severe persistent pain + numerous systemic effects
No deaths since 1950s
o Big black spiders
Dangerous because might be funnel web spider
FWS bite = medical emergency
14 deaths recorded from funnel web bites
Bites from male spiders are more likely to kill you
Bites from both groups often do not result in severe illness
Spiders on the whole are unlikely to cause necrosis

SPIDER TYPES
Type Information
Red Back Spider ~50% bites give minor to no symptoms
Significant envenomation (~20% cases)
o Death unlikely
o Prolonged pain + distress (several days)
o Antivenom hastens return to work some literature says that antivenom doesnt
do anything
Spreading local pain, sweating, headache, nausea, hypertensive in case of significant
envenomation
 Paediatric age, pregnancy, lactation are NOT contraindications for antivenom
Funnel Web Spider Many bites but there could be no significant envenomation
Victims should be observed for at least 6 hours
Bite leaves large bleeding fang marks
Envenomation
o It has a lot of effects because it has a lot of neurotoxins
o Tingling lips, twitching tongue, salivation, lachrymation, sweating, piloerection
o Hypertension, tachycardia, respiratory distress (pulmonary oedema)
o Cats dont die from this, they only get a bit from hypertension
Death can occur within 1 hour
White Tail Spider Became famously blamed for slow-healing ulcers (necrotic aracnidism)
Australian study showed them unlikely to cause necrotic aracnidism (130 definite bites no
ulcers)
One case (SA) caused by fiddleback spider not native species
Cause thought to be secondary infection BUT uncertainty arises surrounding introduced
relatives of American recluse spider

OTHER ANIMAL TOXINS

MARINE CREATURES
Creature Bite Clinical Symptom Treatment
Blue ringed octopus Saliva contains Flaccid paralysis Maintain airways
tetrodoxin (Na Respiratory failure Give fluids
channel blocker) possible No antivenom
Most bites minor available
but can deliver Early basic
lethal bite resuscitation
Painless essential
Can leave small
punctures
Blue bottle Very common Linear Remove tentacles
Sting usually erythematous with hands
painful eruptions (whip Wash site
marks) Immerse in 45
degree water
Ice better than
nothing (old
method of
treatment)
Medical
intervention rarely
required
Box jellyfish Found north of Death due to Sticky-tape
Tropic of Capricorn cardiovascular removes stinging
At least 65 deaths collapse in 20-30 cells (nematocysts)
attributed min for microscope
Severe local pain, identification
erythematous Early basic
wheal resuscitation

Irukandji syndrome
LAND CREATURES
Creature Information
Australian Platypus
Bees, Wasps, Ants
Drop-bear (Koala dropii)
essential for
survival as far as
the hospital (then
on life support)
Cardiovascular
collapse managed
IV antivenom
administered
Several box jellyfish Minor local effects Supportive care
responsible Severe generalised Pain relief
Mostly associated pain and
one is Carukia autonomic effects
barnesi Back, abdomen,
chest pain
tachycardia,
hypertension,
anxiety
Possible cardiac
effect (1 death
attributed)
Unusual venomous mammal
Venom in hind spur of male
Dogs can die from envenomation
Very painful in humans
Current research into platypus venom for development of new analgesics
Stings painful and can result in allergic reactions
Bee and wasp stings leading cause of death from venomous creature
Only bees leave sting in victim
Wasps and ants give repeated stings
Anaphylactic reaction causes death
Koala-shaped carnivorous animal
Drops from tree and eats face of victim
Evidence limited to sightings by backpackers, drunks and other unreliable
sources
No verified photographs exist