Viperidae

viperidae
  • 文章类型: Journal Article
    全球,据估计,有180万至270万例由蛇咬伤引起的envenoming病例。蛇毒是蛋白质毒素的复杂混合物,脂质,小分子,和盐,这些蛋白质通常会导致蛇咬伤受害者的病理。对于它们的化学表征和鉴定,需要使用分析方法。反相液相色谱-电喷雾质谱联用技术(RP-LC-ESI-MS)因其使用方便,灵敏度,以及LC分离后直接偶联的能力。该方法允许复杂混合物的有效分离和分析物的灵敏检测。另一方面,有时也使用基质辅助激光解吸/电离质谱(MALDI-MS),尽管它通常需要额外的样品制备步骤,它为分析较大的生物分子提供了理想的适用性。在这项研究中,将七个医学上重要的蛇毒蛇毒分离为各自的毒液毒素,并通过ESI-MS进行测量。并行,使用纳米分馏分析,柱后高分辨率分级分离用于收集洗脱毒素用于进一步处理以用于MALDI-MS分析。我们的比较结果表明,从ESI-MS和MALDI-MS方法中观察到的去卷积的蛇毒毒素质量具有良好的敏感性,并且在回收的毒素质量中呈现重叠(在25%和57%之间,取决于分析的毒液)。检测到的高丰度毒素的质量范围在4至28kDa之间。总的来说,在ESI-MS和/或MALDI-MS分析中发现39个质量,大多数在5到9kDa之间(46%),13和15kDa(38%),大小为24和28kDa(13%)。在柱后MS分析旁边,进行了额外的凝血生物测定,以证明在工作流程中对毒液活性进行平行的柱后评估.大多数纳米分馏毒液表现出抗凝血活性,三个毒液还表现出具有明显促凝血活性的毒素(Bothropsasper,Crotalusatrox,和Daboiarusselii)观察到后柱。这项研究的结果强调了ESI-MS和MALDI-MS方法在表征蛇毒毒素方面的互补性,并提供了在多种蛇毒蛇毒中发现的定义毒素质量的补充概述。
    Worldwide, it is estimated that there are 1.8 to 2.7 million cases of envenoming caused by snakebites. Snake venom is a complex mixture of protein toxins, lipids, small molecules, and salts, with the proteins typically responsible for causing pathology in snakebite victims. For their chemical characterization and identification, analytical methods are required. Reversed-phase liquid chromatography coupled with electrospray ionization mass spectrometry (RP-LC-ESI-MS) is a widely used technique due to its ease of use, sensitivity, and ability to be directly coupled after LC separation. This method allows for the efficient separation of complex mixtures and sensitive detection of analytes. On the other hand, matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) is also sometimes used, and though it typically requires additional sample preparation steps, it offers desirable suitability for the analysis of larger biomolecules. In this study, seven medically important viperid snake venoms were separated into their respective venom toxins and measured by ESI-MS. In parallel, using nanofractionation analytics, post-column high-resolution fractionation was used to collect the eluting toxins for further processing for MALDI-MS analysis. Our comparative results showed that the deconvoluted snake venom toxin masses were observed with good sensitivity from both ESI-MS and MALDI-MS approaches and presented overlap in the toxin masses recovered (between 25% and 57%, depending on the venom analyzed). The mass range of the toxins detected in high abundance was between 4 and 28 kDa. In total, 39 masses were found in both the ESI-MS and/or MALDI-MS analyses, with most being between 5 and 9 kDa (46%), 13 and 15 kDa (38%), and 24 and 28 kDa (13%) in size. Next to the post-column MS analyses, additional coagulation bioassaying was performed to demonstrate the parallel post-column assessment of venom activity in the workflow. Most nanofractionated venoms exhibited anticoagulant activity, with three venoms additionally exhibiting toxins with clear procoagulant activity (Bothrops asper, Crotalus atrox, and Daboia russelii) observed post-column. The results of this study highlight the complementarity of ESI-MS and MALDI-MS approaches for characterizing snake venom toxins and provide a complementary overview of defined toxin masses found in a diversity of viper snake venoms.
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  • 文章类型: Journal Article
    蛇毒是生物活性分子的混合物,已经进化到固定猎物,但也可以在被咬伤的人类中诱发严重的病理。虽然动物来源的多克隆抗蛇毒血清是蛇咬伤的主要治疗方法,它们通常在疗效上有局限性,并可能引起严重的不良副作用。在最近努力开发改良抗蛇毒血清的基础上,特别是通过单克隆抗体,需要全面了解毒液毒素.在这些毒素中,蛇毒金属蛋白酶(SVMPs)起着举足轻重的作用,特别是在毒蛇毒害中,造成组织损伤,出血和凝血中断。开发针对SVMP的中和单克隆抗体的当前挑战之一是蛋白质的大尺寸和缺乏中和表位的现有知识。这里,我们筛选了一个合成的人抗体文库,以从锯齿毒蛇(Echis属)毒液中分离抗SVMP的单克隆抗体.根据表征,鉴定出几种有效阻断SVMP介导的凝血酶原活化的抗体.低温电子显微镜显示了抗体介导的中和的结构基础,将SVMPs的非催化性富含半胱氨酸的结构域确定为关键靶标。这些发现强调了了解SVMPs的分子机制以对抗其毒性作用的重要性。从而促进更有效的抗蛇毒血清的发展。
    Snake venoms are cocktails of biologically active molecules that have evolved to immobilize prey, but can also induce a severe pathology in humans that are bitten. While animal-derived polyclonal antivenoms are the primary treatment for snakebites, they often have limitations in efficacy and can cause severe adverse side effects. Building on recent efforts to develop improved antivenoms, notably through monoclonal antibodies, requires a comprehensive understanding of venom toxins. Among these toxins, snake venom metalloproteinases (SVMPs) play a pivotal role, particularly in viper envenomation, causing tissue damage, hemorrhage and coagulation disruption. One of the current challenges in the development of neutralizing monoclonal antibodies against SVMPs is the large size of the protein and the lack of existing knowledge of neutralizing epitopes. Here, we screened a synthetic human antibody library to isolate monoclonal antibodies against an SVMP from saw-scaled viper (genus Echis) venom. Upon characterization, several antibodies were identified that effectively blocked SVMP-mediated prothrombin activation. Cryo-electron microscopy revealed the structural basis of antibody-mediated neutralization, pinpointing the non-catalytic cysteine-rich domain of SVMPs as a crucial target. These findings emphasize the importance of understanding the molecular mechanisms of SVMPs to counter their toxic effects, thus advancing the development of more effective antivenoms.
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  • 文章类型: Journal Article
    伊朗存在许多具有医学重要性的毒蛇。Pseudocastespericus(P.persicus),一种医学上重要的蛇,也被称为波斯角毒蛇,有一个延伸到东方的地理分布,西南,和伊朗的中部地区,并在更广泛的地区流行。因此,这个物种是许多蛇咬伤事件的原因。在中部省Semnan发现的P.persicus的毒液含有磷脂酶A2和L-氨基酸氧化酶活性,和高毒性效力。通过反相高效液相色谱(HPLC)分离毒液,并通过十二烷基硫酸钠聚丙烯酰胺凝胶电泳(SDS-PAGE)进行分析,蛋白质印迹和双向电泳。使用液相色谱与串联质谱(LC-MS/MS),确定了一系列组件,与毒液的生化和毒理学特性一致。从2D电泳和shot弹枪方法鉴定的蛋白质包括金属和丝氨酸蛋白酶,磷脂酶,氧化酶,和Kunitz胰蛋白酶抑制剂,以及许多其他成分的质量丰度较低。这项研究提供了一个更详细的了解伊朗的P.persicus毒液的蛋白质谱,可以有效地生产出有效的解毒剂。对所得数据的分析表明,波斯角毒蛇的毒液中存在广泛的蛋白质。这些信息可以更好地了解多克隆抗蛇毒血清如何中和毒液。考虑到这种蛇及其相关物种在伊朗和周边国家的广泛存在,了解该家族的毒液蛋白谱可以为抗蛇毒血清生产商提供很大的支持,例如拉齐疫苗和血清研究所在制备区域抗蛇毒血清方面。
    Numerous species of venomous snakes of medical importance exist in Iran. Pseudocerastes persicus (P. persicus), one of the medically important snakes, also called the Persian horned viper, has a geographical spread that extends to the east, southwest, and central areas of Iran and is endemic across the wider region. As a result, this species is responsible for many snakebite occurrences. Venom from P. persicus found in the central province of Semnan contains phospholipase A2 and L-amino acid oxidase activities, and high toxic potency. The venom was fractionated by reverse-phase high-performance liquid chromatography (HPLC) and analyzed by Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), Western blotting and two-dimensional electrophoresis. Using liquid chromatography with tandem mass spectrometry (LC-MS/MS), a range of components were identified, consistent with the biochemical and toxicological properties of the venom. Proteins identified from 2D electrophoresis and shotgun methods included metallo- and serine proteases, phospholipases, oxidases, and Kunitz trypsin inhibitors, along with many other components at lower qualitative abundance. This study provides a more detailed understanding of the protein profile of Iranian P. persicus venom, which can be effective in the production of an effective antidote against it. The analysis of the resulting data shows that there is a wide range of proteins in the venom of the Persian horned viper. This information can provide a better understanding of how venom is neutralized by polyclonal antivenom. Considering the wide presence of this snake and its related species in Iran and surrounding countries, knowing the venom protein profile of this family can be of great support to antivenom producers such as Razi Vaccine & Serum Research Institute in the preparation of regional antivenoms.
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  • 文章类型: Journal Article
    在快速变化的热环境中,爬行动物主要依赖于原位适应,因为它们的分散能力有限,转移范围的机会有限。然而,气候变化的快速步伐可能会超过这些适应能力或提高能源支出。因此,了解个体和群体尺度上热性状的变异性至关重要,提供有关爬行动物对气候变化脆弱性的见解。我们研究了濒临灭绝的希腊草甸毒蛇(Viperagraeca)的热生态学,希腊和阿尔巴尼亚Pindos山脉1600m以上的高山-亚高山草甸的地方性毒蛇,评估其对高山热环境预期变化的敏感性。我们测量了人工热梯度中的首选体温,包括整个物种地理范围在内的五个种群中的74个人的野外体温,并收集了温度调节的可用数据。我们发现,首选的体温(Tp)仅在最北端和最南端的人群之间有所不同,并且随女性体型的增加而增加,但不取决于性别或女性的妊娠状况。Tp随纬度增加,但不受种群系统发育位置的影响。我们还发现了V.graeca种群的温度调节的高精度以及整个范围内栖息地的热质量变化。体温调节的整体效果很高,表明V.graeca成功地达到目标温度并利用了热景观。目前的气候条件限制了活动周期估计每年1278小时,在未来的气候情景下,预计将大幅增加。温度调节的时间限制,除了采矿导致的栖息地丧失外,觅食和繁殖将对个体的健康和种群的持久性构成严重威胁,由于在V.graeca缩小的山顶栖息地过度放牧,旅游业或滑雪和栖息地退化。
    In a rapidly changing thermal environment, reptiles are primarily dependent on in situ adaptation because of their limited ability to disperse and the restricted opportunity to shift their ranges. However, the rapid pace of climate change may surpass these adaptation capabilities or elevate energy expenditures. Therefore, understanding the variability in thermal traits at both individual and population scales is crucial, offering insights into reptiles\' vulnerability to climate change. We studied the thermal ecology of the endangered Greek meadow viper (Vipera graeca), an endemic venomous snake of fragmented alpine-subalpine meadows above 1600 m of the Pindos mountain range in Greece and Albania, to assess its susceptibility to anticipated changes in the alpine thermal environment. We measured preferred body temperature in artificial thermal gradient, field body temperatures of 74 individuals in five populations encompassing the entire geographic range of the species, and collected data on the available of temperatures for thermoregulation. We found that the preferred body temperature (Tp) differed only between the northernmost and the southernmost populations and increased with female body size but did not depend on sex or the gravidity status of females. Tp increased with latitude but was unaffected by the phylogenetic position of the populations. We also found high accuracy of thermoregulation in V. graeca populations and variation in the thermal quality of habitats throughout the range. The overall effectiveness of thermoregulation was high, indicating that V. graeca successfully achieves its target temperatures and exploits the thermal landscape. Current climatic conditions limit the activity period by an estimated 1278 h per year, which is expected to increase considerably under future climate scenarios. Restricted time available for thermoregulation, foraging and reproduction will represent a serious threat to the fitness of individuals and the persistence of populations in addition to habitat loss due to mining, tourism or skiing and habitat degradation due to overgrazing in the shrinking mountaintop habitats of V. graeca.
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  • 文章类型: Journal Article
    关于毒蛇生殖周期激素调节的知识仍处于初期,尤其是女性和热带物种。迫切需要了解毒蛇的繁殖,以改善辅助繁殖技术并优化圈养这些动物的维持。考虑到这一点,我们通过血清孕酮(P4)和雌二醇(E2)水平并结合超声检查,在不同季节全年监测了Northernpit蛇雌性。根据F-I和F-II(非卵黄发生期)或F-III和F-IV(卵黄发生期)的大小和卵黄发生阶段对卵巢卵泡进行分类。在秋季和冬季,五名成年雄性在这些雌性中轮换进行生殖配对,第一年有17次交配和2次怀孕,第二年有12次交配和5次怀孕。然后,我们根据季节评估P4和E2水平的变化,主要的卵巢结构和输卵管中胚胎或卵子的存在。我们的研究结果表明,当检测到更多的卵黄形成卵泡时,E2水平很高,表明E2对卵黄发生和更高水平的P4可能的影响,每当卵子和胚胎在输卵管中可视化时,暗示它在维持怀孕中的作用。对毒蛇卵巢周期的描述性分析显示,冬季有更多的卵黄形成卵泡,可能是E2增加的结果;而怀孕主要发生在春季,在P4的影响下。超声图像的使用,作为一种微创方法,与血清类固醇水平相关已被证明是体内Northernpit蛇生殖监测的有效方法。此外,这些数据表明,在人类护理下的雌性毒蛇表现出季节性的生殖周期,尽管较早的研究涉及该物种的圈养雄性,但表明精子生产和质量缺乏季节性。
    Knowledge on hormonal regulation of reproductive cycles in viperid snakes is still incipient, especially when it comes to females and tropical species. There is an urgent need to understand the reproduction of venomous snakes to improve assisted reproduction techniques and optimize the maintenance of these animals in captivity. With this in mind, we monitored Northern pit viper females year-round throughout different seasons via serum levels of progesterone (P4) and estradiol (E2) in conjunction with ultrasound examinations. Ovarian follicles were classified according to their size and stage of vitellogenesis in F-I and F-II (non-vitellogenic phase) or in F-III and F-IV (vitellogenic phase). During autumn and winter, five adult males were rotated among these females for reproductive pairing, which resulted in 17 copulations and 2 pregnancies in the first year and 12 copulations and 5 pregnancies in the second year. Then, we assessed changes in P4 and E2 levels according to seasons, predominant ovarian structures and the presence of embryos or eggs in the oviduct. Our findings showed high levels of E2 when a greater number of vitellogenic follicles were detected, indicating a possible influence of E2 on vitellogenesis and higher levels of P4 whenever eggs and embryos were visualized in the oviduct, implying its role in maintaining pregnancy. Descriptive analysis of the vipers\' ovarian cycles revealed a greater number of vitellogenic follicles during winter, probably as a result of increases in E2; whereas pregnancies occurred predominantly in spring, under the influence of P4. The use of ultrasound images, as a minimally invasive methodology, associated with serum steroid levels has proven to be an efficient approach in the reproductive monitoring of Northern pit vipers in vivo. In addition, these data suggest that female pit vipers under human care display a seasonal reproductive cycle, despite earlier studies involving captive males of the species indicating a lack of seasonality in sperm production and quality.
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  • 文章类型: Journal Article
    岛屿在我们对快速演变的理解中发挥了关键作用。大量文献研究了由于孤立和孤立而引起的形态变化,这对动物如何适应生活在非常小的地理区域产生了有用的概括。然而,了解岛礁种群形态变异的演变通常需要有关生长和发育纵向模式的详细数据集,这样的研究通常需要对大量个体进行长期的标记再捕获。响尾蛇提供了解决这些困难中的一些困难的独特机会,因为向响尾蛇串添加响尾蛇段以规则的周期性发生,并且它们的尺寸与在产生所述段的蜕皮周期时的蛇的身体尺寸直接相关。这里,我们使用了一个大型数据库,其中包含从岛上记录的拨浪鼓段大小(CoronadoSur岛,下加利福尼亚州,墨西哥)和大陆(彭德尔顿营地,加州,美国)西部响尾蛇(Crotalusorganus和C.o。caliginis)大约在10,000年前分离,以比较不同蜕皮周期下的体型,这使我们能够评估性别大小二态性的生长速度和模式的差异。我们的研究结果表明,与它们的大陆同行相比,CoronadoSur岛上的响尾蛇似乎出生得更小,生长得更慢,导致“矮化”的岛屿人口。然而,尽管体型有很大差异,这两个人群表现出相同程度的性二态性。我们的研究表明,有可能使用拨浪鼓特征来恢复基本人口参数的详细估计。
    Islands have played a key role in our understanding of rapid evolution. A large body of literature has examined morphological changes in response to insularity and isolation, which has yielded useful generalizations about how animals can adapt to live in very small geographic areas. However, understanding the evolution of morphological variation in insular populations often requires detailed data sets on longitudinal patterns of growth and development, and such studies typically necessitate long-term mark-recapture on a large sample of individuals. Rattlesnakes provide a unique opportunity to address some of these difficulties because the addition of rattle segments to the rattle string occurs with regular periodicity and their size directly correlates with the body size of the snake at the time of the ecdysis cycle generating the segment. Here, we used a large database of rattle segment sizes recorded from island (Isla Coronado Sur, Baja California, Mexico) and mainland (Camp Pendleton, California, United States) populations of Western Rattlesnakes (Crotalus oreganus and C. o. caliginis) that separated approximately 10,000 years ago to compare body sizes at different ecdysis cycles, which allowed us to assess differences in growth rates and patterns of sexual size dimorphism. Our results show that rattlesnakes on Isla Coronado Sur appear to be born smaller and grow more slowly than their mainland counterparts, resulting in a \"dwarfed\" island population. However, despite significant differences in body size, both populations exhibited the same degree of sexual dimorphism. Our study demonstrates the potential to use rattle characteristics to recover detailed estimates of fundamental demographic parameters.
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  • 文章类型: Journal Article
    背景:台湾哈布(Protobothropsmucrosquamatus),绿竹毒蛇(Viridoviperastejnegeri),台湾眼镜蛇(Najaatra)是台湾最有毒的蛇咬伤。患者常表现为肢体肿胀,但误诊率高,和目前可用的诊断工具是有限的。这项研究探讨了蛇咬伤患者的免疫反应,以帮助鉴别诊断。
    方法:这项前瞻性观察性研究调查了蛇咬伤患者细胞因子的变化及其诊断潜力。
    结果:与健康对照组相比,所有蛇咬伤患者的促炎细胞因子IL-6和TNF-α升高。虽然在体液免疫应答细胞因子中没有观察到显著差异,IFN-γ水平有显著差异,眼镜蛇咬伤患者的IL-10水平明显升高。TNF-α水平超过3.02pg/mL的患者更有可能被眼镜蛇咬伤。
    结论:这项研究揭示了各种毒蛇咬伤引发的免疫反应,强调细胞因子模式对蛇咬伤型分化的潜力。需要更大的研究来验证这些发现的临床应用,最终改善蛇咬伤的诊断和治疗。
    BACKGROUND: Taiwan habu (Protobothrops mucrosquamatus), green bamboo viper (Viridovipera stejnegeri), and Taiwan cobra (Naja atra) are the most venomous snakebites in Taiwan. Patients commonly present with limb swelling but misdiagnosis rates are high, and currently available diagnostic tools are limited. This study explores the immune responses in snakebite patients to aid in differential diagnosis.
    METHODS: This prospective observational study investigated the changes in cytokines in snakebite patients and their potential for diagnosis.
    RESULTS: Elevated pro-inflammatory cytokines IL-6 and TNF-α were observed in all snakebite patients compared to the healthy control group. While no significant disparities were observed in humoral immune response cytokines, there were significant differences in IFN-γ levels, with significantly higher IL-10 levels in patients bitten by cobras. Patients with TNF-α levels exceeding 3.02 pg/mL were more likely to have been bitten by a cobra.
    CONCLUSIONS: This study sheds light on the immune responses triggered by various venomous snakebites, emphasizing the potential of cytokine patterns for snakebite-type differentiation. Larger studies are needed to validate these findings for clinical use, ultimately improving snakebite diagnosis and treatment.
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  • 文章类型: Journal Article
    Echisocellatus是尼日利亚最常见的毒蛇之一。抗蛇毒血清是唯一有效的治疗方法,但是该国的有效抗蛇毒血清供应有限。因此,本研究旨在探索有效的可行性,使用尼日利亚的Echisocellatus毒液通过免疫兔子产生单特异性抗体。在免疫中采用世界卫生组织抗蛇毒血清生产指南,并使用蛋白A琼脂糖柱层析纯化所得抗体。通过2个月的免疫接种,抗体滴度达到较高的平台,和血清的SDSPAGE表明存在完整的免疫球蛋白,并伴有重链(50kDa)和轻链(25kDa)。毒液在小鼠中的静脉LD50为0.35mg/kg,并且在2LD50的攻击剂量下的毒液致死性被抗体有效地中和,其效力值为每g抗体0.83mg毒液。抗体还以13±0.66ul的有效剂量(ED)中和了毒液的促凝血活性,支持其用于血液毒性毒害。研究确立了开发有效、针对尼日利亚地毯毒蛇的单特异性抗体。
    Echis ocellatus is one of the commonest snakes responsible for envenomation in Nigeria. Antivenom is the only effective treatment, but the country suffers from a limited supply of effective antivenom. This study therefore aimed to explore the feasibility of effective, mono-specific antibodies production through immunization in rabbits using the venom of Echis ocellatus from Nigeria. The World Health Organization guide on antivenom production was employed in the immunization and the resultant antibodies were purified using protein A agarose column chromatography. Antibody titer reached a high plateau by 2-month immunization, and SDS PAGE of the sera suggests the presence of intact immunoglobulins accompanied with the heavy (50 kDa) and light (25 kDa) chains. The venom has an intravenous LD50 of 0.35 mg/kg in mice, and the venom lethality at a challenge dose of 2 LD50 was effectively neutralized by the antibodies with a potency value of 0.83 mg venom per g antibodies. The antibodies also neutralized the procoagulant activity of the venom with an effective dose (ED) of 13 ± 0.66 μl, supporting its use for hemotoxic envenomation. The study establishes the feasibility of developing effective, mono-specific antibodies against the Nigerian Carpet viper.
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  • 文章类型: Case Reports
    Viperaberusberus是北欧国家中唯一存在的有毒蛇,据报道在温暖的月份中马有毒蛇。对演讲知之甚少,常见的欧洲加法器对马匹的治疗和存活。临床和实验室检查结果,据报道,由于怀疑被蛇咬,在2008-2023年被赫尔辛基大学马医院收治的28匹马的治疗和结果。其中11匹马接受了抗蛇毒血清治疗。其他常见的治疗包括非甾体抗炎药(22/28),抗菌药物(19/28),静脉输液治疗(11/28),糖皮质激素(9/28)和局部治疗(11/28)。所有马匹都幸存下来,直到出院。在接受或未接受抗蛇毒血清治疗的中度尿毒的马之间,住院时间没有差异。与轻度饮酒的马相比,中度饮酒的马更有可能接受抗蛇毒血清治疗,并且需要更长的住院时间。抗蛇毒血清治疗与住院时间短无关。很少有证据支持使用皮质类固醇和抗生素来治疗毒副作用。有必要对更多动物进行研究以评估治疗效果,包括抗蛇毒血清的管理,关于长期结果和毒液生存。
    Vipera berus berus is the only venomous snake present in the Nordic countries and cases of envenomation in horses are reported during the warmer months. Little is known about the presentation, treatment and survival of horses with common European adder envenomation. Clinical and laboratory findings, treatment and outcome are reported for 28 horses admitted to Helsinki University Equine Hospital in 2008-2023 due to suspicion of snake bite. Eleven of these horses received antivenom treatment. Other common treatments included non-steroidal anti-inflammatories (22/28), antimicrobials (19/28), intravenous fluid therapy (11/28), corticosteroids (9/28) and local treatment (11/28). All horses survived until discharge. No difference was detected in the length of hospital stay between horses with moderate envenomation that had or had not received antivenom treatment. Horses with moderate envenomation are more likely to receive antivenom treatment and require longer hospital stay than horses with mild envenomation. Antivenom treatment is not associated with shorter hospital stay. Little evidence supports the use of corticosteroids and antibiotics in treatment of envenomation. Studies with larger numbers of animals are warranted to evaluate the effect of treatment, including administration of antivenom, on long-term outcome and survival from envenomation.
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  • 文章类型: Letter
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