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

Tiger snakes Southern and Eastern Consumption coagulopathy

Australia Presynaptic neurotoxicity
Anti-venom is used for many Rhabdomyolysis muscle
snakes breakdown
Can treat rough scaled
snake, copperhead, broad-
headed, 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 Anticoagulant coagulopathy
Very large snake (>2.5m exception, not defibrination
possible) Rhabdomyolysis
Anti-venom often not Collett snakes have similar
necessary with Red Bellied clinical picture
Black snakes
Treatment with Tiger snake
venom
Risk of injecting anti-venom
because the patient may
 have an allergic reaction to it

Taipans Regions of Northern Australia Consumptive coagulopathy

only Presynaptic neurotoxicity
Powerful venom large Mild rhabdomyolysis
amounts
High mortality if untreated
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? No defibrination

might not want to blow its coagulopathy
camouflage No myolysis
Painful bite Powerful post-synaptic
Treatment via IV AChE neurotoxin
(raise 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 Many bites but there could be no significant envenomation
Spider 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 Maintain
tetrodoxin (Na paralysis airways
channel Respiratory Give fluids
blocker) failure possible No antivenom
Most bites available
minor but can Early basic
deliver lethal resuscitation
bite essential
Painless
Can leave
small
punctures
Blue bottle Very common Linear Remove
Sting usually erythematous tentacles with
 painful eruptions (whip hands
marks) Wash site
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 cardiovascular removes
Capricorn collapse in 20- stinging cells
At least 65 30 min (nematocysts)
deaths Severe local for microscope
attributed pain, identification
erythematous Early basic
wheal resuscitation
essential for
survival as far
as the hospital
(then on life
support)
Cardiovascular
collapse
managed
IV antivenom
administered
Irukandji syndrome Several box Minor local Supportive care
jellyfish effects Pain relief
responsible Severe
Mostly generalised
associated one pain and
is Carukia autonomic
barnesi effects
Back,
abdomen,
chest pain
tachycardia,
hypertension,
anxiety
Possible
cardiac effect
(1 death
attributed)

LAND CREATURES
Creature Information
Australian Platypus 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
Bees, Wasps, Ants 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
Drop-bear (Koala Koala-shaped carnivorous animal
dropii) Drops from tree and eats face of victim
Evidence limited to sightings by backpackers, drunks and other
unreliable sources
No verified photographs exist