Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
3420639 | Transactions of the Royal Society of Tropical Medicine and Hygiene | 2008 | 6 Pages |
Abstract
A man bitten by a large coral snake (Micrurus lemniscatus helleri) in the Amazon basin of Ecuador developed persistent excruciating pain in the bitten arm. On admission to hospital less than 30Â min later, he had a polymorphonuclear leucocytosis, thrombocytopenia and mildly prolonged prothrombin time/partial thromboplastin time. Not until 14Â h after the bite did he develop the first signs of neurotoxicity. Despite treatment with specific antivenom 50Â h after the bite, he required oxygen for respiratory failure 60Â h, and 6Â h of mechanical ventilation 72Â h, after the bite. Over the next 38Â h, he required two further intubations and periods of assisted ventilation before being airlifted to a tertiary referral hospital. Complications included bacterial pneumonia, pneumothorax, bronchial obstruction by mucus plugs and mild rhabdomyolysis. He was discharged from hospital 15 days after the bite with persistent limb weakness and urinary incontinence but eventually recovered. The interesting and unusual features of this case (severe local pain, very slow evolution of neurotoxic envenoming, persistent thrombocytopenia and mild coagulopathy) are discussed in the context of what is known of the composition of Micrurus venoms and the small clinical literature on envenoming from their bites.
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Authors
Stephen R. Manock, German Suarez, David Graham, MarÃa L. Avila-Aguero, David A. Warrell,