A Paradigm Shift in Snakebite Envenoming Therapy: From Conventional Antivenoms to Rationally Designed, Broadly Neutralizing Combination Therapies

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  A Paradigm Shift in Snakebite Envenoming Therapy: From Conventional Antivenoms to Rationally Designed, Broadly Neutralizing Combination Therapies Abstract For over a century, polyclonal antivenom has been the cornerstone of snakebite therapy, saving countless lives. However, the current production method, based on immunizing large animals, has inherent limitations in terms of safety, stability, and supply reliability, thereby creating a pressing need for alternative technologies. This review charts the rise of next-generation antivenoms built on recombinant antibody engineering. We systematically survey the strategies for discovering and developing these molecules, from humanized monoclonal antibodies and VHHs to computationally designed proteins. Our central thesis is that achieving broad-spectrum neutralization against complex venoms requires a shift from single-agent approaches to rationally designed, oligoclonal “cocktail” therapies (defined mixtures of a few select therapeut...

Comparative medical importance of spider bites in Spain over 1997–2020: a retrospective study based on hospital cases coded using ICD

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Comparative medical importance of spider bites in Spain over 1997–2020: a retrospective study based on hospital cases coded using ICD

Abstract

Envenomation by terrestrial toxic animals is considered a serious risk to human health worldwide. Snakes, hymenopterans, spiders, and scorpions have mainly attracted the attention of medical literature. However, the relative importance of spiders has been studied only in a few countries. Here, we present the first retrospective study on the incidence of spider bites requiring hospital care in Spain, compared to bites or stings from snakes, hymenopterans, and scorpions. Using ICD9MC and ICD10 databases from the World Health Organization’s International Classification of Diseases for the period 1997–2020, we quantified the cases of envenomation by spiders, compared to those by other terrestrial toxic animals, the demographic data of envenomation cases, the relative severity of spider bites, and the geographic distribution of envenomation cases. Overall, the incidence of acute intoxication by terrestrial toxic animals in Spain was ca. 1.23 cases per million inhabitants. In decreasing order of importance, cases were due to snakes, hymenopterans, spiders, scorpions, and myriapods. Fatal cases were extremely rare, caused mainly by hymenopterans. No fatalities were caused by spiders, scorpions, and myriapods. A greater incidence of snake bites occurred in northern Spain, but no geographical trends were found for spider bites or scorpion stings. Severe poisoning or life-threatening cases due to bites or stings from toxic terrestrial animals in Spain seems to be very low, especially for spiders, compared to other countries in the world. In general, spiders do not present a risk to human health and should not be considered a major driver of morbidity.


Fernando Cortés-Fossati, Marcos Méndez, Comparative medical importance of spider bites in Spain over 1997–2020: a retrospective study based on hospital cases coded using ICD, Journal of Medical Entomology, 2024;, tjae045, https://doi.org/10.1093/jme/tjae045