Differential Hematotoxic Activity of Southeast Asian Pit Viper Venoms: The Cross-Neutralizing Effect of Available Antivenoms

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  Image Credit: Creative Commons (some rights reserved) CC BY-NC Photo 111998430, (c) Nicholas Hess Differential Hematotoxic Activity of Southeast Asian Pit Viper Venoms: The Cross-Neutralizing Effect of Available Antivenoms Abstract Background/Objectives : Pit vipers (subfamily Crotalinae) are responsible for a large proportion of snakebite envenoming cases in Southeast Asia. Envenomation by these snakes commonly causes hematotoxic effects, including platelet dysfunction and coagulation disturbances. Although antivenom remains the mainstay of treatment, species-specific antivenoms are not available for several regional pit viper species. This study evaluated the hematotoxic activities of selected Southeast Asian pit viper venoms and the cross-neutralizing capacity of commercially available antivenoms.  Methods : Venoms from five medically important pit viper species— Calloselasma rhodostoma ,  Trimeresurus albolabris ,  T. hageni ,  T. purpureomaculatus , ...

Pediatric Scorpion Envenomation in Tunisia: Epidemiology, Clinical Features, Therapeutic Management and Outcomes in a 14-Year Cohort Study

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Pediatric Scorpion Envenomation in Tunisia: Epidemiology, Clinical Features, Therapeutic Management and Outcomes in a 14-Year Cohort Study

Abstract

Background

Scorpion envenomation is a persistent public health concern in Tunisia, particularly in rural areas. Children are especially vulnerable due to low body weight and immature physiological systems.

Methods

We conducted a retrospective cohort study over a 14-year period (2011–2024) in the Pediatric Intensive Care Unit of Hedi Chaker University Hospital, Sfax, Tunisia. Children aged 0–14 years with confirmed scorpion envenomation were included. Epidemiological, clinical, biological, and outcome data were analyzed.

Results

Sixty-nine children were included, with a mean age of 4.6 years; two-thirds were under five years of age. Most cases occurred during summer and originated from rural areas. Systemic manifestations were present in 85.5% of patients. Moderate and severe envenomation were predominant, with 49.3% classified as Grade II and 39.1% as Grade III. Cardiac involvement was frequent, with elevated cardiac troponin observed in nearly half of cases and left ventricular dysfunction in more than one-third. Antivenom was administered in 88.4% of patients, and inotropic support was required in 25.9%. There were no fatalities; however, 18.5% of patients developed sequelae, mainly cardiac. Younger age, severe clinical presentation, seizures, respiratory distress, hyperglycemia, ventricular dysfunction, pulmonary edema, and delayed medical care (>2 hours) were significantly associated with adverse outcomes.

Conclusion

Pediatric scorpion envenomation often leads to systemic and cardiac complications. Early recognition and rapid management are critical to reducing morbidity.