Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka.
OBJECTIVE:We aimed to investigate neurophysiological and clinical effects of common krait envenoming, including the time course and treatment response. METHODOLOGY:Patients with definite common krait (Bungarus caeruleus) bites were recruited from a Sri Lankan hospital. All patients had serial neurol...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2016-02-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | http://europepmc.org/articles/PMC4734751?pdf=render |
| _version_ | 1818060249408471040 |
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| author | Anjana Silva Kalana Maduwage Michael Sedgwick Senaka Pilapitiya Prasanna Weerawansa Niroshana J Dahanayaka Nicholas A Buckley Christopher Johnston Sisira Siribaddana Geoffrey K Isbister |
| author_facet | Anjana Silva Kalana Maduwage Michael Sedgwick Senaka Pilapitiya Prasanna Weerawansa Niroshana J Dahanayaka Nicholas A Buckley Christopher Johnston Sisira Siribaddana Geoffrey K Isbister |
| author_sort | Anjana Silva |
| collection | DOAJ |
| description | OBJECTIVE:We aimed to investigate neurophysiological and clinical effects of common krait envenoming, including the time course and treatment response. METHODOLOGY:Patients with definite common krait (Bungarus caeruleus) bites were recruited from a Sri Lankan hospital. All patients had serial neurological examinations and stimulated concentric needle single-fibre electromyography (sfEMG) of orbicularis oculi in hospital at 6 wk and 6-9 mth post-bite. PRINCIPAL FINDINGS:There were 33 patients enrolled (median age 35 y; 24 males). Eight did not develop neurotoxicity and had normal sfEMG. Eight had mild neurotoxicity with ptosis, normal sfEMG; six received antivenom and all recovered within 20-32 h. Seventeen patients developed severe neurotoxicity with rapidly descending paralysis, from ptosis to complete ophthalmoplegia, facial, bulbar and neck weakness. All 17 received Indian polyvalent antivenom a median 3.5 h post-bite (2.8-7.2 h), which cleared unbound venom from blood. Despite this, the paralysis worsened requiring intubation and ventilation within 7 h post-bite. sfEMG showed markedly increased jitter and neuromuscular blocks within 12 h. sfEMG abnormalities gradually improved over 24 h, corresponding with clinical recovery. Muscle recovery occurred in ascending order. Myotoxicity was not evident, clinically or biochemically, in any of the patients. Patients were extubated a median 96 h post-bite (54-216 h). On discharge, median 8 days (4-12 days) post-bite, patients were clinically normal but had mild sfEMG abnormalities which persisted at 6 wk post-bite. There were no clinical or neurophysiological abnormalities at 6-9 mth. CONCLUSIONS:Common krait envenoming causes rapid onset severe neuromuscular paralysis which takes days to recover clinically consistent with sfEMG. Subclinical neuromuscular dysfunction lasts weeks but was not permanent. Antivenom effectively cleared venom but did not prevent worsening or reverse neuromuscular paralysis. |
| first_indexed | 2024-12-10T13:29:25Z |
| format | Article |
| id | doaj.art-ab96ec886bff4de486be0e96970b5df5 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-12-10T13:29:25Z |
| publishDate | 2016-02-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-ab96ec886bff4de486be0e96970b5df52022-12-22T01:47:02ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352016-02-01102e000436810.1371/journal.pntd.0004368Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka.Anjana SilvaKalana MaduwageMichael SedgwickSenaka PilapitiyaPrasanna WeerawansaNiroshana J DahanayakaNicholas A BuckleyChristopher JohnstonSisira SiribaddanaGeoffrey K IsbisterOBJECTIVE:We aimed to investigate neurophysiological and clinical effects of common krait envenoming, including the time course and treatment response. METHODOLOGY:Patients with definite common krait (Bungarus caeruleus) bites were recruited from a Sri Lankan hospital. All patients had serial neurological examinations and stimulated concentric needle single-fibre electromyography (sfEMG) of orbicularis oculi in hospital at 6 wk and 6-9 mth post-bite. PRINCIPAL FINDINGS:There were 33 patients enrolled (median age 35 y; 24 males). Eight did not develop neurotoxicity and had normal sfEMG. Eight had mild neurotoxicity with ptosis, normal sfEMG; six received antivenom and all recovered within 20-32 h. Seventeen patients developed severe neurotoxicity with rapidly descending paralysis, from ptosis to complete ophthalmoplegia, facial, bulbar and neck weakness. All 17 received Indian polyvalent antivenom a median 3.5 h post-bite (2.8-7.2 h), which cleared unbound venom from blood. Despite this, the paralysis worsened requiring intubation and ventilation within 7 h post-bite. sfEMG showed markedly increased jitter and neuromuscular blocks within 12 h. sfEMG abnormalities gradually improved over 24 h, corresponding with clinical recovery. Muscle recovery occurred in ascending order. Myotoxicity was not evident, clinically or biochemically, in any of the patients. Patients were extubated a median 96 h post-bite (54-216 h). On discharge, median 8 days (4-12 days) post-bite, patients were clinically normal but had mild sfEMG abnormalities which persisted at 6 wk post-bite. There were no clinical or neurophysiological abnormalities at 6-9 mth. CONCLUSIONS:Common krait envenoming causes rapid onset severe neuromuscular paralysis which takes days to recover clinically consistent with sfEMG. Subclinical neuromuscular dysfunction lasts weeks but was not permanent. Antivenom effectively cleared venom but did not prevent worsening or reverse neuromuscular paralysis.http://europepmc.org/articles/PMC4734751?pdf=render |
| spellingShingle | Anjana Silva Kalana Maduwage Michael Sedgwick Senaka Pilapitiya Prasanna Weerawansa Niroshana J Dahanayaka Nicholas A Buckley Christopher Johnston Sisira Siribaddana Geoffrey K Isbister Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka. PLoS Neglected Tropical Diseases |
| title | Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka. |
| title_full | Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka. |
| title_fullStr | Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka. |
| title_full_unstemmed | Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka. |
| title_short | Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka. |
| title_sort | neuromuscular effects of common krait bungarus caeruleus envenoming in sri lanka |
| url | http://europepmc.org/articles/PMC4734751?pdf=render |
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