- Email: [email protected]
182. Two Case Studies of Pregnancy Outcomes after Scorpion Envenomation and F(ab')2 Scorpion Antivenom Treatment
Abstracts Toxins 2012 / Toxicon 60 (2012) 95–248
antivenom persists for greater than 4 hours in North Africa and in North America. Recent clinical trials in North America indicate that severe Centruroides envenomation resolves within 4 hours when promptly treated with effective antivenom. Taken together, these findings suggest that the four-hour endpoint in a similar population could be used to test efficacy of an antivenom specific to North African species. Keywords: scorpions, pediatrics, endpoint determination 10.1016/j.toxicon.2012.04.182
182. Two Case Studies of Pregnancy Outcomes after Scorpion Envenomation and F(ab')2 Scorpion Antivenom Treatment Joanne M. Mallie 1, Sue Hoopmann 1, 2, Janice A. Degan 1, Leslie V. Boyer 1 1
VIPER INSTITUTE, University of Arizona, Tucson, AZ, USA Chandler Regional Medical Center, Chandler, AZ, USA E-mail address: [email protected] (J.M. Mallie).
189
derivatives. Neither of the patients in this series had signs suggestive of type 1 or 3 hypersensitivity; and the rapid resolution of systemic signs in both cases suggests that antivenom use in systemic envenomation was likely more beneficial than harmful. Conclusions: Envenomated patients of childbearing potential should be counseled as to risks and benefits prior to the administration of antivenom. The use of antivenom in many cases is likely to be a safer choice than supportive care alone, but more evidence will be necessary before final conclusions can be made. Keywords: envenomation, pregnancy, antivenom 10.1016/j.toxicon.2012.04.183
183. Development of Immune Sera Against Algerian Scorpion Venoms: Which Antibodies for Envenoming Treatment in Regions At-Risk?
2
Background: The effects of venom and antivenom exposure during Case pregnancy have not been well studied. Clinical trials of scorpion antivenom recently included two pregnant women. Case Studies: Between 2005 and 2011, 1970 patients with presumed Centruroides envenomation were enrolled and treated with an F(ab')2 scorpion antivenom in a multicenter treatment protocol in Arizona, USA. Afterinformed consent, subjects received 3-5 vials of AnascorpÒ, intravenous. Out of 1970 cases, 2 were eventually recognized as having been pregnant at the time of study enrollment. Case 1 involved a 28-year-old woman presenting at 8 weeks’ gestation with nystagmus, tongue fasciculations and limb paresthesias. Aware that she was pregnant, medical staff reviewed the potential risks and benefits of antivenom treatment with her before deciding to proceed in order to minimize the risk of envenomation itself. She received a total of 4 vials of antivenom, and her signs and symptoms resolved 70 minutes after study enrollment. At term she had a normal labor resulting in delivery of a healthy 9-lb boy. Case 2 was a 23-year-old woman who was unaware of pregnancy at the time of the scorpion sting. She presented with nystagmus, tongue fasciculations, chest heaviness, and limb paresthesias. She received lorazepam, morphine and 3 vials of antivenom, with complete resolution of her symptoms in less than 2 hours. One week later, she discovered that she was pregnant; and she had a spontaneous abortion approximately 22 days following the scorpion sting. Discussion: Cause and effect cannot be proven by case description alone. It is clear that good pregnancy outcome is possible with first trimester scorpion sting and F(ab’)2 antivenom treatment; although pregnancy loss following envenomation and treatment for scorpion sting (here) or snakebite (Langley, 2010) is also a consideration. Fetal loss as in Case 2 could result from unrelated causes; from venom interaction with maternal circulation, placenta or fetus; or perhaps from exposure to equine serum
Amina Ladjel-Mendil 1, 2, Sonia Adi-Bessalem 1, 2, Djelila Hammoudi-Triki 1, 2, Fatima Laraba-Djebari 1, 2 1 University of Sciences and Technology “Houari Boumediene”, Laboratory of Cellular and Molecular Biology, Faculty Biological Sciences, Algiers, Algeria 2 Laboratoire de Recherche et de Développement sur les Venins, Route du Petit Staouéli, Algiers, Algeria E-mail address: fl[email protected] (F. Laraba-Djebari).
Background: The number of dangerous scorpion species (Androctonus australis: Hector: Aah, Androctonus ammourexi: Amx and Buthus occitanus tunetanus: Bot) raging in some regions At-Risk in the Maghreb remains a real concern for the immune serum producers. The use of one or a mixture of antigens is still subject of controversy. In this order to propose an efficient immune serum three preparations were undertaken, mono-, bi- and tri-valent were tested. Methods: The efficiency of tri-valent sera was compared to that of bi-valent and mono-valent one. Their effects on induced tissue damage and inflammatory response were evaluated Results: Administration of tri-valent immune sera at 30 min after envenomation, to animals injected with the Aah or Amx or Bot venom neutralized tissue damage (hemorrhage, edema, leukocyte infiltration) in myocardial tissue and hepatic parenchyma. Administration of these antibody treatments also reduced the metabolical perturbations (CPK, LDH, AST, ALT, urea, creatinine and cholesterol) and blood leukocytosis. However, hyperneutrophilia and eosinophilia induced by the venoms were not significantly affected by the antibody treatments. These results showed also the similar efficiency of these three preparations against Aah venom, however, the tri-valent preparation presents a significant neutralizing effect than the mono-valent serum when Amx or Bot venom used for the envenomation. These results are very competitive with those obtained by the already standardized mono-valent immunotherapy. Discussion: Administration of tri-valent antibodies may thus be beneficial in counteracting the whole pathophysiological effects induced by scorpion venoms. The efficiency of this treatment could be due to the neutralization effects of F(ab’)2 fragments on circulating of the three venoms.
antivenom persists for greater than 4 hours in North Africa and in North America. Recent clinical trials in North America indicate that severe Centruroides envenomation resolves within 4 hours when promptly treated with effective antivenom. Taken together, these findings suggest that the four-hour endpoint in a similar population could be used to test efficacy of an antivenom specific to North African species. Keywords: scorpions, pediatrics, endpoint determination 10.1016/j.toxicon.2012.04.182
182. Two Case Studies of Pregnancy Outcomes after Scorpion Envenomation and F(ab')2 Scorpion Antivenom Treatment Joanne M. Mallie 1, Sue Hoopmann 1, 2, Janice A. Degan 1, Leslie V. Boyer 1 1
VIPER INSTITUTE, University of Arizona, Tucson, AZ, USA Chandler Regional Medical Center, Chandler, AZ, USA E-mail address: [email protected] (J.M. Mallie).
189
derivatives. Neither of the patients in this series had signs suggestive of type 1 or 3 hypersensitivity; and the rapid resolution of systemic signs in both cases suggests that antivenom use in systemic envenomation was likely more beneficial than harmful. Conclusions: Envenomated patients of childbearing potential should be counseled as to risks and benefits prior to the administration of antivenom. The use of antivenom in many cases is likely to be a safer choice than supportive care alone, but more evidence will be necessary before final conclusions can be made. Keywords: envenomation, pregnancy, antivenom 10.1016/j.toxicon.2012.04.183
183. Development of Immune Sera Against Algerian Scorpion Venoms: Which Antibodies for Envenoming Treatment in Regions At-Risk?
2
Background: The effects of venom and antivenom exposure during Case pregnancy have not been well studied. Clinical trials of scorpion antivenom recently included two pregnant women. Case Studies: Between 2005 and 2011, 1970 patients with presumed Centruroides envenomation were enrolled and treated with an F(ab')2 scorpion antivenom in a multicenter treatment protocol in Arizona, USA. Afterinformed consent, subjects received 3-5 vials of AnascorpÒ, intravenous. Out of 1970 cases, 2 were eventually recognized as having been pregnant at the time of study enrollment. Case 1 involved a 28-year-old woman presenting at 8 weeks’ gestation with nystagmus, tongue fasciculations and limb paresthesias. Aware that she was pregnant, medical staff reviewed the potential risks and benefits of antivenom treatment with her before deciding to proceed in order to minimize the risk of envenomation itself. She received a total of 4 vials of antivenom, and her signs and symptoms resolved 70 minutes after study enrollment. At term she had a normal labor resulting in delivery of a healthy 9-lb boy. Case 2 was a 23-year-old woman who was unaware of pregnancy at the time of the scorpion sting. She presented with nystagmus, tongue fasciculations, chest heaviness, and limb paresthesias. She received lorazepam, morphine and 3 vials of antivenom, with complete resolution of her symptoms in less than 2 hours. One week later, she discovered that she was pregnant; and she had a spontaneous abortion approximately 22 days following the scorpion sting. Discussion: Cause and effect cannot be proven by case description alone. It is clear that good pregnancy outcome is possible with first trimester scorpion sting and F(ab’)2 antivenom treatment; although pregnancy loss following envenomation and treatment for scorpion sting (here) or snakebite (Langley, 2010) is also a consideration. Fetal loss as in Case 2 could result from unrelated causes; from venom interaction with maternal circulation, placenta or fetus; or perhaps from exposure to equine serum
Amina Ladjel-Mendil 1, 2, Sonia Adi-Bessalem 1, 2, Djelila Hammoudi-Triki 1, 2, Fatima Laraba-Djebari 1, 2 1 University of Sciences and Technology “Houari Boumediene”, Laboratory of Cellular and Molecular Biology, Faculty Biological Sciences, Algiers, Algeria 2 Laboratoire de Recherche et de Développement sur les Venins, Route du Petit Staouéli, Algiers, Algeria E-mail address: fl[email protected] (F. Laraba-Djebari).
Background: The number of dangerous scorpion species (Androctonus australis: Hector: Aah, Androctonus ammourexi: Amx and Buthus occitanus tunetanus: Bot) raging in some regions At-Risk in the Maghreb remains a real concern for the immune serum producers. The use of one or a mixture of antigens is still subject of controversy. In this order to propose an efficient immune serum three preparations were undertaken, mono-, bi- and tri-valent were tested. Methods: The efficiency of tri-valent sera was compared to that of bi-valent and mono-valent one. Their effects on induced tissue damage and inflammatory response were evaluated Results: Administration of tri-valent immune sera at 30 min after envenomation, to animals injected with the Aah or Amx or Bot venom neutralized tissue damage (hemorrhage, edema, leukocyte infiltration) in myocardial tissue and hepatic parenchyma. Administration of these antibody treatments also reduced the metabolical perturbations (CPK, LDH, AST, ALT, urea, creatinine and cholesterol) and blood leukocytosis. However, hyperneutrophilia and eosinophilia induced by the venoms were not significantly affected by the antibody treatments. These results showed also the similar efficiency of these three preparations against Aah venom, however, the tri-valent preparation presents a significant neutralizing effect than the mono-valent serum when Amx or Bot venom used for the envenomation. These results are very competitive with those obtained by the already standardized mono-valent immunotherapy. Discussion: Administration of tri-valent antibodies may thus be beneficial in counteracting the whole pathophysiological effects induced by scorpion venoms. The efficiency of this treatment could be due to the neutralization effects of F(ab’)2 fragments on circulating of the three venoms.