bites & stings in thailand...bites & stings important venomous snakes in thailand ••...

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Bites & Stings Bites & Stings in in Thailand Thailand Suchai Suteparuk, M.D. Division of Toxicology Chulalongkorn University Suchai Suteparuk, M.D. Suchai Suteparuk, M.D. Division of Toxicology Division of Toxicology Chulalongkorn University Chulalongkorn University

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Page 1: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Bites & Stingsin

Thailand

Bites & StingsBites & Stingsin in

ThailandThailandSuchai Suteparuk, M.D.

Division of Toxicology

Chulalongkorn University

Suchai Suteparuk, M.D.Suchai Suteparuk, M.D.

Division of ToxicologyDivision of Toxicology

Chulalongkorn UniversityChulalongkorn University

Page 2: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

AcknowledgementAcknowledgement

•• This presentation can be reproduced or This presentation can be reproduced or

distributed for academic purposes only.distributed for academic purposes only.

Page 3: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Bites & StingsBites & Stings

•• ReptilesReptiles

•• ArthropodsArthropods

•• Toxic marine Toxic marine creaturescreatures

Page 4: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

SnakebitesSnakebites

•• WorldwideWorldwide

–– 2,500,000 snakebites causing about 125,000 2,500,000 snakebites causing about 125,000

deaths per yeardeaths per year

•• Thailand scenarioThailand scenario

–– most common with about 7,000 cases and 30 most common with about 7,000 cases and 30

deaths annuallydeaths annually

–– peak incidence during Aprilpeak incidence during April--November November

Page 5: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Snake venomsSnake venoms

•• NeurotoxinNeurotoxin

•• CardiotoxinCardiotoxin

•• CytolysinCytolysin

•• MyotoxinMyotoxin

•• ProcoagulantProcoagulant

•• AnticoagulantAnticoagulant

•• HemorrhaginHemorrhagin

•• Platelet Platelet

aggregator/inhibitoraggregator/inhibitor

Page 6: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling
Page 7: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Important Venomous Snakes Important Venomous Snakes in Thailandin Thailand

•• Neurotoxin producing snakesNeurotoxin producing snakes

–– Thai Cobra (Thai Cobra (Naja Naja kaouthiakaouthia),),

Siamese Spitting cobra (Siamese Spitting cobra (Naja Naja siamensissiamensis))

–– King cobra (King cobra (Ophiophagus Ophiophagus hannahhannah))

Page 8: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Cobra (showing hood)

Page 9: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Cobra (showing hoodmarks)

Page 10: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

King cobra

Page 11: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Important Venomous Snakes Important Venomous Snakes in Thailandin Thailand

•• Neurotoxin producing snakesNeurotoxin producing snakes–– Banded krait (Banded krait (Bungarus Bungarus fasciatusfasciatus))

• Central Thailand

–– Malayan krait (Malayan krait (Bungarus Bungarus candiduscandidus))

• Northeastern & Southern Thailand

–– RedRed--headed krait (headed krait (Bungarus Bungarus flavicepsflaviceps))

• Southern Thailand esp in forests

Page 12: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Banded krait

Page 13: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Malayan krait

Page 14: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Red-headed krait

Page 15: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Important Venomous Snakes Important Venomous Snakes in Thailandin Thailand

•• Hematotoxin producing snakesHematotoxin producing snakes

Vipers (Viperinae)Vipers (Viperinae)

–– RussellRussell’’s viper (s viper (DaboiaDaboia russelli russelli siamensissiamensis))

• Central and Eastern Thailand

Page 16: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Important Venomous Snakes Important Venomous Snakes in Thailandin Thailand

•• Hematotoxin producing snakesHematotoxin producing snakes

Pit vipers (Crotalinae)Pit vipers (Crotalinae)

–– Malayan pit viper (Malayan pit viper (Calloselasma Calloselasma rhodostomarhodostoma))

• Eastern & Southern Thailand

–– Green pit vipers (Green pit vipers (Trimeresurus spp.Trimeresurus spp.))

• Bangkok, Central & Eastern Thailand

Page 17: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Russell’s viper

Page 18: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Malayan pit viper

Page 19: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Green pit viper

Page 20: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Green pit viper

Page 21: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Green pit viper

Page 22: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling
Page 23: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Important Venomous Snakes Important Venomous Snakes in Thailandin Thailand

•• MyotoxinMyotoxin

–– Sea snakes (Sea snakes (Hydrophinae Hydrophinae & & LaticudinaeLaticudinae))

Page 24: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Sea snake

Page 25: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Sea snake

Page 26: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Important Venomous Snakes Important Venomous Snakes in Thailandin Thailand

•• RearRear--fanged snakesfanged snakes

–– Mangrove snake Mangrove snake

• Redness, swelling and tenderness

–– Keel back snakeKeel back snake

• Bleeding tendency, sometimes severe

Page 27: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Boiga dendrophila

Page 28: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Wiroj Suksamai (www.siamensis.org/board/8517.html)

Rhabdophis subminiatus

Page 29: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Fang marks

Teeth marks

Page 30: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Neurotoxin: Systemic S & SNeurotoxin: Systemic S & S

•• Neuromuscular junction blockade Neuromuscular junction blockade

–– Muscle paralysis which started from the group of Muscle paralysis which started from the group of

small sized muscles, larger and then generalized small sized muscles, larger and then generalized

paralysisparalysis

Page 31: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Neurotoxin: Systemic S & SNeurotoxin: Systemic S & S

•• Neuromuscular junction blockade Neuromuscular junction blockade

–– ptosisptosis

–– droolingdrooling

–– dysphagiadysphagia ----> aspiration> aspiration

–– respiratory paralysisrespiratory paralysis

–– ggeneralized paralysiseneralized paralysis

Page 32: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Ptosis

Page 33: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

HematotoxinHematotoxin: Systemic S & S: Systemic S & S

•• Vipers Vipers : : thromboplastinthromboplastin--like activity like activity stimulate common stimulate common hemostatichemostatic pathway pathway classical DICclassical DIC–– systemic bleedingsystemic bleeding

–– thrombocytopeniathrombocytopenia

–– acute renal failureacute renal failure

Page 34: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

HematotoxinHematotoxin: Systemic S & S: Systemic S & S

•• Pit vipers Pit vipers : thrombin: thrombin--like activity like activity

stimulate fibrin formation stimulate fibrin formation fibrinogen fibrinogen

depletion depletion defibrinationdefibrination syndromesyndrome

–– systemic bleeding (not severe)systemic bleeding (not severe)

–– thrombocytopenia (direct effect)thrombocytopenia (direct effect)

Page 35: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Local Symptoms & SignsLocal Symptoms & Signs

•• very mild : very mild : BBanded kraitanded krait, M, Malayan alayan kkraitrait, non, non--envenomatedenvenomated bitesbites

•• mild : mild : early cobras, early King cobra, Rearly cobras, early King cobra, Russellussell’’s s viper (RV)viper (RV)

•• inflamed with necrosis : inflamed with necrosis : cobras, Kcobras, King cobraing cobra

Page 36: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Local Symptoms & SignsLocal Symptoms & Signs

•• edemaedema ::Green pit viper (GPV)Green pit viper (GPV)

•• blisters, blisters, ecchymosisecchymosis : : Malayan pit viper Malayan pit viper (MPV), (MPV), GPVGPV

•• Compartment syndrome : Compartment syndrome : MPVMPV

•• Digital ischemia : Digital ischemia : GPVGPV

Page 37: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Necrosis from cobra bite

Page 38: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Necrosis from cobra bite (late)

Page 39: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Edema from GPV

Page 40: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Hemorrhagic and multiple hemorrhagic

blebs from Malayan pit viper bite

Page 41: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Compartment syndrome

Digital ischemia

Page 42: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

DiagnosisDiagnosis

•• Systemic S&SSystemic S&S

•• Local S&SLocal S&S

•• Snake morphology, habitatsSnake morphology, habitats

Page 43: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

LaboratoryLaboratory

•• ImmunodiagnosisImmunodiagnosis & & SerodiagnosisSerodiagnosis are are

available but not ready for clinical practiceavailable but not ready for clinical practice

Page 44: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

LaboratoryLaboratory

•• CBC, platelet count, VCT for CBC, platelet count, VCT for hematotoxinhematotoxin

•• renal function, muscle enzyme, serum renal function, muscle enzyme, serum

electrolytes for electrolytes for myotoxinmyotoxin

Page 45: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Severity AssessmentSeverity Assessment

•• Neurotoxin:Neurotoxin:

–– muscle powermuscle power

–– severity of respiratory failureseverity of respiratory failure

Page 46: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Severity AssessmentSeverity Assessment

Severity Ecchymosis Platelet VCT Systemicbleeding

Mild No Normal Normal No

Moderate Yes Decreased Prolonged No

Severe Yes Decreased > 30 min. Yes

• Hematotoxin

Page 47: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

TreatmentTreatment

•• GeneralGeneral

•• Specific treatmentSpecific treatment

•• AntivenomAntivenom

Page 48: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

General TreatmentGeneral Treatment

•• PrePre--hospitalhospital

–– transfer to medical personnel as soon as possible transfer to medical personnel as soon as possible

with or without snakeswith or without snakes

–– activity limitation & immobilizationactivity limitation & immobilization

–– clean the wound, clean the wound, do notdo not cut, suck, cauterize or cut, suck, cauterize or

apply local remedyapply local remedy

–– tourniquet only if can be done properly ????tourniquet only if can be done properly ????

Page 49: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

General TreatmentGeneral Treatment

•• InIn--hospitalhospital

–– ABCABC’’s & emergency problems treatments & emergency problems treatment

–– reassurereassure

–– rest the bitten parts and raise if swollenrest the bitten parts and raise if swollen

–– adequate hydrationadequate hydration

–– flow sheetflow sheet

Page 50: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

General TreatmentGeneral Treatment

•• InIn--hospitalhospital

–– analgesics: analgesics: no sedationno sedation in cases of neurotoxin, in cases of neurotoxin,

and and no aspirinno aspirin in cases of in cases of hematotoxinhematotoxin

–– appropriate (broad spectrum) antibiotics for appropriate (broad spectrum) antibiotics for

evident local or systemic infectionevident local or systemic infection

–– tetanus prophylaxis (if not contraindicated) tetanus prophylaxis (if not contraindicated)

Page 51: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

AntivenomAntivenom

•• For indicated cases onlyFor indicated cases only

•• No need for skin test (no data to confirm its No need for skin test (no data to confirm its

necessity)necessity)

•• MonovalentMonovalent for Cobras, King cobras, BK, for Cobras, King cobras, BK,

MK, RV, MPV, GPVMK, RV, MPV, GPV

Page 52: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

AntivenomAntivenom

•• Polyvalent available for Polyvalent available for

–– Neurotoxin: Cobra, King cobra & BKNeurotoxin: Cobra, King cobra & BK

–– HematotoxinHematotoxin: RV, MPV, GPV: RV, MPV, GPV

Page 53: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

ArthropodsArthropods

•• Hymenoptera (Bees and wasps)Hymenoptera (Bees and wasps)

–– localized and extended edema from stingslocalized and extended edema from stings

–– anaphylaxis from bee stingsanaphylaxis from bee stings

–– angioedemaangioedema from multiple bee stingsfrom multiple bee stings

Page 54: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

ArthropodsArthropods

•• WaspsWasps

–– multiple wasp stings can cause hemolytic anemia, multiple wasp stings can cause hemolytic anemia,

thrombocytopenia, DIC, acute renal failure, thrombocytopenia, DIC, acute renal failure,

rhabdomyolysis and nonrhabdomyolysis and non--cardiogeniccardiogenic pulmonary pulmonary

edemaedema

Page 55: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Bees

Page 56: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Wasp

Page 57: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Bee sting lesion

Page 58: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Wasp sting lesions

Page 59: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

ArthropodsArthropods

•• Hymenoptera Treatment Hymenoptera Treatment –– Supportive careSupportive care

• analgesics

• antihistamines

–– In severe casesIn severe cases

• treat hypersensitivity

• vasopressor if needed

• steroid (controversy)

Page 60: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

ArthropodsArthropods

•• Scorpions, spiders, centipedes and Scorpions, spiders, centipedes and

millipedesmillipedes

–– localized and extended edemalocalized and extended edema

–– painpain

–– systemic effects are rare for species found in systemic effects are rare for species found in

ThailandThailand

Page 61: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Scorpion

Page 62: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Centipede

Page 63: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Spider

Page 64: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Toxic marine lifeToxic marine life

•• Thailand scenarioThailand scenario

–– seasonal, sporadic, small outbreaksseasonal, sporadic, small outbreaks

Page 65: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling
Page 66: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

Page 67: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

TetrodotoxinTetrodotoxin

•• Puffer fish (Puffer fish (LagocephalusLagocephalus spp.spp.))

•• Asiatic horseshoe crab (Asiatic horseshoe crab (CarcinoscorpiusCarcinoscorpius

rotundicaudarotundicauda))

Page 68: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

TetrodotoxinTetrodotoxin

•• BlueBlue--ringed octopus (ringed octopus (HapalochlaenaHapalochlaena sppspp))

–– bitebite

–– very low incidencevery low incidence

Page 69: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling
Page 70: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Dept of Medicine, Chulalongkorn Uviv

Bites & Stings

TetrodotoxinTetrodotoxin

•• Neuromuscular junction blockadeNeuromuscular junction blockade

•• generalized paralysis generalized paralysis respiratory failurerespiratory failure

Page 71: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

Conus spp

Page 72: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling
Page 73: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling
Page 74: Bites & Stings in Thailand...Bites & Stings Important Venomous Snakes in Thailand •• RearRear--fanged snakesfanged snakes –– Mangrove snake Mangrove snake • Redness, swelling

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