Gefahren durch Gifttiere - Unfälle mit Giftschlangen

Zusammenfassung

In den Verbreitungsgebieten von Gifttieren ist die Versorgung der Verletzungen durch diese ein Teil des klinischen Alltags der medizinischen Versorgungseinrichtungen. Für in diesen Gegenden exponiertes Personal während z. B. Hilfseinsätzen sollten ebenfalls Vorkehrungen für das Management solcher Verletzungen getroffen werden. Außerhalb dieser Gebiete sind Zoopersonal und Terrarienbesitzer gefährdet. Die weitaus meisten Verletzungen werden durch Giftschlangen verursacht, die mit ca. 600 giftigen Arten insbesondere in den warmen Klimazonen verbreitet sind. Aber auch Vergiftungen durch Spinnen, Skorpione und giftige Seetiere können lebensbedrohlich sein. Schlangengifte bestehen aus einer Vielzahl von Einzelkomponenten, die speziesabhängig ein breites Spektrum von unterschiedlichen Gifteffekten und damit ein buntes klinisches Bild erzeugen können. Es werden lokal-proteolytische, autopharmakologische, hämatologische, neurologische, muskuläre, kardiale und renale Gifteffekte unterschieden. Beim Management von Gifttierverletzungen sind, abhängig von der Hauptgiftwirkung und neben den Ersthelfermaßnahmen, supportive Therapiemaßnahmen und spezifische Antiveninbehandlungen differenziert anzuwenden. Mono- und polyvalente Antivenine stehen zur Verfügung. Nicht wirksame oder schädigende Erste-Hilfe-Maßnahmen müssen vermieden werden. Durch angepasstes Verhalten lassen sich Gifttierverletzungen in aller Regel vermeiden. Aufklärung und Maßnahmen zur Verhaltenssteuerung gehören zu den zentralen Präventionsmaßnahmen vor dem Einsatz in Verbreitungsgebieten von Gifttieren.

Abstract

In regions where poisonous animals are widely distributed, the management of injuries due to these animals is part of the routine medical care. Personnel e. g. deployed for humanitarian aid missions in these areas have to be prepared to face these challenges as well. Beside this group zoo personnel and snake charmers here in Europe are also endangered. The most common form of animal poisoning is due to snake bites. There are approximately 600 different species of poisonous snakes, commonly found in the warm climatic regions. But poisoning from spiders, scorpions and some marine animals can also be life threatening. There are different kinds of snake venoms, which result into different clinical presentations depending on the components of the venom. The venom may be cytotoxic, hematotoxic, neurotoxic, rhabdomyolytic, cardiotoxic, renotoxic or may cause an autoimmune reaction by complement activation. In the management of injuries following animal poisoning, besides the first aid measures taken, the injured is supposed to be managed according to the poison component in the venom with specific antivenin treatment and supportive therapeutic care. There are mono- and polyvalent antivenins available. Noneffective first-aid measures or measures which can cause further trauma must always be avoided. In general adapted behaviour in the field can prevent envenomation. Education on preventive measures with the aim of behaviour change are central components for pre-deployment preparations.

Gifttiere - Giftschlangen - Gifteffekte - Antivenin - Kompressions-Immobilisations-Verband

Venomous animals - venomous snakes - snake envenomation - antivenom - toxinology - compression-immobilisation method

Literatur

• 1 Chippaux J P, Kambewasso A. Snake bites and antivenom availability in the urban community of Niamey, Niger.  Bull Soc Pathol Exot. 2002;  95 181-183
• 2 Chippaux J P, Rage-Andrieux V, Le M ener-Delore, Charrondiere M, Sagot P, Lang J. Epidemiology of snake envenomation in Gabon.  Bull Soc Pahtol Exot. 2002;  95 184-187
• 3 Warrell D A. Injuries, envenoming, poisoning and allergic reactions caused by animals. In: Wealtherall DJ, Ledingham JGG, Warrell DA (eds) Oxford Textbook of Medicine. 2nd edn. Oxford; Oxford University Press 1987: 6.66-6.77
• 4 Amitai Y, Mines Y, Aker M, Goitein K. Scorpion sting in children. A review of 51 cases.  Clin Pediatr (Phila.). 1985;  24 136-40
• 5 Scorpion envenomation in children: Should all stings be given antivenom?: http://www.kfshrc.edu.sa/annals/195/98 - 189.html. 
• 6 Chippaux J P. Snake-bites: appraisal of the global situation. Bull.  World Health Organ. 1998;  76 515-524
• 7 Swarrop S, Grab B. Snake bite mortality in the world.  Bull WHO. 1954;  10 35-76
• 8 The clinical management of snake bites in the South East Asian Region: http://w3.whosea.org/bct/snake/2introB.htm. 
• 9 Myanmar-Looking at health care: http://www.settlement.org/cp/english/myanmar/health.html. 
• 10 Langley R L, Morrow W E. Deaths resulting from animal attacks in the United States.  Wilderness Environ Med. 1997;  8 8-16
• 11 Gold B S, Dart R C, Barish R A. Bites of venomous snakes.  N Engl J Med. 2002;  347 347-356
• 12 Habermehl G G. 7 Reptilia (Kriechtiere). In: Habermehl GG (Hrsg) Gift-Tiere und ihre Waffen. Berlin; Springer-Verlag 1994: 147
• 13 Korthals Altes M, Zilker T R. Klinisches Bild und Behandlung von Giftschlangenbissen.  Der Notarzt. 1998;  14 10-15
• 14 Matthew J L, Gera T. Ophitoxaemia (Venomous snake bite). Medicine-online, 2000; http://www.priory.com/med/ophitoxaemia.htm. 
• 15 Nelson B K. Snake envenomation. Incidence, clinical presentation and management.  Med Toxicol Adverse Drug Exp. 1989;  4 26-27
• 16 Stocker K, Meier J. Schlangengiftproteine in der Hämostaseologie: Neue Erkenntnisse.  Folia Haematol. 1989;  116 935-953
• 17 Norris R. Snake venom poisoning in the United States: A medical emergency! http://www.stanford.edu/group/em/documents/Didactics/snakebites.htm. 
• 18 Flank L. Snakebite: If you flub up; http://www.geocities.com/lflank/bite.html. 
• 19 Mebs D. Giftschlangen: Seeschlangen. In: Mebs D (Hrsg) Gifttiere. Stuttgart; Wiss. Verl.-Ges. 2000: 324
• 20 Strong J L, Hunter K S, Enderson B L. Emergency Medicine: A comprehensive study guide. New York; McGraw-Hill 1996:
• 21 Litovitz T L, Klein-Schwartz W, White S, Cobaugh D J, Youniss J, Drab A, Benson B E. 1999 Annual report of American Association of Poison Control Centers Toxic Exposure Surveillance System.  Am J Emerg Med. 2000;  18 517-574
• 22 Otten E J, McKimm D. Venomous snakebites in a patient allergic to horse serum.  Ann Emerg Med. 1983;  12 624-627
• 23 Saini R K, Sharma S, Singh S, Pathania N S. Snake bite poisoning: A preliminary report.  J Assoc Phys India. 1984;  32 195-197
• 24 Girish K S, Jagadeesha D K, Rajeev K B, Kemparaju K. Snake venom hyaluronidase: an evidence für isoforms and extracellular matrix degradation.  Mol Cell Biochem. 2002;  240 105-110
• 25 Warrell D A, Ormerod L D. Snake venom ophthalmia and blindness caused by the spitting cobra (Naja nigricollis) in Nigeria.  Am J Trop Med Hyg. 1976;  25 525-529
• 26 Gruntzig J. Spitting cobra ophthalmia (Naja nigricollis).  Klin Monatsbl Augenheilkd. 1984;  185 527-530
• 27 Junghanns T, Bodio M. Notfall-Handbuch Gifttiere: Diagnose - Therapie - Biologie. Junghanns T (Hrsg) Stuttgart; Thieme-Verlag 1996:
• 28 Mirtschin P J. Fatal cerebral haemorrhage after snake bite.  Med J Aust. 1991;  155 850-851
• 29 Curry S C, Kunkel D B. Death from a rattlesnake bite.  Am J Emerg Med. 1985;  3 227-235
• 30 Aung-Khin M. The problem of snake bites in Burma.  Snake. 1980;  12 125-127
• 31 Reid H A, Theakston R DG. The management of snake bites.  Bull WHO. 1983;  63 885-895
• 32 Watt C J, Cennaro J F. Pit vipers in south Georgia and north Florida.  Trans Southern Surg Assoc. 1966;  77 348
• 33 Homma M, Tu A T. Morphology of local tissue damage in experimental snake envenomation.  Br J Exp Pathol. 1971;  52 538
• 34 Souza A RB, Muniz E G. Jararacas e Acidentes Ofídicos no Brasil: Fundação de Medicina Tropical - FMT/IMT - AM. Monographie. 2000:
• 35 Yamamoto C, Tsuru D, Oda-Ueda N, Ohno M, Hattori S, Kim S T. Trimeresurus flavoviridis (habu snake) venom induces human erythrocyte lysis through enzymatic lipolysis, complement activation and decreased membrande expression of CD55 and CD59.  Pharmacol Toxicol. 2001;  89 188-194
• 36 Gillissen A, Theakston R D, Barth J, May B, Krieg M, Warrell D A. Neurotoxicity, haemostatic disturbances and haemolytic anaemia after a bite by a Tunisian saw-scaled or carpet viper (Echis ”pyramidum”-complex): failure of antivenom treatment.  Toxicon. 1994;  32 937-944
• 37 Paul V K. Animal and insect bites. In: Singh N (Ed) Medical emergencies in children. 2nd ed. New Dehli; Sagar Publications 1993:
• 38 Ramsey P A, Klickstein G D. Coral snake bite.  J Amer Med Ass. 1962;  182 151-153
• 39 Mc Collough N C, Gennaro J F. Coral snake bites in the United States.  J Fla Med Ass. 1963;  49 968-972
• 40 Heatwole H. Seasnakes. Kensington; NSW Univ. Press 1987:
• 41 Szold O, Ben-Abraham R, Frolkis I, Sorkine M, Sorkine P. Tumor necrosis factor as a mediator of cardiac toxicity following snake envenomation.  Crit Care Med. 2003;  31 1449-1453
• 42 Marsh N A, Whaler B C. The Gaboon viper (Bitis gabonica): its biology, venom components and toxinology.  Toxicon. 1984;  22 669-694
• 43 Huang W N, Sue S C, Wang D S, Wu P L, Wu W G. Peripheral binding mode and penetration depth of cobra cardiotoxin on phospholipid membranes as studied by a combined FTIR and computer simulation approach.  Biochemistry. 2003;  42 7457-7466
• 44 Dubovskii P V, Lesovoy D M, Dubinnyi M A, Utkin Y N, Arseniev A S. Interaction of the p-type cardiotoxin with phospholipid membranes.  Eur J Biochem. 2003;  270 2038-2046
• 45 Zhang H L, Xu S J, Wang Q Y, Song S Y, Shu Y Y, Lin Z J. Structure of a cardiotoxic phospholipase A (2) from Ophiophagus hannah with the „pancreatic loop”.  J Struct Biol. 2002;  138 207-215
• 46 Seedat Y K, Reddy J, Edington A. Acute renal failure due to proliferative nephritis from snake bite poisoning.  Nephron. 1974;  13 455-463
• 47 Gundappa R K, Sud K, Kohli H S, Jha V, Gupta K L, Joshi K, Sakhuja V. Snakebite induced acute interstitial nephritis: report of a rare entity.  Ren Fail. 2002;  24 369-372
• 48 White J, Warrell D, Eddleston M, Currie B J, Whyte I M, Isbister G K. Clinical toxinology - where are we now?.  J Toxicol Clin Toxicol. 2003;  41 263-276
• 49 Vijeth S R, Dutta T K, Shahapurkar J. Correlation of renal status with hematologic profile in viperine bite.  Am J Trop Med Hyg. 1997;  56 168-170
• 50 Chugh K S, Singhal P C, Kher V K, Gupta V K, Malik G H, Narayan G, Datta B N. Spectrum of acute cortical necrosis in Indian patients.  Am J Med Sci. 1983;  286 10-20
• 51 Chugh K S, Aikat B K, Sharma B K, Dash S C, Mathew M T, Das K C. Acute renal failure following snakebite.  Am J Trop Med Hyg. 1975;  24 692-697
• 52 Sitprija V, Boonpucknavig V. Extracapillary proliferative glomerulonephritis in Russell's viper bite.  Brit Med J. 1980;  280 1417
• 53 Ratcliffe P J, Pukrittayakamee S, Ledingham J GG, Warrell D A. Direct nephrotoxicity of Russell's viper venom demonstrated in the isolated perfused rat kidney.  Am J Trop Med Hyg. 1989;  40 312-319
• 54 Reid H A. Venomous bites and stings. In: Black JA (Ed) Paediatric Emergencies. London; Butterworths 1979:
• 55 Sutherland S K. Treatment of snake bite.  Aust Fam Physician. 1990;  19 24-42
• 56 Lo Vecchio F, DeBus D M. Snakebite envenomation in children: a 10-year retrospective review.  Wilderness Environ Med. 2001;  12 184-189
• 57 Pochanugool C, Wildde H, Bhanganada K, Chanhome L, Cox M J, Chaiyabutr N, Sitprija V. Venomous snakebite in Thailand. II: Clinical experience.  Mil Med. 1998;  163 318-323
• 58 Mattingly J, Bosse G. Snake bite in the State of Kentucky, 3/2001; http://www.krpc.com/proffed/snake%5Csnakebite.cfm. 
• 59 Russell F E. Snake venom poisoning.  Vet Hum Toxicol. 1991;  33 584-586
• 60 Sutherland S K, Coulter A R, Harris R D. Rationalisation of first-aid measures for elapid snakebite.  Lancet. 1979;  1 183-185
• 61 Amaral C F, Campolina D, Dias M B, Bueno C M, Rezende N A. Tourniquet ineffectiveness to reduce the severity of envenoming after Crotalus durissus snake bite in Belo Horizonte, Minas Gerais, Brazil.  Toxicon. 1998;  36 805-808
• 62 Hung D Z, Liau M Y, Lin-Shiau S Y. The clinical significance of venom detection in patients with cobra snakebite.  Toxicon. 2003;  41 409-415
• 63 Maya D C, Vasantha B M, Krishnan L K. Development of viper-venom antibodies in chicken egg yolk and assay of their antigen binding capacitiy.  Toxicon. 2002;  40 857-861
• 64 Shaw B A, Hosalkar H S. Rattlesnake bites in children: antivenin treatment and surgical indications.  Bone Joint Surg Am. 2002;  84-A (9) 1624-1629
• 65 Bhat R N. Viperine snake bite poisoning in Jammu.  J Indian Med Ass. 1974;  63 383-392
• 66 Wetzel W W, Christy N P. A king cobra bite in New York city.  Toxicon. 1989;  27 393-395
• 67 Sawai Y. Study on deaths due to snakebite in Anuradhapura District, Sri Lanka.  Snake. 1984;  16 7-15
• 68 Burgess J L, Dat B V. Snake venom coagulopathy: Use and abuse of blood products in the treatment of pit viper envenomation.  Ann Emerg Med. 1991;  20 79-801