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ABSTRACT: Heparin, which was widely used thirty years ago for the treatment of viper envenomations, is now contra-indicated during the acute phase, which is at risk for hemorrhage and death. We report a case of pulmonary embolism, a rare situation in the context of viper envenomation. By means of this case report, we want to discuss the pathophysiological links between envenomation and thromboembolic disease, and on the other hand, the potential heparin usefulness, not during the acute, hemorrhagic phase, but as a prophylactic treatment when hemorrhagic risk has been replaced by an inflammatory syndrome, with increased fibrinogen and platelets which are then prothrombotic factors.
Bulletin de la Société de pathologie exotique 06/2012; 105(3):162-5.
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ABSTRACT: An ischaemic stroke is a rare complication of viper envenomation that is due to multifactorial pathophysiological mechanisms. The authors describe the case of a 55-year-old patient bitten by the viper Cerastes cerastes. The patient was admitted to the intensive care unit with multiple organ failure, disseminated intravascular coagulopathy, rhabdomyolysis, anuria and elevated troponin level. The persistent disturbance of consciousness has motivated a brain scan which has revealed a bifocal ischemic stroke. The complex venom of the species C. cerastes may induce hypotension, tissue necrosis, acute renal failure, bleeding disorders or DIC. With the cessation of a non-indicated heparintherapy and haemodialysis, the patient recovered in a few weeks despite the initial infusion of an unsuitable antivenom due to the late identification of the reptile. The preventive treatment of the complications of this envenomation is based on the infusion of the polyvalent antivenom Favirept(®).
Annales francaises d'anesthesie et de reanimation 12/2011; 31(1):82-5. · 0.77 Impact Factor
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ABSTRACT: The purpose of this report is to describe the case of a 28-year-old woman in whom acute respiratory distress syndrome (ARDS) following cholecystectomy led to the discovery of eosinophilic lung disease. Outcome was favorable after oxygenotherapy and medical treatment using ivermectin and corticosteroids. The case shows that hypereosinophilic syndrome can be the underlying cause of ARDS.
Médecine tropicale: revue du Corps de santé colonial 04/2011; 71(2):181-2.
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ABSTRACT: Snake bites are responsible for a high mortality rate in Africa. Problems for the early care of the victims are many. We published three observations of Moroccan typical viperin severe envenomings (rapidly extensive edema, necrosis, haemorrhagic shock) are presented. The overall mortality of those bites is 4%. In the Maghreb, viperin syndromes are the result of the lebetin viper (Vipera lebetina), the horned viper or sand viper (Cerastes cerastes), sometimes Bitis or Echis sp. Immunotherapy remains effective against haemorrhage, even when administered late, in severe disease (bleeding). Death remains inevitable if antivenin is not being administered or if it is at the stage of multiorgan failure. Heparin is contra-indicated in the acute context, but at distance from the bite, the persistence of inflammatory syndrome can cause phlebitis or pulmonary embolism. Fresh frozen plasma and corticosteroids are ineffective and unnecessary. Signs of gravity are rapidly extensive swelling and systemic manifestations, particularly bleeding. The severity of poisoning is related to the difficulties of access to health centers, the use of traditional medicine for more than half of the victims, the lack of training of caregivers, finally and most importantly, the lack of antivenomous serum,that is not within reach of prescribing at the appropriate places and times. Despite its cost and allergic risk (become rare with the current serums), immunotherapy which is the only weapon effective against the venom, should be part of emergency essential drugs.
Annales francaises d'anesthesie et de reanimation 05/2008; 27(4):330-4. · 0.77 Impact Factor
