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Open Access Research

Use of antivenoms for the treatment of envenomation by Elapidae snakes in Guinea, Sub-Saharan Africa

Mamadou C Baldé1, Jean-Philippe Chippaux23*, Mamadou Y Boiro1, Roberto P Stock4 and Achille Massougbodji3

Author Affiliations

1 Institut Pasteur de Guinée, Kindia, Guinée

2 Institut de Recherche pour le Développement, Cotonou, Bénin

3 Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Bénin

4 Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México

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Journal of Venomous Animals and Toxins including Tropical Diseases 2013, 19:6  doi:10.1186/1678-9199-19-6

Published: 28 March 2013

Abstract

Background

In Guinea Elapids are responsible for 20% of envenomations. The associated case fatality rate (CFR) ranged 15-27%, irrespective of treatment.

Results

We studied 77 neurotoxic envenomations divided in 3 groups: a set of patients that received only traditional or symptomatic treatments, and two other groups that received either 2 or 4 initial vials of Antivipmyn® Africa renewed as necessary. CFR was 27.3%, 15.4% and 17.6%, respectively. Although antivenom treatment was likely to reduce CFR, it didn’t seem to have an obvious clinical benefit for the patients, suggesting a low treatment efficacy. Mean delay to treatment or clinical stages were not significantly different between the patients who recovered and the patients who died, or between groups. Interpretation of these results is complicated by the lack of systematic studies under comparable conditions. Of particular importance is the absence of assisted ventilation, available to patients in all the other clinical studies of neurotoxic envenomation.

Conclusion

The apparent lack of clinical benefit may have several causes. The hypothesis of a limited therapeutic window, i.e. an insufficient formation of antigen-antibody complexes once toxins are bound to their targets and/or distributed beyond the reach of antivenom, should be explored.

Keywords:
Elapid; Neurotoxins; Treatment; Antivenom; Guinea; Africa