The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review

Mark Aalten; Carsten F J Bakhuis; Ilias Asaggau; Maaike Wulfse; Maurits F van Binsbergen; Eran R A N Arntz; Max F Troenokarso; Jashvin L R Oediet Doebe; Ubah Mahamuud; Leila Belbachir; Myrthe Meurs; Nastya A Kovalenko; Marcel A G van der Heyden

doi:10.1080/15563650.2021.1943427

The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review

Mark Aalten, Carsten F J Bakhuis, Ilias Asaggau, Maaike Wulfse, Maurits F van Binsbergen, Eran R A N Arntz, Max F Troenokarso, Jashvin L R Oediet Doebe, Ubah Mahamuud, Leila Belbachir, Myrthe Meurs, Nastya A Kovalenko, Marcel A G van der Heyden

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Abstract

CONTEXT: The black mamba (Dendroaspis polylepis) is, due to its extremely toxic venom, one of the most dangerous snake species in Sub-Saharan Africa. A D. polylepis bite is a medical emergency and requires adequate action to prevent severe complications. However, there are no comprehensive reviews available based on clinical cases, and no readily accessible guidelines for standardized treatment. Therefore, we aim to provide an overview regarding the currently available clinical literature on D. polylepis envenomations; in order to promote knowledge on symptomatology and treatment options.

METHODS: We searched for cases reporting humans bitten by D. polylepis in PubMed, Embase, Scopus, and Sabinet. We searched the reference lists of all eligible articles for additional articles. After quality assessment, 29 cases were included in this review. We used descriptive analysis to create an overview of the collected parameters.

DISCUSSION: Among the included case reports and case series, D. polylepis envenomations most frequently resulted in decreased respiratory function, sweating and paralysis. The onset of symptoms usually occurred within 60 minutes. Neurological symptoms occurred more often than symptoms of autonomic dysfunction. In the reported cases most patients (26/29) received antivenom and most survived (25/29). We recommend the reporting of additional structured case reports to improve future analyses on the clinical course of envenomations, in order to improve public health response to D. polylepis envenomations.

Original language	English
Pages (from-to)	860-868
Number of pages	9
Journal	Clinical Toxicology
Volume	59
Issue number	10
DOIs	https://doi.org/10.1080/15563650.2021.1943427
Publication status	Published - Oct 2021

Keywords

Black mamba
Dendroaspis
Dendroaspis polylepis
antivenins
envenomation
snake bites
symptoms
treatment

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10.1080/15563650.2021.1943427Licence: CC BY-NC-ND

The clinical course and treatment of black mamba Dendroaspis polylepis envenomations a narrative reviewFinal published version, 1.39 MBLicence: CC BY-NC-ND

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Aalten, M., Bakhuis, C. F. J., Asaggau, I., Wulfse, M., van Binsbergen, M. F., Arntz, E. R. A. N., Troenokarso, M. F., Oediet Doebe, J. L. R., Mahamuud, U., Belbachir, L., Meurs, M., Kovalenko, N. A., & van der Heyden, M. A. G. (2021). The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review. Clinical Toxicology , 59(10), 860-868. https://doi.org/10.1080/15563650.2021.1943427

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title = "The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review",

abstract = "CONTEXT: The black mamba (Dendroaspis polylepis) is, due to its extremely toxic venom, one of the most dangerous snake species in Sub-Saharan Africa. A D. polylepis bite is a medical emergency and requires adequate action to prevent severe complications. However, there are no comprehensive reviews available based on clinical cases, and no readily accessible guidelines for standardized treatment. Therefore, we aim to provide an overview regarding the currently available clinical literature on D. polylepis envenomations; in order to promote knowledge on symptomatology and treatment options.METHODS: We searched for cases reporting humans bitten by D. polylepis in PubMed, Embase, Scopus, and Sabinet. We searched the reference lists of all eligible articles for additional articles. After quality assessment, 29 cases were included in this review. We used descriptive analysis to create an overview of the collected parameters.DISCUSSION: Among the included case reports and case series, D. polylepis envenomations most frequently resulted in decreased respiratory function, sweating and paralysis. The onset of symptoms usually occurred within 60 minutes. Neurological symptoms occurred more often than symptoms of autonomic dysfunction. In the reported cases most patients (26/29) received antivenom and most survived (25/29). We recommend the reporting of additional structured case reports to improve future analyses on the clinical course of envenomations, in order to improve public health response to D. polylepis envenomations.",

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author = "Mark Aalten and Bakhuis, {Carsten F J} and Ilias Asaggau and Maaike Wulfse and {van Binsbergen}, {Maurits F} and Arntz, {Eran R A N} and Troenokarso, {Max F} and {Oediet Doebe}, {Jashvin L R} and Ubah Mahamuud and Leila Belbachir and Myrthe Meurs and Kovalenko, {Nastya A} and {van der Heyden}, {Marcel A G}",

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year = "2021",

month = oct,

doi = "10.1080/15563650.2021.1943427",

language = "English",

volume = "59",

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Aalten, M, Bakhuis, CFJ, Asaggau, I, Wulfse, M, van Binsbergen, MF, Arntz, ERAN, Troenokarso, MF, Oediet Doebe, JLR, Mahamuud, U, Belbachir, L, Meurs, M, Kovalenko, NA & van der Heyden, MAG 2021, 'The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review', Clinical Toxicology , vol. 59, no. 10, pp. 860-868. https://doi.org/10.1080/15563650.2021.1943427

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T1 - The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations

T2 - a narrative review

AU - Aalten, Mark

AU - Bakhuis, Carsten F J

AU - Asaggau, Ilias

AU - Wulfse, Maaike

AU - van Binsbergen, Maurits F

AU - Arntz, Eran R A N

AU - Troenokarso, Max F

AU - Oediet Doebe, Jashvin L R

AU - Mahamuud, Ubah

AU - Belbachir, Leila

AU - Meurs, Myrthe

AU - Kovalenko, Nastya A

AU - van der Heyden, Marcel A G

PY - 2021/10

Y1 - 2021/10

N2 - CONTEXT: The black mamba (Dendroaspis polylepis) is, due to its extremely toxic venom, one of the most dangerous snake species in Sub-Saharan Africa. A D. polylepis bite is a medical emergency and requires adequate action to prevent severe complications. However, there are no comprehensive reviews available based on clinical cases, and no readily accessible guidelines for standardized treatment. Therefore, we aim to provide an overview regarding the currently available clinical literature on D. polylepis envenomations; in order to promote knowledge on symptomatology and treatment options.METHODS: We searched for cases reporting humans bitten by D. polylepis in PubMed, Embase, Scopus, and Sabinet. We searched the reference lists of all eligible articles for additional articles. After quality assessment, 29 cases were included in this review. We used descriptive analysis to create an overview of the collected parameters.DISCUSSION: Among the included case reports and case series, D. polylepis envenomations most frequently resulted in decreased respiratory function, sweating and paralysis. The onset of symptoms usually occurred within 60 minutes. Neurological symptoms occurred more often than symptoms of autonomic dysfunction. In the reported cases most patients (26/29) received antivenom and most survived (25/29). We recommend the reporting of additional structured case reports to improve future analyses on the clinical course of envenomations, in order to improve public health response to D. polylepis envenomations.

AB - CONTEXT: The black mamba (Dendroaspis polylepis) is, due to its extremely toxic venom, one of the most dangerous snake species in Sub-Saharan Africa. A D. polylepis bite is a medical emergency and requires adequate action to prevent severe complications. However, there are no comprehensive reviews available based on clinical cases, and no readily accessible guidelines for standardized treatment. Therefore, we aim to provide an overview regarding the currently available clinical literature on D. polylepis envenomations; in order to promote knowledge on symptomatology and treatment options.METHODS: We searched for cases reporting humans bitten by D. polylepis in PubMed, Embase, Scopus, and Sabinet. We searched the reference lists of all eligible articles for additional articles. After quality assessment, 29 cases were included in this review. We used descriptive analysis to create an overview of the collected parameters.DISCUSSION: Among the included case reports and case series, D. polylepis envenomations most frequently resulted in decreased respiratory function, sweating and paralysis. The onset of symptoms usually occurred within 60 minutes. Neurological symptoms occurred more often than symptoms of autonomic dysfunction. In the reported cases most patients (26/29) received antivenom and most survived (25/29). We recommend the reporting of additional structured case reports to improve future analyses on the clinical course of envenomations, in order to improve public health response to D. polylepis envenomations.

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KW - Dendroaspis

KW - Dendroaspis polylepis

KW - antivenins

KW - envenomation

KW - snake bites

KW - symptoms

KW - treatment

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DO - 10.1080/15563650.2021.1943427

M3 - Review article

C2 - 34219550

SN - 1556-3650

VL - 59

SP - 860

EP - 868

JO - Clinical Toxicology

JF - Clinical Toxicology

IS - 10

ER -

The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review

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