Central American polyvalent snake venom antisera solution for injection 10ml ampoules

Snake envenomation remains an important yet neglected medical problem in many countries, with around five million people affected, and over a hundred thousand deaths annually. Plasma-derived antivenoms are the main therapeutic agent available. Monovalent antivenoms are produced via the immunization of large animals, e.g., horses, with one venom, after which the horse serum can neutralize the homologous venom, with minimal or no cross neutralization against other venoms. It is necessary, therefore, for the culprit snake to be identified, so that the appropriate specific antivenom can be selected. Polyvalent antivenoms (pAVs) are produced via immunization with a number of snake venoms, and the serum can neutralize all the venoms used in its production. Thus, pAVs can be used to treat several venoms from a country/region, and the identification of the culprit snake is not necessary. There are various parameters and processes involved in the production of pAVs, depending on the requirements and resources available. Most commercial pAVs use a mixture of both elapid and viperid venoms as immunogens, while some pAVs use either elapid or viperid venoms. Some pAVs are produced through the mixing of more than one monovalent or polyvalent antivenom. These various types of pAVs have their own characteristics, and have benefits and drawbacks. The major benefits of pAVs are the wide coverage of many medically important venoms, including many heterologous venoms. They also remove the need to identify the culprit snake, and they can be produced at a lower cost than several monovalent antivenoms. Interesting polyvalent antivenoms, termed 'syndromic pAVs' (s-pAVs), have recently gained attention. They are produced for use according to the syndromes manifested in snakebite patients. The venoms that produce these syndromes are used as immunogens in the production of 'syndromic antivenoms'. For example, 'neurotoxic polyvalent antivenom' and 'hematotoxic polyvalent antivenom' are produced using the neurotoxic elapid and hematotoxic viperid venoms as immunogens, respectively. They were first marketed by the Thai Red Cross in 2012, and have since gained attention as a possible therapeutic modality to help solve the problem of snakebite envenomation globally. The merits of these s-pAVs, including their efficacy and wide paraspecificities, are discussed.

Abstract licence: CC BY

, remains a significant public health challenge in the northern Indian states of Punjab, Haryana, Uttar Pradesh, Uttarakhand, and Himachal Pradesh. Despite the availability of polyvalent anti-snake venom (ASV), inconsistent dosing strategies, delayed administration, and disparities in healthcare contribute to high morbidity and mortality rates. This review examines optimal ASV dosing protocols, clinical outcomes, and host-specific factors that influence the therapeutic efficacy in hemotoxic envenomation. Drawing from regional epidemiological data, toxicological insights, and clinical studies, the review underscores the influence of bite-to-needle intervals, ASV administration routes, and infrastructural readiness on patient survival. Notably, intravenous administration proves superior, while early intervention significantly reduces systemic complications. The study identifies key gaps in national guidelines, particularly the mismatch between regional venom variability and available ASV formulations. It also explores emerging alternatives like Varespladib and monoclonal antivenoms. Methodologically, the review adopts a narrative synthesis of peer-reviewed literature and policy frameworks. It concludes that standardizing ASV treatment based on regional evidence, enhancing healthcare capacity, and integrating public health education are essential to improving outcomes. The findings support the need for locally tailored, patient-centric treatment protocols and stronger public health systems to mitigate snakebite-related burdens.

Abstract licence: CC BY

BACKGROUND: Snakebites caused by Bitis nasicornis and Bitis gabonica are rare but can lead to severe systemic and local complications, including acute compartment syndrome (ACS). The role of surgical intervention in snakebite management remains controversial, with limited data available for snakebite envenomation. CASE PRESENTATION: Two cases of upper limb envenomation by Bitis nasicornis and Bitis gabonica were managed at the General University Hospital in Prague in year 2024. Both developed acute compartment syndrome requiring prompt antivenom therapy, fasciotomy, and intensive care. In the first case, antivenom (EchiTab-Plus-ICP) was given within 1 h, 10 vials in total, and fasciotomy at 10 h; the patient was discharged on day 16 with preserved limb function. In the second, antivenom (SAIMR) was administered within 3 h, 4 vials in total (the maximum available in Europe at that time), and fasciotomy at 8 h; recovery was complete by day 7. Diagnosis of ACS was based on clinical signs without intracompartmental pressure measurement. CONCLUSION: These cases highlight that timely surgical intervention, combined with intensive care and antivenin may play a critical role in preventing irreversible tissue damage following viperid envenomation. However, universal guidelines are lacking. Incorporating intracompartmental pressure monitoring into treatment protocols may further improve diagnostic accuracy and patient outcomes.

Abstract licence: CC BY

Scorpions are predatory arachnids whose venomous sting primarily affects people in tropical and subtropical regions. Most scorpion stings can only cause localized pain without severe envenomation. Less than one-third of the stings cause systemic envenoming and possibly lead to death. About 350,000 scorpion stings in Northern Africa are recorded yearly, resulting in about 810 deaths. In Eastern/Southern Africa, there are about 79,000 stings recorded yearly, resulting in 245 deaths. Farmers and those living in poverty-stricken areas are among the most vulnerable to getting stung by scorpions. However, compared to adults, children are at greater risk of severe envenomation. Scorpion venom is made up of complex mixtures dominated by peptides and proteins that confer its potency and toxicity. These venom toxins have intra- and interspecies variations associated with the scorpion's habitat, sex, diet, and age. These variations alter the activity of antivenoms used to treat scorpion sting envenomation. Thus, the study of the proteome composition of medically important scorpion venoms needs to be scaled up along their geographical distribution and contributions to envenomation in Southern and Northern Africa. This will help the production of safer, more effective, and broad-spectrum antivenoms within these regions. Here, we review the clinical implications of scorpion sting envenomation in Southern and Northern Africa. We further highlight the compositions of scorpion venoms and tools used in scorpion venomics. We discuss current antivenoms used against scorpion sting envenomation and suggestions for future production of better antivenoms or alternatives. Finally, we discuss the therapeutic properties of scorpion venom.

Abstract licence: CC BY

Despite the considerable global impact of snakebite envenoming, available treatments remain suboptimal. Here, we report the discovery of a broadly-neutralizing human monoclonal antibody, using a phage display-based cross-panning strategy, capable of reducing the cytotoxic effects of venom phospholipase A2s from three different snake genera from different continents. This highlights the potential of utilizing monoclonal antibodies to develop more effective, safer, and globally accessible polyvalent antivenoms that can be widely used to treat snakebite envenoming.

Abstract licence: CC BY

Snakebite envenoming (SBE) is a global public health concern, primarily due to the lack of effective antivenom for treating snakebites inflicted by medically significant venomous snakes prevalent across various geographic locations. The rising demand for safe, cost-effective, and potent snakebite treatments highlights the urgent need to develop alternative therapeutics targeting relevant toxins. This development could provide promising discoveries to create novel recombinant solutions, leveraging human monoclonal antibodies, synthetic peptides and nanobodies. Such technologies as recombinant DNA, peptide and epitope mapping phage display etc) have the potential to exceed the traditional use of equine polyclonal antibodies, which have long been used in antivenom production. Recombinant antivenom can be engineered to target certain toxins that play a critical role in snakebite pathology. This approach has the potential to produce antivenom with improved efficacy and safety profiles. However, there are limitations and challenges associated with these emerging technologies. Therefore, identifying the limitations is critical for overcoming the associated challenges and optimizing the development of recombinant antivenoms. This review is aimed at presenting a thorough overview of diverse technologies used in the development of recombinant antivenom, emphasizing their limitations and offering insights into prospects for advancing recombinant antivenoms.

Abstract licence: CC BY-NC-ND