ABSTRACT
Southeast Asia is home to a diverse array of venomous snakes, including elapids (Naja spp., Ophiophagus hannah, Bungarus spp., Hydrophis spp., Laticauda spp., Calliophis spp.), pitvipers (Trimeresurus spp., Tropidolaemus spp., Calloselasma rhodostoma, Deinagkistrodon acutus), Azemiops feae, and Eastern Russell’s Viper (Daboia siamensis), and rear-fanged venomous colubrids (e.g., Rhabdophis spp.). Neurotoxic paralysis is typically associated with envenomation by cobras, King Cobra (post-synaptic) and kraits (mainly pre-synaptic). Seasnake envenomation primarily causes systemic myotoxicity that leads to rhabdomyolysis and acute kidney injury. Consumptive coagulopathy, thrombocytopenia, hemorrhagic syndrome and hypovolemic shock are commonly the manifestations or sequelae of viperid envenomation, and in Russell’s Viper bites, severe complications of organ damage such as pituitary infarct and acute kidney injury can ensue. Tissue necrosis is seen in local envenomation caused by cobras, King Cobra and viperid snakes, whereas bites from kraits and seasnakes are characterized by minimal or trivial local tissue effect. Coral snakes, on the other hand, rarely cause life-threatening envenomations but can cause tissue swelling and pain that persists for days following envenomation. The species of snake involved is usually clinically diagnosed or deduced based on a syndromic approach, as a reliable tool for diagnosis and monitoring is not yet available commercially in Southeast Asia. Effective treatment of snakebite envenomation entails the use of appropriate specific antivenoms, which are unfortunately not available in certain countries. The use 560of heterologous antivenoms may or may not confer protective neutralization; hence, for paraspecific utility, the antivenom efficacy should be rigorously assessed prior to clinical use. As snake venom compositions are diverse and variable, innovation in the immunization technique should be explored to broaden the species coverage and to increase the neutralization potency of antivenom used in the region.
