title: Bites in Australian snake handlers--Australian snakebite project (ASP-15).
abstract: BACKGROUND
  Snakebites in snake handlers are an important clinical problem that may differ to bites in the general population.
  
  
  OBJECTIVE
  To investigate the epidemiology and clinical presentation of bites in snake handlers.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Bites in snake handlers recruited as part of the Australian Snakebite Project (ASP) from 2004 to 2011 were included in the study. Data were extracted from the ASP database, which included demographic and clinical information, laboratory tests and antivenom treatment.
  
  
  RESULTS
  From 1089 snake bites recruited to ASP, there were 106 (9.7%) bites in snake handlers. The median age was 40 years (range: 16-81 years) and 104 (98%) were males. The commonest circumstances of the bites were handling snakes (47), catching snakes (22), feeding snakes (18) and cleaning cages (11). Bites were to the upper limb in 103 cases. Bites were most commonly by Red-bellied black snakes (20), Brown snakes (17), Taipan (15), Tiger snakes (14) and Death adders (14). Envenoming occurred in 77 patients: venom-induced consumption coagulopathy in 45 patients (58%), neurotoxicity in 10 (13%) and myotoxicity in 13 (17%). Systemic hypersensitivity reactions (SHSRs) to venom occurred in eight, satisfying clinical criteria for anaphylaxis in five, of which three were hypotensive. Antivenom was administered in 60 envenomed patients. SHSRs to antivenom occurred in 15 (25%; 95% CI:15-38%), including 2 (3%:1-13%) with severe (hypotensive) reactions.
  
  
  CONCLUSIONS
  Bites in snake handlers remain a common, important problem involving a broad range of snakes. Neurotoxicity and myotoxicity are relatively common, consistent with the snakes involved. Venom anaphylaxis occured, despite previously being a poorly recognized problem in snake handlers. The incidence of SHSRs to antivenoms, including anaphylaxis, was not higher than that observed in non-snake handlers.
authors.affiliation: Discipline of Clinical Pharmacology, University of Newcastle, Calvary Mater Newcastle, Waratah NSW 2298, Australia. geoff.isbister@gmail.com
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
authors.forename: S G A
authors.initials: SG
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000453:epidemiology; D017750:Animal Technicians / Q000706:statistics & numerical data; D000997:Antivenins / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D015984:Causality; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology; D006969:Hypersensitivity, Immediate / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology*; D009784:Occupational Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012909:Snake Bites / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000997:Antivenins