title: Detection of Snake Venom in Post-Antivenom Samples by Dissociation Treatment Followed by Enzyme Immunoassay.
abstract: Venom detection is crucial for confirmation of envenomation and snake type in snake-bite patients. Enzyme immunoassay (EIA) is used to detect venom, but antivenom in samples prevents venom detection. We aimed to detect snake venom in post-antivenom samples after dissociating venom-antivenom complexes with glycine-HCl (pH 2.2) and heating for 30 min at 950 °C. Serum samples underwent dissociation treatment and then Russell's viper venom or Australian elapid venom measured by EIA. In confirmed Russell's viper bites with venom detected pre-antivenom (positive controls), no venom was detected in untreated post-antivenom samples, but was after dissociation treatment. In 104 non-envenomed patients (negative controls), no venom was detected after dissociation treatment. In suspected Russell's viper bites, ten patients with no pre-antivenom samples had venom detected in post-antivenom samples after dissociation treatment. In 20 patients with no venom detected pre-antivenom, 13 had venom detected post-antivenom after dissociation treatment. In another 85 suspected Russell's viper bites with no venom detected pre-antivenom, 50 had venom detected after dissociation treatment. Dissociation treatment was also successful for Australian snake envenomation including taipan, mulga, tiger snake and brown snake. Snake venom can be detected by EIA in post-antivenom samples after dissociation treatment allowing confirmation of diagnosis of envenomation post-antivenom.
authors.affiliation: Clinical Toxicology Research Group, University of Newcastle, Newcastle 2298, Australia. kalanapm@gmail.com.|South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka. kalanapm@gmail.com.|Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. kalanapm@gmail.com.
authors.forename: Kalana P
authors.initials: KP
authors.lastname: Maduwage
authors.affiliation: Clinical Toxicology Research Group, University of Newcastle, Newcastle 2298, Australia. margaret.Oleary@newcastle.edu.au.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: O'Leary
authors.affiliation: Monash Venom Group, Monash University, Melbourne 3168, Australia. anjana.silva@monash.edu.
authors.forename: Anjana
authors.initials: A
authors.lastname: Silva
authors.affiliation: Clinical Toxicology Research Group, University of Newcastle, Newcastle 2298, Australia. geoff.isbister@gmail.com.|South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka. geoff.isbister@gmail.com.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
mesh_terms: D000997:Antivenins / Q000627:therapeutic use; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D012909:Snake Bites / Q000097:blood / Q000188:drug therapy; D012910:Snake Venoms / Q000097:blood*
chemical_list: D000997:Antivenins; D012910:Snake Venoms
keywords: antivenom; dissociation; enzyme immunoassay; snakebite; venom; venom detection