Neurotoxic snakebites in Africa: Clinical implications, therapeutic strategies, and antivenom efficacy

• Published in: Toxicon (Oxford) 2024-08, Vol.247, p.107811, Article 107811
• Main Authors: Alfa-Ibrahim Adio, Abdulbaki, Malami, Ibrahim, Lawal, Nafiu, Jega, Amina Yusuf, Abubakar, Bilyaminu, Bello, Muhammad Bashir, Ibrahim, Kasimu Ghandi, Abubakar, Murtala Bello, Abdussamad, Abdussamad, Imam, Mustapha Umar
• Format: Article
• Language: English
• Subjects: Africa; Africa - epidemiology; Animals; Antivenins - therapeutic use; Antivenom; Elapidae; Humans; Neuromuscular paralysis; Neurotoxicity; Neurotoxicity Syndromes - etiology; Snake Bites - drug therapy; Snake Bites - therapy; Snakebite
• ISSN: 0041-0101; 1879-3150; 1879-3150
• DOI: 10.1016/j.toxicon.2024.107811

Snakebite is a significant health concern in Africa, particularly due to neurotoxic envenomation which can lead to neuromuscular paralysis and respiratory failure. In Nigeria, snakes from the Elapidae family are a notable cause of envenomation cases, though these incidents are underreported. This review examined case reports of neurotoxic envenomation in Africa, highlighting the clinical impacts and the efficacy of available antivenoms. Preclinical studies showed that the polyvalent antivenom from the South African Institute for Medical Research (SAIMR) was highly effective against neurotoxicity with a protective efficacy (R) of 1346.80 mg/mL, while clinical assessment emphasized the need for high-dose antivenom therapy along with supportive measures like mechanical ventilation. Unlike hemorrhagic envenomation, where antivenom promptly resolves bleeding, neurotoxic cases often require additional interventions. The review underscores the necessity for tailored approaches in antivenom therapy to address the complexities of neurotoxic snakebites and reduce their public health burden in Africa. [Display omitted] •Snakebite is a major neglected tropical disease in Africa, causing high mortality and morbidity•Neurotoxic snakebites in Africa cause neuromuscular paralysis and respiratory dysfunction.•Inoserp Pan Africa antivenom is safer, more effective, and better tolerated than the South African polyvalent antivenom.•Treatment often requires 2-10 vials of antivenom with supportive care like mechanical support and cholinesterase inhibitors.