Application of ELISA in Taiwan cobra snakebite

Background: Cobra snakebites have been shown to induce significant local tissue necrosis in addition to systemic neurotoxic paralysis. Owing to the notable tissue swelling, cobra snakebite is frequently misdiagnosed as habu (Trimeresurus mucrosquamatus) snakebite initially. The administration of correct and specific antivenin was typically delayed. Here, we developed an enzyme-linked immunosorbent assay (ELISA) to detect Taiwan cobra venom existed in the serum of the cobra snakebite victims. Methods: Sandwich-ELISA with horseradish-peroxidase conjugated method for detecting cobra venoms in biological samples were used and applied in a case of snakebite to confirm our clinical diagnosis. Serum samples of clinical cobra snakebite patients were collected when patients were admitted to the emergency room. Result: This established technique allowed us to detect as less as 1 ng/ml. The linear regression of standard cobra venom in the serum in concentration ranging from 1 ng/ml to 100ng/ml was well with R-value to be 0.9779. Totally, 31 serum samples of 27 recognized and suspected cobra snakebite patients were analyzed by the developed ELISA technique. The highest venom level detected was 1270ng/ml in a case 2 hours after being envenomed. The serum concentrations of the venom in the bitten patients were well correlated with the severity of local tissue destruction. Conclusions: these results indicate that ELISA method that we have developed is valuable in early diagnosis and severity assessment of Taiwan cobra snakebite.
Hung D, Liau M, Lin-Shiau S. Division of Toxicology, Emergency Department, Taichung Veterans General Hospital, Taichung, [...]