NEUROTOXICITY AND HEMOSTATIC DISTURBANCES IN PATIENTS ENVENOMED BY THE PAPUAN BLACK SNAKE (PSEUDECHIS-PAPUANUS)

Among 335 patients presenting with snakebites in Central Province, Pap ua New Guinea, nine were proved by enzyme immunoassay to have been bit ten by Papuan black snakes (Pseudechis papuanus). Seven showed clinica l evidence of envenoming. Early symptoms included vomiting and tender local lymph nodes. Five patients had neurotoxic signs and one required mechanical ventilation. Spontaneous systemic bleeding occurred in two patients. Coagulation studies in four patients showed thrombocytopeni a, prolongation of prothrombin time, mild defibrination and depletion of other clotting factors with elevated fibrin(ogen) degradation produ cts and other evidence of fibrinolysis. One patient developed mild ren al dysfunction. There was no evidence of intravascular haemolysis or r habdomyolysis. These clinical observations, which do not distinguish v ictims of P. papuanus from those of taipans (Oxyuranus scutellatus can ni), suggest that the venom contains neurotoxic, haemorrhagic and mild procoagulant activities. Only two other cases of proven envenoming by this species have been reported. There appears to have been a decline in the abundance of this species, and hence its medical importance, o ver the last 25 years.