We prospectively compared the ability of antivenom and edrophonium (Tensilon®) to improve paralytic symptoms in 8 patients envenomed by the Philippine cobra (Naja naja philippinensis). Twenty, 50 or 100 ml of Philippine cobra antivenom were administered in a double-blind fashion by constant intravenous infusion over 30 min. Even the largest dose of antivenom failed to produce marked improvement within 2 h, though enzyme-linked immunosorbent assays and neutralization tests demonstrated that it possessed high titres of anti-neurotoxin antibodies. Tensilon® given at 2 h was significantly more effective than antivenom at increasing the duration of upward gaze (78±28 vs 43±26 sec, P<0·001), and either completely reversed or markedly decreased paralysis in every patient. The Tensilon® test should be given to all patients with paralytic envenoming by cobras, and anticholinesterases administered to those with a positive response.

Journal Article The Rapid Diagnosis of Leptospirosis: A Prospective Comparison of the Dot Enzyme-Linked Immunosorbent Assay and the Genus-Specific Microscopic Agglutination Test at Different Stages of Illness Get access George Watt, George Watt U. S. Naval Medical Research Unit Number 2, Manila, Philippines Please address requests for reprints to the Publications Office, U. S. Naval Medical Research Unit Number 2, APO San Francisco, California 95628. Search for other works by this author on: Oxford Academic PubMed Google Scholar Lily M. Alquiza, Lily M. Alquiza U. S. Naval Medical Research Unit Number 2, Manila, Philippines Search for other works by this author on: Oxford Academic PubMed Google Scholar Laurena P. Padre, Laurena P. Padre U. S. Naval Medical Research Unit Number 2, Manila, Philippines Search for other works by this author on: Oxford Academic PubMed Google Scholar Maria Linda Tuazon, Maria Linda Tuazon U. S. Naval Medical Research Unit Number 2, Manila, Philippines Search for other works by this author on: Oxford Academic PubMed Google Scholar Larry W. Laughlin Larry W. Laughlin U. S. Naval Medical Research Unit Number 2, Manila, Philippines Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 157, Issue 4, April 1988, Pages 840–842, https://doi.org/10.1093/infdis/157.4.840 Published: 01 April 1988 Article history Received: 30 June 1987 Revision received: 02 November 1987 Published: 01 April 1988

We studied 39 patients envenomed by the Philippine cobra (Naja naja philippinensis). Neurotoxicity occurred in 38 cases and was the predominant clinical feature. Respiratory paralysis developed in 19 patients, and was often rapid in onset--in 3 cases apnea occurred within 30 min of the bite. There were 2 deaths, both in patients who were moribund upon arrival at the hospital. Three patients developed necrosis, and 14 individuals with systemic symptoms had no local swelling. Both cardiotoxicity and reliable nonspecific signs of envenoming were absent. Bites by the Philippine cobra produce a distinctive clinical picture characterized by severe neurotoxicity of rapid onset and minimal local tissue damage.

Although human cases of leptospirosis have been reported from the Philippines, there is a lack of data on its prevalence. We therefore surveyed three rice-farming villages for the presence of leptospiral antibody. Out of 155 sera tested, 63 (43.6%) tested positive using the standard microagglutination test. Antibodies were more frequent in men than women (48 vs. 31%, respectively, p less than 0.01), and less common in the elderly. Exposure to leptospires occurs frequently in rice farmers, and leptospirosis is likely to be an underdiagnosed cause of both mild and severe febrile illness in the Philippines.

The effect of a 7-day course of intravenous penicillin (6 million units/day) on severe, advanced leptospirosis was examined in a randomised, placebo-controlled, double-blind trial involving 42 patients. Every measurable aspect of the disease was favourably affected by penicillin. Fever lasted more than twice as long in the placebo group (11·6 [SD 8·34] days vs 4·7 [4·19] days, p<0·005), and by the fourth day after starting penicillin more than half the treatment group, but only 1 of 19 in the placebo group, were afebrile (p<0·005). Creatinine rises persisted more than thrice as long in the patients receiving only placebo (8·3 [8·46] days vs 2·7 [1·90] days; p<0·01). Penicillin also shortened the hospital stay and prevented leptospiruria. Intravenous penicillin should be given to patients with severe leptospirosis, even if therapy can be begun only late in the course of their disease.

The effects of tourniquet application were prospectively studied in 36 hospitalized patients who developed neurotoxic symptoms after bites by the Philippine cobra (Naja naja philippinensis). Tourniquets had been applied in 94% of cases and delayed the onset of symptoms. Four patients were asymptomatic prior to the release of their tourniquet and in 11 patients symptoms worsened precipitously. Most importantly, 4 patients developed complete respiratory paralysis requiring artificial ventilation on its removal. Medical personnel seeing patients after a possible cobra bite should remove any tourniquet very gradually with both specific therapy and ventilatory support at hand. We recommend tourniquet application in the Philippines only after the bite of a definitely identified cobra and when removal can take place under controlled hospital conditions.

We investigated mortality from cobra (Naja naja philippinensis) bite among Filipino rice farmers. Village records in one area were examined and we conducted a careful survey in this and two additional areas among inhabitants at varying risk for snakebite. The death rate from cobra bite was estimated to be as high as 107.1 deaths per 100,000 population per year at one site. Most victims were young (median age 17) and 98% were males. Only 8% of the victims studied reached a hospital. The confirmed death rate averaged 53.8/100,000 for the three populations.