When a bite occurs, venom is expelled through the action of a compressor muscle that surrounds the venom gland, and is delivered by a duct to the fangs through which it is injected into the tissues of an individual. Venom is synthesized and stored in a specialized gland. Schematic illustration of the venom system in a snake of the family Viperidae (viperids part a). Venoms from snakes of the family Elapidae (elapids) predominantly induce neurotoxic manifestations, such as neuromuscular paralysis 2. Venoms from snakes of the family Viperidae (viperids) cause local effects and systemic manifestations associated with bleeding, coagulopathies and hypovolaemic shock 2. Some toxins in venom provoke local tissue damage, often resulting in permanent sequelae, whereas others induce systemic effects, including neurotoxic manifestations (leading to, for example, respiratory paralysis), bleeding, acute kidney injury, rhabdomyolysis (that is, a generalized breakdown of muscle fibres), cardiotoxicity, autonomic hyperactivity or thrombosis. The composition of snake venoms shows high complexity and diversity 1, resulting in a variable biochemical and toxicological profile that determines a wide range of clinical manifestations. Venom is injected through the snake's fangs, which are modified teeth connected via a duct to a venom gland ( Fig. Snakebite envenoming is a neglected tropical disease resulting from the injection of a highly specialized toxic secretion - venom - by a venomous snake into humans, usually under accidental circumstances. Confronting snakebite envenoming at a global level demands the implementation of an integrated intervention strategy involving the WHO, the research community, antivenom manufacturers, regulatory agencies, national and regional health authorities, professional health organizations, international funding agencies, advocacy groups and civil society institutions. Novel therapeutic alternatives based on recombinant antibody technologies and new toxin inhibitors are being explored. Analgesics, ventilator support, fluid therapy, haemodialysis and antibiotic therapy are also used. Intravenous administration of antivenom is the only specific treatment to counteract envenoming. The high variability in snake venom composition is responsible for the various clinical manifestations in envenomings, ranging from local tissue damage to potentially life-threatening systemic effects. Snake venoms are complex mixtures of proteins that exert a wide range of toxic actions. Impoverished populations living in the rural tropics are particularly vulnerable snakebite envenoming perpetuates the cycle of poverty. Snakebite envenoming is a neglected tropical disease that kills >100,000 people and maims >400,000 people every year.
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