Clinical toxicology (Philadelphia, Pa.) · 2026
The venomous primate: unpacking the clinical manifestations of slow loris bites - an 11-year retrospective case series.
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Tongpoo Achara, Sanprasert Kitisak
Аннотация
INTRODUCTION: The slow loris (Nycticebus coucang) is the only venomous primate, possessing a specialized defense mechanism capable of causing severe allergic reactions. Despite the potential for life-threatening envenomation, clinical data remain limited. This study aims to characterize the clinical manifestations and management of slow loris bites and grade allergic severity using the 2024 World Allergy Organization criteria.
METHODS: A retrospective case series was conducted on 28 patients presenting with slow loris bites at the Ramathibodi Poison Center. Medical records were reviewed for demographics, bite circumstances, clinical presentation, and treatment outcomes. The severity of systemic allergic reactions was graded according to the 2024 World Allergy Organization criteria.
RESULTS: A total of 28 patients were reviewed; fingers 13 (46%) and hands 4 (14%) were the most common bite sites. Significantly, 12 (43%) patients developed anaphylaxis, with eight (29%) experiencing angioedema and eight (29%) progressing to anaphylactic shock. World Allergy Organization severity grading indicated that four (14%) patients had grade 3 reactions, and eight (29%) had severe grade 4 reactions. Cutaneous symptoms were observed in 10 (36%) cases, while respiratory and gastrointestinal symptoms occurred in five (18%) and six (21%) cases, respectively. Wound infection was rare, occurring in only one (4%) patient.
CONCLUSIONS: Slow loris envenomation is an immunological emergency defined by severe anaphylaxis rather than secondary infection. A significant diagnostic challenge is the occurrence of anaphylaxis presenting as isolated hypotension without the classic mucocutaneous signs. Consequently, management must prioritize hemodynamic monitoring and early epinephrine administration over wound care.
METHODS: A retrospective case series was conducted on 28 patients presenting with slow loris bites at the Ramathibodi Poison Center. Medical records were reviewed for demographics, bite circumstances, clinical presentation, and treatment outcomes. The severity of systemic allergic reactions was graded according to the 2024 World Allergy Organization criteria.
RESULTS: A total of 28 patients were reviewed; fingers 13 (46%) and hands 4 (14%) were the most common bite sites. Significantly, 12 (43%) patients developed anaphylaxis, with eight (29%) experiencing angioedema and eight (29%) progressing to anaphylactic shock. World Allergy Organization severity grading indicated that four (14%) patients had grade 3 reactions, and eight (29%) had severe grade 4 reactions. Cutaneous symptoms were observed in 10 (36%) cases, while respiratory and gastrointestinal symptoms occurred in five (18%) and six (21%) cases, respectively. Wound infection was rare, occurring in only one (4%) patient.
CONCLUSIONS: Slow loris envenomation is an immunological emergency defined by severe anaphylaxis rather than secondary infection. A significant diagnostic challenge is the occurrence of anaphylaxis presenting as isolated hypotension without the classic mucocutaneous signs. Consequently, management must prioritize hemodynamic monitoring and early epinephrine administration over wound care.