Clinical features of green pit viper bites vary from asymptomatic to fatal bleeding. Antivenin promptly reverses the coagulopathy but has considerable adverse side effects. In this study, potential clinical predictors of severe outcomes (wound necrosis, wound infection, and systemic bleeding) and antivenin allergy were determined in 271 moderate to severe cases of green pit viper bites by multivariate analysis. The incidences of systemic bleeding, wound necrosis, secondary infection, and antivenin allergy were 17.3%, 6.6%, 5.5%, and 20.8% respectively. The predictors of systemic bleeding were the combination of thrombocytopenia and prolonged venous clotting time and bite sites away from digits. A bite on the fingers or toes was a risk factor for skin necrosis (P ϭ 0.03). Systemic absorption of the venom from digits may be poor, resulting in severe local but mild systemic effects. The presence of blisters often led to necrosis and secondary infections (P ϭ 0.0037 and P ϭ 0.0006, respectively). Although negative skin test results do not exclude the possibility of antivenin allergy, positive results indicate a high risk (P ϭ 0.016) requiring special precautions.Venomous snake bite is a common health problem in Thailand. 1 In Bangkok and nearby areas, green pit vipers (Trimeresurus albolabris and T. macrops) comprise more than 90% of biting species. 2 Their venom has a thrombinlike effect and platelet-aggregating activity causing hypofibrinogenemia and thrombocytopenia. [3][4][5] The clinical features manifest as local and systemic symptoms. 6 Local effects are vasculopathy resulting in edema, ecchymosis around the wound, blisters, and necrosis. The systemic effect is mainly mucosal bleeding.In an analysis of clinical features and natural courses of 281 Thai patients bitten by a green pit viper, 6-9 2-3% of the patients had necrosis of fingers that necessitated surgery and 10% of the cases had coagulopathy. Only one percent of all cases manifested systemic bleeding, mostly as gum and gastrointestinal hemorrhage. However, few cases of fatal hemorrhage have been reported. 6,7 Although antivenin can promptly reverse systemic effects (Manasandana S, unpublished data), 20% of patients had antivenin hypersensitivity and 2% had severe reactions. 8 Because 90% of green pit viper bites do not cause coagulopathy, antivenin should not be administered indiscriminately. Patients should be monitored for coagulopathy and given antivenin only in severe cases. The purpose of the present study is to determine clinical variables at presentation that reliably predict the major events complicating the management of these patients, namely skin necrosis, wound infection, systemic bleeding, and antivenin hypersensitivity. The results will be used for developing a guideline for the management of green pit viper bite patients to avoid severe morbidity, prolonged observation, and unnecessary antivenin administration. MATERIALS AND METHODSThe medical records of 278 definitively diagnosed patients with green pit viper bites who were admitted to ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.