Common Viper Bites in the Czech Republic - Epidemiological and Clinical Aspects during 15 Year Period (1999–2013)

Abstract

The aim of this study was to analyse most important epidemiological and clinical aspects of registered snakebites caused by a native common European viper Vipera berus in the Czech Republic over a period of 15 years (1999–2013). Data have been collected retrospectively from a database of the Toxinology Centre belonging to the General University Hospital in Prague. In total, 191 cases of snakebites caused by common viper were registered during the study period. Systemic envenoming occurred in 49 (25.7%) patients, local envenoming without systemic symptoms was recorded in 91 (47.6%) and asymptomatic dry bites were seen in 51 (26.7%) cases, respectively. Twenty-four patients (12.6% of all bites) were treated with administration of antivenom. None of the victims died as a result of snakebite during the observation period. Native viper snakes usually did not cause serious harm to the patients, with the exception of children. Antivenom should be administered in all cases with systemic manifestations, in children even with serious local affection and administered as soon as possible. Envenomed patients should be admitted to the hospital and treated at least under supervision of specialists with experience in snakebite treatment, who can indicate and provide administration of the antivenom.

Preclinical Assessment of a New Polyvalent Antivenom (Inoserp Europe) against Several Species of the Subfamily Viperinae

“…In Europe, the epidemiological studies of snakebites show that mortality is not a serious problem; nevertheless, most cases required hospitalization and a rapid recognition of symptoms because it is essential to decide if immunotherapy is required [3,4,6,12,13]. Usually, immunotherapy with antivenoms is indicated only to patients with systemic envenoming (approximately 4,000 annual cases in Europe), but it was suggested that antivenom should be indicated to young children and pregnant women—representing 50% of snakebite cases—even if they do not have systemic symptoms [3,4].…”

“…For regions inhabited by several medically important snake species, the World Health Organization recommends the manufacture of polyspecific antivenoms that are effective against all possible regional snake varieties [2]. This is important because, as a rule, patients cannot identify the species that bit them; thus, an expert analysis of the shape of the snakebite is required [12]. In the present study, the safety and venom-neutralizing efficacy of Inoserp Europe—a new F(ab’) 2 polyvalent antivenom, designed to cover envenoming caused by medically important snakes of the Eurasian region—were evaluated.…”

Vipera snakebite in Europe: a systematic review of a neglected disease

“…Considering that Europe has a relatively high number of Vipera species with relevant medical aspects, and that Europe shows the most favourable habitat, the underestimation is even greater, confirming the fact that snakebite in Europe is a disease with neglected incidence, morbidity and mortality. This is also justified by the fact that sporadic individual case reports and case series are found in the literature 4–81 …”

Venomics of Vipera berus berus to explain differences in pathology elicited by Vipera ammodytes ammodytes envenomation: Therapeutic implications

“…The principal local effects of Vbb venom poisoning are haemorrhage, oedema, myonecrosis, bruising and pain [2,[6][7][8], and hypotension is the most important sign of systemic envenomation [8][9][10][11]. This is reflected in gastrointestinal problems, with recurrent vomiting, nausea, circulatory instability and haematological disturbances.…”

“…The most striking difference in pathological action on man is, however, in eliciting neurotoxic effects. These are very rarely observed in the case of Vbb venom bites but frequently in that of Vaa and constitute a medical emergency, since they can progress from ptosis to intense muscular weakness that can persist for several hours [4][5][6][7][8][9][10]. By analysing the Vbb venom proteome we proposed an explanation, at the molecular level, of the differences in clinical pictures inflicted by the Vbb and Vaa venoms.…”