Envenomation by Montpellier Snake, Malpolon monspessulanus Following Prolonged Bites

Abstract

First reports of envenoming by South American water snakes Helicops angulatus and Hydrops triangularis from Bolivian Amazon: a one-year prospective study of non-front-fanged colubroid snakebites. Toxicon. 2021;202:53-9. 8. da Silva AM, Mendes VKDG, Monteiro WM, Bernarde PS. Non-venomous snakebites in the Western Brazilian Amazon. Rev Soc Bras Med Trop. 2019;52:e20190120. 9. Ministry of Health of Brazil. How is Brazil taking care of tourists' health? Available at: https://bvsms.saude.gov.br/ bvs/publicacoes/como_cuidar_saude_brasil_ingles.pdf. Accessed July 20, 2021. 10. de Medeiros CR, Duarte MR, de Souza SN. Differential diagnosis between venomous (Bothrops jararaca, Serpentes, Viperidae) and "Nonvenomous" (Philodryas olfersii, Serpentes, Dipsadidae) snakebites: is it always possible?

A Guide to the Clinical Management of Vipera Snakebite in Italy

“…Two non-front-fanged colubroid (NFFC) snakes of the family Psammophiidae, Malpolon monspessulanus and Malpolon insignitus , can also be found in Italy (with a national distribution limited to the central-western Liguria and the island of Lampedusa, respectively—see [ 76 , 77 ]). These two species are generally believed to induce only mild, local envenomation symptoms, although some reports indicating more severe symptoms exist [ 15 , 78 , 79 , 80 , 81 ]. Two additional species of NFFC venomous snakes, namely Telescopus fallax and Macroprotodon cucullatus , can also be found in Italy, but there are currently no official reports of envenomation caused by them in humans [ 82 ].…”

Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management

“…Front-fanged snakes (i.e., families Viperidae, Elapidae and Atractaspididae) are generally considered to be the most dangerous venomous snakes (see [ 21 ]), and are accountable for the vast majority of medically relevant ophidic accidents [ 22 , 23 , 24 ]. Although the only front-fanged snakes present in Europe are viperids (family: Viperidae), the continent also hosts some rear-fanged venomous snakes [ 25 , 26 , 27 , 28 , 29 ], generally considered medically neglectable but still able to cause clinically relevant symptoms with their bites [ 30 , 31 , 32 ].…”

“…Their European distribution encompasses the Balkans, Greece, Portugal, Spain, southern France, Mediterranean northwestern Italy and some Mediterranean islands [ 25 , 26 , 28 , 29 ]. Although generally considered able to elicit only mild, local envenomation symptoms, snakes of this genus have been reported to sometimes cause more serious disturbances [ 30 , 31 ].…”

“…In case of a prolonged bite, local symptoms involving the bitten area are erythema, edema and pain. Systemic symptoms, including neurotoxic effects (e.g., oculomotor paralysis), have sometimes been reported following Malpolon envenomations [ 30 , 31 , 59 ].…”

“…venom is partially unknown. To date, snake venom metalloproteinases, peptidase M1 and cysteine-rich secretory proteins are thought to be its most prominent components [ 30 , 31 , 59 ].…”