Envenomation by Montpellier snake (Malpolon monspessulanus) with cranial nerve disturbances

Asp Viper (Vipera aspis) Envenomation: Experience of the Marseille Poison Centre from 1996 to 2008

“…However it is unlikely that confusion of two species occurred since the Montpellier snake is larger and more aggressive than the asp viper. In addition rare descriptions of envenomations by Malpolon are characterized by slight or minimal local signs even if neurotoxicity is observed immediately [28]. This pattern was never observed after asp viper envenomation in our series.…”

Proteomic insight into the venom composition of the largest European rear-fanged snake, Malpolon monspessulanus monspessulanus

“…Indeed, like in many opistoglyph snakes, the teeth used to deliver venom are posteriorly in the upper jaw (typically below the eye) and they are smaller compared to the large fangs of front-fanged snake. However, a case of envenomation with cranial nerve disturbances has been recorded in the south of France, where the victim had his finger inserted deep into the mouth of the reptile for prolonged time ( Pommier and de Haro, 2007 ). Interestingly, and unlike the reptile's typical prey, the patient mostly had neurological symptoms such as visual disturbances rather than hemorrhagic symptoms.…”

“…Moreover, at least three cases of neurotoxic envenoming have been reported. In the detailed report of such recent neurotoxic envenomation, it is indicated that the finger of the victim was deep inside the buccal cavity of the snake and likely received prolonged contact with the posterior maxillary teeth, maximizing the likelihood of envenomation ( Pommier and de Haro, 2007 ). This rare and unfortunate situation suggests that most of the Montpellier snake's documented bites may be “dry”, likely implicating only the small teeth of the front upper or bottom jaws without envenomation.…”

Envenomation by Montpellier Snake, Malpolon monspessulanus Following Prolonged Bites

“…Yet, envenomation is rare and poorly documented. 6,7 Clinical cases: Two boys (A, a 16-y-old, and B, a 13-y-old) were bitten while handling adult Montpellier snakes in southeast France, in April 2018 and in February 2021, respectively. The snake's species was identified in the field by experienced professional herpetologists.…”

“…However, 2 reports from Spain (1979) and France (2007) described severe clinical signs of envenomation, including neurological disorders affecting cranial nerves (eg, ptosis, difficulty swallowing, dyspnea, trouble focusing) combined with extensive swelling. 6,7 In the first case, a man was bitten on the hand. In the second case, the victim was envenomed when he put his finger into the snake’s mouth for unclear reasons.…”