Exotic Snakebites Reported to Pennsylvania Poison Control Centers: Lessons Learned on the Demographics, Clinical Effects, and Treatment of These Cases

Miller, Stephen W.; Osterhoudt, Kevin C.; Korenoski, Amanda; Patel, Ketan; Vaiyapuri, Sakthivel

doi:10.3390/toxins12120755

Cited by 8 publications

(8 citation statements)

References 35 publications

(38 reference statements)

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“…Our results show an overall increase in the number of exotic snakebites reported to the NPIS compared to what has been described previously [20]. Consistent with other reports [3,4,[11][12][13][14]23,24], the diversity of species remains broad, and males were more likely to be the victims of snakebites. The majority of bites in this series, and others where snakes are kept in captivity, occur on the upper extremities, to fingers, hands and wrists, following deliberate handling interaction especially by males [12], as is the case with bites by native adders (Vipera berus) in the UK [25].…”

Section: Discussionsupporting

confidence: 91%

“…As in other reports [12,23], the specific time from bite to administration of antivenom was not always recorded but was available in approximately 70-80% of cases (76% in our series). In our review the median time to antivenom administration for exotic species was 12 h (range 1-48 h) but included one case of administration of privately held antivenom.…”

Section: Discussionmentioning

confidence: 59%

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Bites by exotic snakes reported to the UK National Poisons Information Service 2009–2020

Jagpal

Williams

Eddleston³

et al. 2022

Clinical Toxicology

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Introduction: Snakebite is recognised as a neglected tropical disease and a cause of substantial morbidity and mortality. Whilst the most medically important snakes are typically native of Asia, Africa, Latin America and Oceania, the possibility of encountering these snakes is no longer limited by geography due to an increasing number of exotic (non-native) snakes being held in captivity. Methods: A retrospective review of snakebite enquiries to the UK National Poisons Information Service (NPIS) between 2009 and 2020. Enquiries about the European adder (Vipera berus) or where the identity of the snake was unknown were excluded. Results: There were 321 exotic snakebites in 300 patients involving 68 different species during this period. Ten patients were bitten on more than one occasion. The majority of patients (64.5%) were male. Most bites were inflicted by snakes of the family Colubridae (184/321, 57.3%); seventeen bites resulted in moderate symptoms (predominantly swelling of the bitten limb). There were 30 (9.3%) bites by Viperidae and 14 (4.3%) bites by Elapidae. All severe cases (n ¼ 15) resulted from bites by either Viperidae (n ¼ 10) or Elapidae (n ¼ 5). Antivenom was given in 17 cases. One fatality was recorded. Conclusions: Despite their low incidence, exotic snakebites present a substantial challenge for UK healthcare professionals. Although rare, these bites typically occur in individuals (usually male) who keep snakes as part of their occupation or hobby and are therefore at risk of multiple bites. Bites can result in venom hypersensitisation and the risk of venom-induced anaphylaxis. Rapid access to expert clinical advice is available in the UK on a 24-hour basis through the National Poisons Information Service and is strongly recommended in all cases of exotic snakebite.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 59%

Bites by exotic snakes reported to the UK National Poisons Information Service 2009–2020

Jagpal

Williams

Eddleston³

et al. 2022

Clinical Toxicology

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“…Two previous US studies examined snakebites from non-native or exotic species. One of those studies surveyed Pennsylvania poison control centers' reports of exotic snakebites during a 14-year period [7]. Eighteen non-native, envenomated snakebite patients were identified, and in most cases, antivenom to treat these patients was difficult to obtain.…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen non-native, envenomated snakebite patients were identified, and in most cases, antivenom to treat these patients was difficult to obtain. It was also reported that since venomous, non-native snakebites are infrequent, available vials of antivenom had expired [7]. The second study examined envenomation across the US and found 258 snakebites from non-native species during a six-year period [8].…”

Section: Discussionmentioning

confidence: 99%

African Bush Viper Envenomation: A Case Report

Imperato¹,

Amaducci²,

Abo³

et al. 2022

Cureus

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Atheris squamigera envenomation is an infrequently documented occurrence in the United States (US). Cases of envenomation may induce severe coagulopathies, renal failure, and potentially life-threatening hemorrhage. Currently, there are no antivenoms specific to the Atheris genus, but there have been documented cases of the use of antivenoms for other species. A 26-year-old man presented to the emergency department (ED) complaining of swelling and discomfort in his left foot after being bitten by an Atheris squamigera that he kept as a pet. After performing a physical exam, it was noted that the patient's envenomation was likely mild. Throughout his hospital stay, he developed lab abnormalities, most notably an elevated D-dimer and low fibrinogen. His clinical symptoms improved after a short stay, and he did not require antivenom treatment. This case highlights a rare, but potentially life-threatening envenomation that may be encountered in the US due to the continued practice of exotic pet ownership and sales. Moreover, procurement of antivenom for non-native species poses a unique challenge to US physicians responsible for treating these patients.

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“…Another study found that one quarter of the snakebites reported in the UK between 2004 and 2010 resulted from non-indigenous snakes, but only 3% were attributed to venomous non-indigenous snakes [5]. Envenomation by exotic pets is an increasing concern in Europe, the USA and Asia, because physicians are often not used to treating patients after an exotic snakebite [3,[6][7][8][9][10][11][12][13]. In addition, the continuing worldwide antivenom shortage poses a further difficulty for specific treatment, since antivenom is the firstline therapy in patients with severe snakebites [2].…”

Section: Introductionmentioning

confidence: 99%

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

et al. 2022

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OBJECTIVE: The private keeping of exotic venomous snakes is legally permitted in Switzerland. The aim of the present study was to characterise the epidemiological and clinical features of bites by exotic venomous snakes over a period of 22 years in Switzerland. METHODS: We included all calls related to exotic snakebites recorded at the Swiss National Poisons Information Centre (Tox Info Suisse) from 1997 to 2018. Exclusion criteria comprised indigenous snakes, non-venomous exotic snakes such boas or pythons, clinical courses incompatible with a snakebite or calls from abroad. Follow-up information was graded according to the Poisoning Severity Score. RESULTS: Within the study period, 1,364 calls related to snakebites were recorded at Tox Info Suisse; 148 (11%) cases were attributed to exotic venomous snakes and fulfilled the study criteria. A total of 112 (98%) of 114 patients with medical follow-up information exhibited sufficient causality between exposure and clinical effects. Only adult patients were affected. The median age was 40 years (range 16–71) and the male gender was predominant (n = 136, 92%). Viperidae were involved in 87 (78%) and Elapidae in 25 (22%) patients. Overall, the main affected body part was the hand (89 patients, 79%). In the majority of the patients the clinical course was mild (46, 41%) or moderate (40, 36%), in a lower proportion asymptomatic (6, 5%) or with severe symptoms (20, 18%). No fatalities were reported in the study period. Severe symptoms were observed after elapid bites in six patients (24%) and after viper bites in 14 patients (16%). Besides local effects, neurological disorders after elapid bites and haematological disorders after viper bites were most frequently reported. Antivenom was administered in 24% (27 patients: 18 Viperidae, 21% and 9 Elapidae, 36%; 5 patients (4%) required multiple doses), overall, with good resolution of symptoms. CONCLUSION: Exotic snakebite is a rare occurrence in Switzerland but has led to medically relevant morbidity, sometimes requiring antivenom treatment. Over half of the envenomed patients required symptomatic or specific treatment. No fatalities or bites in children were reported.

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Exotic Snakebites Reported to Pennsylvania Poison Control Centers: Lessons Learned on the Demographics, Clinical Effects, and Treatment of These Cases

Cited by 8 publications

References 35 publications

Bites by exotic snakes reported to the UK National Poisons Information Service 2009–2020

Bites by exotic snakes reported to the UK National Poisons Information Service 2009–2020

African Bush Viper Envenomation: A Case Report

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

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