Infant death after nose-horned viper (Vipera ammodytes ammodytes) bite in Croatia: A case report

Lukšić, Boris; Čulić, Viktor; Stričević, Luka; Brizić, Ivica; Poljak, Nikola Kolja; Tadić, Zoran

doi:10.1016/j.toxicon.2010.08.009

Cited by 16 publications

(3 citation statements)

References 17 publications

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“…Arrhythmias in V. a. ammodytes bitten patients could be also due to the V. a. ammodytes venom itself, particularly the ammodytoxins. These are capable of inducing several conduction and electrophysiological disturbances, including the occurrence of malignant ventricular arrhythmias [15], due to direct myo-cytotoxic, electrophysiological, prothrombotic and coronary vasoconstrictive effects [16,17]. …”

Section: Discussionmentioning

confidence: 99%

A Single Dose of ViperfavTM May Be Inadequate for Vipera ammodytes Snake Bite: A Case Report and Pharmacokinetic Evaluation

Kurtović

Brvar

Grenc

et al. 2016

Toxins

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ViperfavTM is a commercial F(ab’)2 antivenom prepared against European vipers venom. It is safe and effective for treating envenomation caused by Vipera aspis and Vipera berus. Therapeutic efficacy for treating Vipera ammodytes ammodytes (V. a. ammodytes) envenoming has not been yet described, although protective efficacy has been demonstrated in preclinical studies. We report on a 32-year-old man bitten by V. a. ammodytes who was treated with Viperfav™. Viperfav™ promptly reduced local extension and improved systemic pathological signs, but 24 h after the incident a recurrence of thrombocytopenia occurred despite a favorable pharmacokinetic profile with systemic clearance (1.64 (mL·h−1)·kg−1) and elimination half-life (97 h) among the highest ever reported. The recommended dose of Viperfav™ for V. aspis and V. berus bites may be inadequate for serious V. a. ammodytes envenomations. Following V. a. ammodytes bite, serial blood counts and coagulation profiles should be performed to help guide Viperfav™ treatment, along with supplemental administration as indicated.

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Section: Discussionmentioning

confidence: 99%

A Single Dose of ViperfavTM May Be Inadequate for Vipera ammodytes Snake Bite: A Case Report and Pharmacokinetic Evaluation

Kurtović

Brvar

Grenc

et al. 2016

Toxins

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“…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 …”

Section: Introductionmentioning

confidence: 99%

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

Paolino

Nicola²,

Pontara

et al. 2020

Acad Dermatol Venereol

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In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.

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“…Plasma glucose levels as high as 486 mg/dL at 2 hours and 223 mg/dL at 4 hours have been documented in an infant, after a lethal bite from the nose-horned viper (Vipera ammodytes ammodytes) in Croatia. 58 In a retrospective study of viper bites in a pediatric population, hyperglycemia was found to correlate with the risk of high-grade envenoming based on clinical severity criteria described by Audebert et al 59 Plasma glucose > 200 mg/dL has also been reported in seven of 44 cases of the many-banded krait (Bungarus multicinctus multicinctus) envenoming in Taiwan. One of the victims was later diagnosed to have diabetes mellitus.…”

Section: Adrenal Disordersmentioning

confidence: 99%

Endocrine and Metabolic Manifestations of Snakebite Envenoming

Bhattacharya

Gopalakrishnan

Kalra

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Snakebite envenoming is a neglected, public health problem in tropical and subtropical regions. Local tissue necrosis, neurotoxic, and hemo-vasculotoxic effects are well-recognized features, whereas the endocrine and metabolic derangements are not as well known. In addition to contributing to morbidity, some of these manifestations can be potentially life-threatening if not recognized early. The most prominent endocrine manifestation is hypopituitarism (HP), which can manifest acutely or remain asymptomatic and present years later. Unexplained recurrent hypoglycemia and refractory hypotension are early clinical clues to suspect corticotroph axis involvement in acute settings. Chronic pituitary failure may present, like Sheehan's syndrome, several years after the bite. The occurrence of acute kidney injury, capillary leak syndrome, and disseminated intravascular coagulation are predictors of HP. Adrenal hemorrhages are documented in autopsy series; however, primary adrenal insufficiency is very rare and confounded by the presence of HP. Hyponatremia, hypokalemia or hyperkalemia, and dysglycemia can occur, but the mechanisms involved are only partially understood. Awareness, a high index of suspicion, correct interpretation of hormonal parameters, and timely treatment of these abnormalities can be lifesaving.

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Infant death after nose-horned viper (Vipera ammodytes ammodytes) bite in Croatia: A case report

Cited by 16 publications

References 17 publications

A Single Dose of ViperfavTM May Be Inadequate for Vipera ammodytes Snake Bite: A Case Report and Pharmacokinetic Evaluation

A Single Dose of ViperfavTM May Be Inadequate for Vipera ammodytes Snake Bite: A Case Report and Pharmacokinetic Evaluation

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

Endocrine and Metabolic Manifestations of Snakebite Envenoming

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