Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment

Abstract

Aim. This case report presents envenoming by the Chinese pit viper Protobothrops mangshanensis (formerly Zhaoermia) and its treatment. Methods. A 38 year old snake breeder suffered two-fang bites to elbow by a Chinese pit viper Protobothrops mangshanensis resulting in local edema of the affected arm. No other signs of envenoming appeared. On the 5 th day following the bite a hematoma developed on the other arm which had been mechanically injured 14 days before. Laboratory testing revealed severe coagulopathy with hypofibrinogenemia and immeasurably prolonged coagulation times. Results. As substitution therapy with fibrinogen and fresh frozen plasma was unsuccessful and specific antivenom is not produced, antivenin against some other Asian pit vipers GREEN PIT VIPER ANTIVENIN, Thai Red Cross, Thailand was applied. Three doses of antivenom reversed the course of the hemocoagulation disorder. Conclusion. The case confirms the persistence of active venom components affecting coagulation, difficulty in ameliorating the hemocoagulatin disorder caused by snake venom through substitution therapy and the effectiveness of delayed treatment using antivenin. It points out the potential risk of a clinically asymptomatic progress of envenoming by snake venoms containing hemocoagulation acting components, if the hemocoagulation disorder is not investigated and suitably treated. Therapy using the GREEN PIT VIPER ANTIVENIN, Thai Red Cross, Thailand in this case of envenomation by a Protobothrops mangshanensis bite proved to be applicable and the antivenom could be characterised as a paraspecific active.

Biochemical and proteomic analyses of venom from a new pit viper, Protobothrops kelomohy

“…and Protobothrops sp. [8,9,19,28,35,40]. An in vivo study using TAAV against the heterologous venoms of four Indonesian Trimeresurus species confirmed that the closer phylogenetic relationship of interspecific snakes provided better cross-neutralizing capacity [28].…”

“…Within these validated species, a new distribution of P. mucrosquamatus has been recently reported in Nan Province, northern Thailand [7]. Protobothrops bites have constituted a serious health problem given that its highly hematotoxic venom causes a profoundly delayed coagulopathy, hypofibrinogenemia [8,9], potent hemorrhagic shock effects, acute kidney injury, rhabdomyolysis and fatality [10][11][12]. P. mucrosquamatus has been widely recognized for its high medical importance (Category 1) in China and Taiwan, and moderate medical importance (Category 2) in India, Vietnam, Myanmar (Kachin State) and Laos [13].…”

The Treatment of Unidentified Hematotoxic Snake Envenomation and the Clinical Manifestations of a Protobothrops kelomohy Bite

“…bites from other countries show that envenomation may cause many complications similar to those in this case. 7 -10 In this case report, P kelomohy venom could produce both local and systemic effects. The clinical symptoms included suspected compartment syndrome in the bitten limb and systemic involvement, including coagulopathy and rhabdomyolysis, which developed within the first day of the bite, indicating the severity of the venom.…”

“…Two cases involving the use of green pit viper antivenom against Protobothrops mangshanensis have been reported. 8,9 These patients had a delay in the onset of complications involving bleeding observed on days 5 and 6 after envenomation. Both cases showed improvement of coagulopathy within 24 h after the first dose of green pit viper antivenom.…”

Habitat association in the critically endangered Mangshan pit viper (Protobothrops mangshanensis), a species endemic to China

“…Most studies on the Mangshan pit viper have focused on venom ( Mebs et al, 2006 ; Murakami et al, 2008 ; Valenta, Stach & Otahal, 2012 ), identification of individuals ( Yang et al, 2013 ), and on population status and distribution ( Gong et al, 2013 ). However, little is known about their habitat requirements, which would provide basic information about how the snake meets its needs for survival; therefore, this information is especially crucial in efforts to preserve this at-risk species ( Zhou, 2012 ).…”