Retrospective Documentation of a Confirmed White-Lipped Green Pit Viper (Trimeresurus albolabris Gray, 1842) Bite in the South-Central Hills of Nepal

Abstract

This case report documents envenomation by an arboreal white-lipped green pit viper (Trimeresurus albolabris), a species found in South and Southeast Asia that causes the majority of venomous snakebites among Southeast Asian pit vipers. Clinical features vary from asymptomatic to serious coagulopathy that may progress into life-threatening or fatal hemorrhage. The proven life-threatening cases described in published literature, however, are sparse. Practically, no specific antivenom targeted to pit viper bites is available in Nepal. We report a case (managed with several non-evidence-based interventions) of noticeable coagulopathic envenomation due to confirmed T albolabris bite in Nepal. This is the first known reported case of such a bite in Nepal. This case highlights the urgent need to improve diagnosis, monitoring, and supportive care for bite victims and to study the effectiveness of Thai pit viper antivenoms for the treatment of T albolabris envenomations.

Case Report: Management of Pit Viper Envenoming without Antivenom: A Case Series

“…There is no evidence that the polyvalent snake antivenoms imported from India neutralized venoms of other species of snakes of Nepal. 2,5 Most of our patients presented with local symptoms and coagulopathy. The common tests to measure coagulopathy due to hemotoxic snake envenoming are 20WBCT and PT/INR.…”

Proteome Decomplexation of Trimeresurus erythrurus Venom from Mizoram, India

“…The pathophysiological abnormalities caused by SVMPs include hemorrhage, edema, myonecrosis, hypotension, blistering, dermonecrosis, and coagulopathy. 28,40 The clinical manifestations of green pit vipers are characterized by local symptoms such as extensive pain, bleeding, and progressive swelling of the bite site, also tissue necrosis in few cases, 9,12,30,41 which can be attributed to SVMPs constituting approx. 10% of T. erythrurus venom (Figure 1D).…”

“…erythrurus (Table ) which were eluted in peaks 6, 7, and 8 observed as 30–37 kDa bands in the SDS-PAGE profile (Figure E). The thrombin-like enzymes (TL-SVSPs), a subgroup of SVSPs, cleave fibrinogen to fibrin monomers, leading to the formation of unstable clots (initial procoagulant effects), which readily get dissolved, thereby giving an overall anticoagulant effect (consumptive coagulopathy) caused by defibrination. , This pathological effect has been frequently observed in victims of Trimeresurus bites. , Interestingly, four proteins showing sequence homology with serine proteases cloned from a venom gland cDNA library of T. albolabris were observed in the T. erythrurus proteome.…”

Snakebite in the Hills and Mountains of Nepal

“…20 No antivenom is available to treat pit viper envenoming as there is no evidence that the polyvalent snake antivenoms imported from India neutralize the venoms of other species of snakes in Nepal. 4 , 21 Often, the referral centres are far away, with tedious transportation routes, 22 making it even more troublesome to reach a good facility. Even if some patients reach referral centres, the long transit time raises the probability of local and systemic complications, sometimes resulting in death on the way to the hospital.…”