Saw-Scaled Viper Bites in Sri Lanka: Is It a Different Subspecies? Clinical Evidence from an Authenticated Case Series

Abstract

Abstract. The saw-scaled viper (SSV) (Echis carinatus) is considered to be a highly venomous snake in Sri Lanka despite any published clinical justification. Being a rarity, the clinical profile of SSV bites is not well established in Sri Lanka. We report a series of 48 (n-48) SSV bites from the Northern Province of Sri Lanka. The majority (65%) of victims had evidence of local envenoming at the site of the bite; however, 29% showed spontaneous bleeding and 71% had coagulopathy. There were no deaths in the series. The envenoming was mild in contrast to the mortality and significant morbidity associated with SSV bites in West Africa and some parts of India. These observations need to be further explored with laboratory studies to identify the venom components, study of morphological characteristics, and genetic profiling of the Sri Lankan SSV to see if it is different from the subspecies found elsewhere.

Proteomics and antivenomics of Echis carinatus carinatus venom: Correlation with pharmacological properties and pathophysiology of envenomation

“…It was also detected by LC-MS/MS analysis in the current study (Table 1 ). Since this basic myotoxic PLA 2 can induce edema in the footpad of experimental Swiss albino mice 52 , the persistent local swelling and edema observed in Echis bite patients 43 , 44 can be correlated with the presence of significant amounts of CRISPs, snaclecs and PLA 2 s in the ECV proteome (Fig. 2a–c ).…”

“…Further, other symptoms of envenomation, such as hemoptysis, haematemesis, and haematuria, observed in a few patients bitten by E . carinatus 43 , 44 (personal communication from Dr. A. Zachariah, CMC, Vellore) may be correlated to the existence of PLA 2 s, SVMPs, and SVSPs in ECV (Table 1 , Fig. 2c ).…”

A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka

“…Most saw-scaled viper ( Echis carinatus ) bites (69%) occurred in the night, outdoors [19]. However a study done in Jaffna peninsula Sri Lanka shows most saw-scaled viper ( Echis carinatus ) bites occurred during daylight [20].…”

“…They inhabit the coastal areas of the dry zone [19]. A study done by Kularatne et al [20] in Jaffna peninsula Sri Lanka shows that 15% of bite victims were school children.…”

Life threatening intracerebral haemorrhage following saw- scaled viper (Echis carinatus) envenoming-authenticated case report from Sri Lanka

“…In a case series involving 48 SSV bite victims, 71% had coagulopathy as evidence by 20 min WBCT. Spontaneous bleeding occurred in 29% and majority of them had either haematuria or haematemesis [4]. All the published case series of SSV bite in Sri Lanka failed to report any life threatening bleeding manifestations such as retoperitoneal, plero-pericardial or intracranial bleeding [4-6].…”