Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management

Abstract

Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment. We report the clinical symptoms induced by envenomations and poisoning caused by reptiles, fishes, amphibians and mammals in Europe, ranging from mild, local symptoms (e.g., erythema, edema) to systemic and potentially deadly. The present work constitutes a tool for physicians to recognize envenomation/poisoning symptoms caused by the most medically relevant European vertebrates and to decide which approach is the most appropriate to treat them.

Zootoxins and Domestic Animals: A European View

“…Poisonous amphibians are ubiquitous in Europe. Among many genera, only a few, Salamandra (fire and alpine salamanders), Bufo, Bombina , and Pleurodeles can have relevant toxic effects on humans and animals [ 10 , 71 ]. The largest species of salamander in Europe is the fire salamander ( Salamandrinae, Salamandra salamandra ) [ 72 ].…”

“…Even if there are many anecdotal reports on dog poisoning involving the fire salamander, only a few case reports have been published [ 6 , 71 ]. A possible cause of the scarce information about fire salamander poisoning in domestic animals in the scientific literature is the acute evolution and usually fatal outcome of the disease, with many of the cases remaining undiagnosed [ 10 ].…”

A Guide to the Clinical Management of Vipera Snakebite in Italy

“…Snakebites are an often-overlooked issue in Europe [ 11 , 12 , 13 , 14 ]. In fact, although Europe is home to a considerable number of medically important snake species, exclusively belonging to the subfamily Viperinae (i.e., “true vipers”, family Viperidae [ 13 , 14 , 15 ]), people in this continent are rarely exposed to inadvertent interactions with wild snakes, and can usually rapidly access healthcare institutes in case of complications due to envenomation. Nonetheless, despite the reduced annual number of snakebite records, serious and even life-threatening snakebite accidents do occur [ 11 , 14 ].…”

Venomics of the milos viper (Macrovipera schweizeri) unveils patterns of venom composition and exochemistry across blunt-nosed viper venoms

“…Indeed, pit vipers (subfamily Crotalinae) are the main cause of snakebite-related morbidity and mortality in the Neotropics ( Gutiérrez, 2014 ; da Silva et al, 2019 ), while true vipers (subfamily Viperinae) are snakes of high medical importance in Africa, Asia and Europe ( WHO, 2020 ). For instance, envenomations caused by blunt-nosed vipers (genus Macrovipera ) are known to cause considerably severe, potentially lethal clinical manifestations in the Near and Middle East ( Warrell, 2008 ; Amr et al, 2020 ; Dehghani et al, 2023 ), and are considered medically important also in Europe ( Jestrzemski et al, 2022 ; Paolino et al, 2023 ).…”