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Pathophysiology and Treatment of Envenomation by European Vipers

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Clinical Toxinology in Asia Pacific and Africa

Abstract

Significant envenoming caused by European snakes is related to bites by species belonging to the family Viperidae, genus Vipera. The most common vipers in Europe are Vipera berus berus, Vipera aspis, and Vipera ammodytes. Vipers living in more restricted areas are, e.g., Vipera latastei, Vipera xanthina, Vipera lebetina, Vipera ursinii, Vipera berus bosniensis, and Vipera palaestinae. The venom of European vipers may cause anything from mild to severe and sometimes life-threatening reactions. Envenoming related to bites by European vipers may cause severe systemic symptoms and extensive local tissue damage. The symptoms caused by the different European vipers are rather similar, but there are a few important differences. Bites in the extremities result in local swelling and hemorrhagic discoloration. Parts or the whole of the bitten extremity might become affected, but the swelling may also gradually involve large parts of the trunk. The severity of the envenoming is related to the amount of venom injected and the age of the patient. Small children are more vulnerable as a certain dose becomes more noxious the smaller the victim is. Common systemic symptoms are abdominal pain, vomiting and diarrhea, hemodynamic instability, CNS depression – even coma and seizures have been observed in small children – and anemia that may become pronounced and require blood transfusions. Leukocytosis is common and if pronounced it may be a sign of severe envenoming. Also thrombocytopenia may occur. Some southern European vipers, e.g., Vipera aspis and Vipera berus bosniensis, may also cause neurological symptoms. A recent publication indicates that neurotoxicity also may develop after bites by Vipera ammodytes. Treatment of bites by European vipers includes both symptomatic care and specific therapy with antivenins. In Europe both equine and ovine antivenins are available. Vipera berus berus is considered to have the most widespread geographical distribution of all venomous snakes.

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References

  • Aravanis C et al. Acute myocardial infarction and cerebrovascular accident in a young girl after a viper bite. Br Heart J. 1982;47:500–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Audebert F, Sorkine M, Bon C. Envenoming by viper bites in France: clinical gradation and biological quantification by ELISA. Toxicon. 1992;30:599–609.

    Article  CAS  PubMed  Google Scholar 

  • Audebert F, Sorkine M, Robbe-Vincent A, Bon C. Viper bites in France: clinical and biological evaluation; Kinetics of Envenomations. Hum Exp Toxicol. 1994;13:683–8.

    Article  CAS  PubMed  Google Scholar 

  • Beer E, Musiani R. A case of intestinal infarction following Vipera aspis bite. Toxicon. 1998;36:729–33.

    Article  CAS  PubMed  Google Scholar 

  • Bouquier JJ, Guibert L, Dupont R, Umdenstock R. Les piqûres de Vipère chez l’enfant. Arch Fr Pediatr. 1974;31:285–96.

    CAS  PubMed  Google Scholar 

  • Boviatsis EJ, Kouyialis AT, Papatheodorou G, Gavra M, Korfias S, Sakas DE. Multiple hemorrhagic brain infarcts after viper envenomation. Am J Trop Med Hyg. 2003;68:253–7.

    PubMed  Google Scholar 

  • Chippaux JP. Epidemiology of snake bites in Europe: a systematic review of the literature. Toxicon. 2012;59:86–99.

    Article  CAS  PubMed  Google Scholar 

  • de Haro L. Management of snakebites in France. Toxicon. 2012;60:712–8.

    Article  PubMed  Google Scholar 

  • de Haro L, Robbe-Vincent A, Saliou B, Valli M, Bon C, Choumet C. Unusual neurotoxic envenomations by Vipera aspis aspis snakes in France. Hum Exp Toxicol. 2002;21:137–45.

    Article  PubMed  Google Scholar 

  • Gerrard M, Pugh R. An adder bite with unusual consequences. Practitioner. 1982;226:527–8.

    CAS  PubMed  Google Scholar 

  • González D. Epidemiological and clinical aspects of certain venomous animals of Spain. Toxicon. 1982;20:925–8.

    Article  PubMed  Google Scholar 

  • Grenc D, Groselj-Grenc M. Vipera berus and Vipera ammodytes bites in Slovenia: distribution and clinical characteristics. Clin Toxicol. 2012;50:286.

    Google Scholar 

  • Karlson-Stiber C, Persson H. Antivenom treatment in Vipera berus envenoming – report of 30 cases. J Int Med. 1994;235:57–71.

    Article  CAS  Google Scholar 

  • Karlson-Stiber C, Persson H, Heath A, Al-Abdulla IH, Sjöström L. First clinical experiences with specific sheep Fab fragments in snake bite. Report of a multicentre study of Vipera berus envenoming. J Int Med. 1997;241:53–8.

    Article  CAS  Google Scholar 

  • Karlson-Stiber C, Salmonson H, Persson H. A nationwide study of Vipera berus bites during one year – epidemiology and morbidity of 231 cases. Clin Toxicol. 2006;44:25–30.

    Article  Google Scholar 

  • Kjellström BT. Acute pancreatitis after snake bite. Acta Chir Scand. 1989;155:291–2.

    PubMed  Google Scholar 

  • Klemmer K. Classification and distribution of European, North African, and North and West Asiatic venomous snakes. In: Bücherl W, Buckley E, Deulofeu V, editors. Venomous animals and their venoms, vol. 1. New York: Academic; 1968. p. 309–25.

    Chapter  Google Scholar 

  • Lomonte B, Lundgren J, Johansson B, Bagge U. The dynamics of local tissue damage induced by Bothrops asper snake venom and myotoxin II on the mouse cremaster muscle: an intravital and electron microscopic study. Toxicon. 1994;32:41–55.

    Article  CAS  PubMed  Google Scholar 

  • Malina T et al. First clinical experiences about the neurotoxic envenoming inflicted by lowland populations of the Balkan adder, Vipera berus bosniensis. Neuro Toxicol. 2011;32:68–74.

    CAS  Google Scholar 

  • Marinov I, Atanasov VN, Stankova E, Duhalov D, Petrova S, Hubenova A. Severe coagulopathy after Vipera ammodytes ammodytes snake bite in Bulgaria: a case report. Toxicon. 2010;56:1066–9.

    Article  CAS  PubMed  Google Scholar 

  • Moore RS. Second-degree heart block associated with envenomation by Vipera berus. Arch Emerg Med. 1988;5:116–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Pande R, Khan HN. Acute pancreatitis following adder bite in the UK: a case report. Ann R Coll Surg Engl. 2010;92:1–2.

    Article  Google Scholar 

  • Persson H, Irestedt B. A study of 136 cases of adder bite treated in Swedish hospitals during one year. Acta Med Scand. 1981;210:433–9.

    Article  CAS  PubMed  Google Scholar 

  • Persson H et al. Poisoning severity score. Grad Acute Poison Clin Toxicol. 1998;36:205–13.

    CAS  Google Scholar 

  • Pozio E. Venomous snake bites in Italy: epidemiological and clinical aspects. Trop Med Parasit. 1988;39:62–6.

    CAS  Google Scholar 

  • Salmonsson H, Karlson-Stiber C, Persson H. Thrombocytopenia in envenoming by the common European Adder, Vipera berus. Clin Toxicol. 2010;48:296–7.

    Google Scholar 

  • Sars L, Sega S, Zidar J. Neurotoxicity caused by Vipera ammodytes bite: a case report. J Toxicol. 2013;51(4):275.

    Google Scholar 

  • Schabel F, Mitterstieler G, Nirk S. Kasuistik Glomerulonephritis nach Schlangenbiss. Padiatr Padol. 1980;15:61–6.

    CAS  PubMed  Google Scholar 

  • Sjöström L, Karlson-Stiber C, Persson H, Ibrahim H, Al-Abdulla SC. Development and clinical application of immunoassays for European adder (Vipera berus berus) venom and antivenom. Toxicon. 1996;34:91–8.

    Article  PubMed  Google Scholar 

  • Tiwari I, Johnston WJ. Blood coagulability and viper envenomation. Lancet. 1986;15:613–4.

    Article  Google Scholar 

  • Westerström A, Petrow B, Tzankov N. Envenoming following bites by the Balkan adder Vipera berus bosniensis – first documented case series from Bulgaria. Toxicon. 2010;56:1510–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Swedish Poisons Information Centre, Stockholm, Sweden

    Hans Persson

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  1. Hans Persson
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Correspondence to Hans Persson .

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Editors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    P. Gopalakrishnakone

  2. Dept. of Soil, Water and Environment, University of Dhaka, Dhaka, Bangladesh

    S.M.A. Faiz

  3. Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Christeine Ariaranee Gnanathasan

  4. Department of Medicine, Bayero University Kano Aminu Kano Teaching Hospital, Kano, Nigeria

    Abdulrazaq Garba Habib

  5. Department of Forensic Medicine and Toxi, University of Colombo, Colombo, Sri Lanka

    Ravindra Fernando

  6. Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan

    Chen-Chang Yang

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Persson, H. (2015). Pathophysiology and Treatment of Envenomation by European Vipers. In: Gopalakrishnakone, P., Faiz, S., Gnanathasan, C., Habib, A., Fernando, R., Yang, CC. (eds) Clinical Toxinology in Asia Pacific and Africa. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6288-6_9-1

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  • DOI: https://doi.org/10.1007/978-94-007-6288-6_9-1

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  • Publisher Name: Springer, Dordrecht

  • Online ISBN: 978-94-007-6288-6

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