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Exotic snakebite
Essentials
- 1
Exotic snakebite is a growing issue worldwide, especially with the growth in illegally held snakes.
- 2
Symptoms and signs may be different to those seen in Australian snakebites.
- 3
As many non-Australian snakes, especially the vipers, cause local tissue destruction and damage, pressure bandage immobilization is not recommended.
- 4
Expert advice is available and recommended in managing these cases and helping locate antivenom.
- 5
Often there is a higher rate of allergic reaction due to overseas antivenom compared with Australian antivenom.
Introduction
Snakebite is a global phenomenon, with >2.5 million cases, >100,000 deaths and >400,000 amputations annually (this is greater than the annual amputation rate due to landmines). Australia accounts for a tiny fraction of all snakebite cases.
Exotic snakebite is a worldwide problem, with increasing seizures of illegally imported snakes and illegal collections by national authorities.
Exotic snakebite in Australia is either where an Australian snake species bites a person in a region where this snake is not usually found (e.g. a pet taipan bites its owner in Hobart), or where a snake not native to Australia bites someone in Australia. This chapter will focus on this second scenario.
Table 26.2.1 provides a list of selected genera/species, with distribution, clinical effects and major modes of treatment.
Table 26.2.1
Selected exotic snakes—overview of clinical effects and management
| Snake | Distribution a | Clinical effects b | Treatment c |
|---|---|---|---|
| Family Colubridae | |||
| Boomslang ( Dispholidus typus ) | SSAf | CC, NF, BH, HF | AV, BP, IV, NC |
| Bird/vine/twig snakes ( Thelotornis spp.) | SSAf | CC, NF, BH, HF | BP, IV, NC |
| Family Natricidae | |||
| Keelback and yamakagashi ( Rhabdophis spp.) | SEAs, EAs | CC, BH, HF | AV, IV, BP |
| Family Elapidae | |||
| New Guinea small-eyed snake (Micropechis ikaheka) | PNG (New Guinea) | PU, M, AC, NF | AV, IV, NC, ST |
| Bolo (Ogmodon vitianus) | PNG (Fiji) | ?LS | IV, ST |
| Bougainville coral snake (Parapistocalamas hedigeri) | PNG (Bougainville) | ?LS | IV, ST |
| Solomons coral snake (Salomonelaps par) | PNG (Solomon Islands) | ?LS | IV, ST |
| PNG forest snakes ( Toxicocalamus spp.) | PNG (New Guinea) | ?LS | IV, ST |
| Asian coral snakes ( Calliophis spp.) | SEAs | PU, RF | IV, ST, AC |
| Asian spitting cobras ( Naja spp.) | SEAs, EAs, Ind | PN, SO, LI, HF | AV, IV, LC, AC |
| Asian cobras ( Naja spp.) | SEAs, EAs, Ind, As | PN, RF, LI (some) | AV, IV, LC, AC |
| King cobra (Ophiophagus hannah) | SEAs, Ind | PN, RF, LI, HF | AV, IV, LC, AC, ST |
| Kraits ( Bungarus spp.) | SEAs, EAs, Ind | PP, PN, RF, M | AV, IV, ST |
| Desert black snake (Walterinnesia aegyptia) | ME, NtAf | PN, RF | ST, IV, ?AV d |
| Water cobras ( Naja [ex Boulengerina ] spp.) | SSAf | PN, RF | ST, IV |
| African spitting cobras ( Naja spp.) | SSAf, NtAf, ME | SO, LI, PN, HF | AV, IV, LC |
| African cobras ( Naja spp.) | SSAf, NtAf, ME | PN, RF, LI (some) | AV, IV, LC, ST, AC? |
| Mambas ( Dendroaspis spp.) | SSAf | PD, RF, LI (some) | AV, IV, ST, LC |
| Rinkhals (Hemachatus haemachatus) | SSAf | LI, PN | AV, IV, LC, ST |
| African coral snakes ( Aspidelaps spp.) | SSAf | PN, RF | IV, ST, AC? |
| African garter snakes ( Elapsoidea spp.) | SSAf | LS | IV, ST |
| Tree cobras ( Pseudohaje spp.) | SSAf | LS | IV, ST |
| Spotted harlequin snakes ( Homoroselaps spp.) | SSAf | ?LS | IV, ST |
| Burrowing cobra ( Paranaja spp.) | SSAf | LS | IV, ST |
| American coral snakes ( Micrurus , Leptomicrurus spp.) | NtAm, CeAm, StAm | PN, PP (some), M, RF | AV, IV, ST |
| US coral snake ( Micruroides euryxanthus ) | NtAm | PN, RF | IV, ST |
| Sea snakes (many species) | Indo-Pacific | PN, RF, M, NF | AV, IV, ST, AC, NC |
| Family Viperidae (Viperinae; old world, non-pit vipers/adders) | |||
| Russell’s vipers ( Daboia spp.) | SEAs, EAs, Ind | CC, BH, BD, BS, NF, HF, LI, PU, RF, M | AV, IV, ST, LC, NC, BP |
| Saw scaled vipers ( Echis spp.) | Ind, WAs, ME, NtAf, SSAf | CC, BH, BD, NF, HF, LI | AV, IV, ST, LC, NC, BP |
| Horned vipers ( Pseudocerastes spp.) | ME, WAs | LS, PU? | IV, ST |
| Horned vipers ( Cerastes spp.) | ME, NtAf | LI, CC, BH, NF, HF | AV, IV, ST, LC, NC, BP |
| Puff and Gaboon adders ( Bitis spp.) | SSAf, NtAf | LI, HF, BD | AV, IV, ST, LC |
| Berg adders ( Bitis atropos , etc.) | SSAf | LI, HF, PU, RF | IV, ST, LC |
| Night adders ( Causus spp.) | SSAf, NtAf | LS, PU | IV, ST, LC |
| Bush vipers ( Atheris , Montatheris , Proatheris spp.) | SSAf | LS, CC, HF | AV e , IV, ST, LC, BP |
| McMahon’s viper ( Eristocophis mcmahoni ) | WAs, ME | LI, HF, PU? | IV, ST, LC |
| Barbour’s bush viper ( Adenorhinos barbouri ) | SSAf | LS | IV, ST |
| Fea’s viper ( Azemiops feae ) | EAs, SEAs, As | LS | IV, ST |
| European adders ( Vipera , Macrovipera spp.) | NtAf, EU, ME, As | LI, CC, HF, BD, PU | AV, IV, ST, LC, BP |
| Family Viperidae (Crotalinae; pit vipers) | |||
| Copperhead, cottonmouth, cantils ( Agkistrodon spp.) | NtAm, CeAm | LI, CC, HF, BD, NF | AV, IV, ST, LC |
| Jumping vipers ( Atropoides spp.) | CeAm | LS, HF | IV, ST, LC |
| Lancehead vipers ( Bothrops spp.) | StAm, CeAm | LI, HF, CC, BD, NF, LA, RF, DV (Caribbean spp.) | AV, IV, ST, LC, NC |
| Palm pit vipers ( Bothriechis spp.) | CeAm | LI, HF, BD | AV, IV, ST, LC, NC |
| Malayan pit viper (Calloselasma rhodostoma) | SEAs | LI, HF, CC, BH, BD, NF | AV, IV, ST, LC, NC |
| Montane pit vipers ( Cerriphidion spp.) | CeAm | LI, HF, BD | AV, IV, ST, LC, NC |
| North American rattlesnakes ( Crotalus spp.) | NtAm | LI, HF, CC, BH, BD, NF, PP & RF (few spp.) | AV, IV, ST, LC, NC, BP |
| South American rattlesnakes ( Crotalus spp.) | CeAm, StAm | CC, BH, M, PP, RF, NF | AV, IV, ST, NC |
| Hundred pace viper (Deinagkistrodon acutus) | EAs | LI, HF, BD, NF | AV, IV, ST, LC, NC |
| Mamushis, etc ( Gloydius spp.) | EAs, SEAs | LI, HF, CC, BD, PU, RF, M, NF | AV, IV, ST, LC, NC |
| Hump nosed vipers ( Hypnale spp.) | Ind | LI, HF, CC, BH, NF | IV, ST, LC, NC |
| Bushmaster ( Lachesis spp.) | CeAm, StAm | LI, HF, CC, BH, BD | AV, IV, ST, LC |
| Horned pit viper ( Ophryacus spp.) | CeAm | LI, HF | IV, ST, LC |
| Montane pit vipers ( Porthidium spp.) | CeAm | LI, HF | IV, ST, LC |
| Habus ( Protobothrops spp.) | EAs, Ind | LI, HF, CC, BH, BD | AV, IV, ST, LC, NC |
| Pygmy rattlesnakes ( Sistrurus spp.) | NtAm | LI, HF, CC, BD | AV, IV, ST, LC |
| Green tree vipers ( Trimeresurus spp. incorporating spp. variously assigned to the genera Ovophis , Crypteletrops , Popeia , Parias , Viridovipera , Himalayophis , Peltopelor ) | SEAs, EAs, Ind | (varies significantly between species) LI, HF, CC, BH, BD, NF | AV, IV, ST, LC, NC, BP |
| Temple pit vipers ( Tropidolaemus spp.) | SEAs, Ind | LI, HF | IV, ST, LC |
| Mount Mang pit viper ( Protobothrops [ex Zhaoermia ] mangshanensis ) | EAs | LI, HF | IV, ST, LC |
The Australian snake fauna is not listed here (see previous chapter).
a Key to distribution : (Note: distribution is based on region and does not imply a given snake is either common or is found throughout the region; it may have limited distribution within the region.) As , Rest of Asia; Aus , Australia; CeAm , Central America; EAs , Eastern Asia (China, Japan, Korea, etc.); Eur , Europe; Ind , Indian region; ME , Middle East; NtAf , North Africa; NtAm , North America; PNG , New Guinea and adjacent Pacific; SEAs , South East Asia; SSAf , Sub-Saharan Africa; StAm , South America; Was , Western Asia.
b Key to clinical effects: (Note: listed clinical effects are based on best available information, but in some cases, very little information is available, and for these snakes, it should be considered a ‘best guess’ to guide care, not definitive.) AC , Anticoagulant coagulopathy; BD , haemorrhagin-based bleeding; BH , coagulopathy-based bleeding; BS , anterior pituitary infarction/hypopituitarism; CC , consumptive coagulopathy; DV , thrombosis & DVTs, etc.; HF , haemodynamic problems, shock; LA , local abscess formation; LI , local tissue injury/necrosis; LS , local swelling, not necrosis; M , myolysis; NF , renal damage/failure; PD , pre- and postsynaptic synergistic paralysis and fasciculation (mambas); PN , postsynaptic flaccid paralysis; PP , presynaptic flaccid paralysis; PU , flaccid paralysis, unspecified toxin types; RF , respiratory failure; SO , venom spit ophthalmia.
c Key to treatment: AC , Postsynaptic only flaccid paralysis may respond to neostigmine+atropine, if antivenom delayed or unavailable; AV , antivenom available (for details of available antivenoms see www.toxinology.com ); BP , consider blood products as replacement in consumptive coagulopathy with major active bleeding—if antivenom available ensure adequate antivenom given first; IV , ensure adequate IV fluid hydration, watch for and treat shock (mostly hypovolaemic); LC , local wound care essential (necrosis or abscess potential); NC , particular risk of renal damage, ensure good hydration, renal output, strict fluid balance charting; ST , supportive treatment; may include intubation and ventilation for respiratory paralysis.
d No specific antivenom available, but some report South African Vaccine Producers polyvalent may be helpful in severe Walterinnesia bites.
e No specific antivenom available, but some report South African Vaccine Producers anti- Echis may be helpful in severe Atheris bites.
Bites by captive non-native (exotic) venomous snakes
There is an increasing number and diversity of exotic venomous snakes being kept in captivity, especially in private collections, either legally or often illegally (in Australia only registered zoos can legally keep exotic venomous snakes).
Exotic snakes may cause quite different patterns of envenoming compared with native snakes, and exotic antivenoms are required, which may be difficult to obtain. Doctors may not be trained in managing such bites. The person bitten may have limited knowledge of the risks, appropriate first aid, and if the snakes are illegally kept, may delay presentation with resultant more severe complications. Bites occurring in legal collections (zoos) present early, with correct first aid and appropriate antivenom immediately available.
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