Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012, 156(2):183-185 | DOI: 10.5507/bp.2012.021

Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment

Jiri Valenta, Zdenek Stach, Michal Otahal
Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic

Aim: This case report presents envenoming by the Chinese pit viper Protobothrops mangshanensis (formerly Zhaoermia) and its treatment.

Methods: A 38 year old snake breeder suffered two-fang bites to elbow by a Chinese pit viper Protobothrops mangshanensis resulting in local edema of the affected arm. No other signs of envenoming appeared. On the 5th day following the bite a hematoma developed on the other arm which had been mechanically injured 14 days before. Laboratory testing revealed severe coagulopathy with hypofibrinogenemia and immeasurably prolonged coagulation times.

Results: As substitution therapy with fibrinogen and fresh frozen plasma was unsuccessful and specific antivenom is not produced, antivenin against some other Asian pit vipers GREEN PIT VIPER ANTIVENIN, Thai Red Cross, Thailand was applied. Three doses of antivenom reversed the course of the hemocoagulation disorder.

Conclusion: The case confirms the persistence of active venom components affecting coagulation, difficulty in ameliorating the hemocoagulatin disorder caused by snake venom through substitution therapy and the effectiveness of delayed treatment using antivenin. It points out the potential risk of a clinically asymptomatic progress of envenoming by snake venoms containing hemocoagulation acting components, if the hemocoagulation disorder is not investigated and suitably treated. Therapy using the GREEN PIT VIPER ANTIVENIN, Thai Red Cross, Thailand in this case of envenomation by a Protobothrops mangshanensis bite proved to be applicable and the antivenom could be characterised as a paraspecific active.

Keywords: snakebite, coagulopathy, afibrinogenemia, chinese pit viper, Protobothrops mangshanensis

Received: August 25, 2011; Accepted: February 9, 2012; Prepublished online: April 19, 2012; Published: June 1, 2012  Show citation

ACS AIP APA ASA Harvard Chicago IEEE ISO690 MLA NLM Turabian Vancouver
Valenta, J., Stach, Z., & Otahal, M. (2012). Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment. Biomedical papers,�156(2),�183-185. doi:�10.5507/bp.2012.021
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Mebs D, Kuch U, Coronas FI, Batista CV, Gumprecht A, Possani LD. Biochemical and biological activities of the venom of the Chinese pitviper Zhaoermia mangshanensis, with the complete amino acid sequence and phylogenetic analysis of a novel Arg49 phospholipase A2 myotoxin. Toxicon 2006;47:797-811. Go to original source... Go to PubMed...
    2. Murakami MT, Kuch U, Betzel C, Mebs D, Arni RK. Crystal structure of a novel myotoxic Arg49 phospholipase A2 homolog (zhaoermiatoxin) from Zhaoermia mangshanensis snake venom: insights into Arg49 coordination and the role of Lys122 in the polarization of the C-terminus. Toxicon 2008;51:723-35. Go to original source... Go to PubMed...
    3. Tan NH.. Isolation and characterization of the thrombin-like enzyme from Cryptelytrops purpureomaculatus venom. Comp Biochem Physiol C Toxicol Pharmacol 2010;151:131-6. Go to original source... Go to PubMed...
    4. Oyama E, Furudate N, Senuki K, Takahashi H. Purification and characterization of a new platelet aggregation inhibitor with dissociative effect on ADP-induced platelet aggregation, from the venom of Protobothrops elegans (Sakishima-habu). Toxicon 2009;53:706-12. Go to original source... Go to PubMed...
    5. Chen Z, Wu J, Zhang Y, Yang X, Yu G, Zhu S, Lee W, Lu Q, Zhang Y. A novel platelet glycoprotein Ib-binding protein with human platelet aggregation-inhibiting activity from Trimeresurus jerdonii venom. Toxicon 2011;57:672-9. Go to original source... Go to PubMed...
    6. Chan JC, Kwok MM, Cockram CS, Prematilleke MN, Tomlinson B, Critchley JA. Blood coagulation abnormalities associated with envenoming by Trimeresurus albolabris in Hong Kong. Singapore Med J 1993;34:145-7. Go to PubMed...
    7. Warrell DA. Clinical toxicology of snakebite in Asia. In: Meier J, White J, editors. Handbook of Clinical Toxicology of Animal Venoms and Poisons. Boca Raton, New York, London, Tokyo: CRC Press; 1995. p. 493-593. Go to original source...
    8. Chen YW, Chen MH, Chen YC, Hung DZ, Chen CK, Yen DH, Huang CI, Lee CH, Wang LM, Yang CC. Differences in clinical profiles of patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri envenoming in Taiwan. Am J Trop Med Hyg 2009;80:28-32. Go to original source...
    9. Rojnuckarin P, Mahasandana S, Intragumthornchai T, Sutcharitchan P, Swasdikul D. Prognostic factors of green pit viper bites. Am J Trop Med Hyg 1998;58:22-5. Go to original source... Go to PubMed...
    10. Mba EC, Onyemelukwe GC. Antithrombin III in Echis carinatus envenomation in northern Nigeria. Acta Haematol 1989;81:98-100. Go to original source... Go to PubMed...

    Return to the content