Biology Reference
In-Depth Information
spp. (polyvalent) antivenom (Correia et al., 2010). Sometimes, the victim may be better
informed than the medical team responsible for his or her care. For instance, a female
technician maintaining an institutional venomous animal collection was bitten on the
distal phalanx of her right fifth digit while handling a
P. olfersii
(De Araújo and dos
Santos, 1997). Although there was no immediate pain or bleeding, edema involving the
entire hand developed 15 min after the bite. She presented at an emergency department
where all her vital signs and results of tests (unspecified) were reportedly within nor-
mal limits. However, the medical team recommended administration of anti-
Bothrops
spp. (polyvalent) antivenom, which the patient wisely declined. She was treated only
with an “antihistaminic” injection (De Araújo and dos Santos, 1997).
The most frequently documented symptoms from
Philodryas
spp. include: lac-
erations/puncture wounds, mild local pain, edema, erythema, and ecchymoses (
Table
4.1
; Ribeiro et al., 1999; Salomão et al., 2003). A report of vertigo that developed
several days after a bite from
P. o. latirostris
(
Table 4.1
) is considered in Section
4.4. A frequently cited fatal case attributed to a
P. olfersii
bite is discussed later. An
anecdotal case mentioned by Means (2010) as communicated by Professor William
Lamar described an alleged
P. viridissimus
(green palm snake or common green
racer; Plate 4.42) bite inflicted on a pet shop worker in Virginia, USA. The victim
suffered severe local effects and, ultimately, compartment syndrome was diagnosed.
It was suggested that the severity of the “envenoming” may have been due to man-
ual pressure exerted on the snake's head during attempts to extricate its jaws from
the victim, leading to manual expression of gland contents into the wound (William
Lamar, written personal communication with SAW, April 2010). However, the lack
of any significant storage capacity in Duvernoy's glands of most species studied to
date, including
Philodryas
spp., makes it more likely that stimulation of sustained
glandular secretion contributed to the severity of this case. Acquired hypersensitiv-
ity to snake secretions or venom constituents must also be considered, especially in
a person with a probable history of close contact with multiple ophidian species (see
Section 4.6 and
Table 4.1
). Due to reportedly severe edema, fasciotomy was per-
formed (Means, 2010; William Lamar, personal written communication with SAW,
April 2010). Despite numerous attempts to review the hospital case notes, we have
been unable to obtain full clinical documentation of this case. It is unclear whether
specific compartmental pressures (e.g., by Wick catheter or Stryker intracompart-
mental pressure transducer) were obtained (see
Table 4.2
) in order to support sur-
gical intervention. The victim also reportedly suffered considerable postfasciotomy
disability. Fasciotomy has a known adverse effect profile and a history of inappro-
priate use in snakebite, resulting in long-term morbidity.
4
Therefore, without further
data on the foregoing case, it is impossible to separate possible local venom-induced
4
Unfamiliarity with the local effects of some snake bites may mislead medical professionals into consid-
ering fasciotomy. García-Gubern et al. (2010) reported a Puerto Rican racer or culebra corredora puertor-
riqueña,
Alsophis portoricensis
, bite in a pediatric patient that caused significant local edema. The patient
was transferred for surgical consultation in consideration for a fasciotomy. As noted above, only objec-
tively measured and markedly elevated intracompartmental pressures (typically well exceeding 30 mmHg)
can justify consideration of surgical management of any snake bite. This is rarely needed, even in cases of
bites from known medically important viperids and elapids.
