Medically Significant Bites by “Colubrid” Snakes - "Venomous" Bites from Non-Venomous Snakes - page 171

Symptom/Sign b Species c Comments

Blistering/Blebs Alsophis ( Borikenophis ) portoricensis, Heterodon nasicus, Platyceps

rhodorachis, Madagascarophis meridonalis, Oxybelis spp ., Philodryas
chamissonis, Thamnophis elegans vagrans

The bites of some species produced relatively transient blistering (e.g., T. e.
vagrans ), while bites of others (e.g., H. nasicus ) have occasionally produced a
more protracted blistering disease (see Plate 4.24D-J).

Ecchymoses d Boiga irregularis, Boiga nigriceps, Boiruna maculata, Dispholidus

typus, Erythrolamprus bizona, Helicops angulatus, Ithycyphus miniatus,
Liophis poecilogyrus sublineatus, Philodryas baroni, Philodryas olfersii,
Rhabdophis subminiatus, R. tigrinus, Thamnodynastes pallidus

P. olfersii has produced widespread ecchymoses, suggesting systemic envenoming, in
at least one documented case (see text and Plate 4.40A and B). The ecchymoses caused
by envenoming from Hazard Level 1 species may encompass large areas of dependent
sites on the victim (posterior thighs, flanks; see Plate 4.20M-O and 4.46C).

Edema d Alsophis (Borikenophis) portoricensis, Boiga irregularis, Boiga nigriceps,

D. typus, Hemorrhois ravergieri, H. nasicus, Hydrodynastes gigas,
Ithycyphus miniatus, Philodryas olfersii, P. patagoniensis, P. viridissimus,
Ptychophis flavovirgatus, Rhabdophis subminiatus, R. tigrinus, Symphimus
spp ., Thamnodynastes spp ., Thamnodynastes pallidus, Thelotornis capensis,
Thrasops flavigularis

The cases included contain relatively well-documented expanding or persistent
edema. For examples of local edema from some of the listed species, see Plates
4.24I and J, 4.26E, and 4.44B and C. Excluded are cases without supportive docu-
mentation, or with descriptions suggestive of limited edematous effects. Those
with clinically less significant edema are included in Table 4.1.

Lymphadenopathy Platyceps rhodorachis, H. nasicus, Malpolon monspessulanus, P. olfersii,

R. tigrinus

Additional published cases have described isolated instances of more transient
lymphadenopathy (see Table 4.1 and Plate 4.24D-J).

Cranial nerve
palsies

Malpolon monspessulanus Several reports with one well-documented, verified case demonstrating the medically

significant neurotoxic properties of Duvernoy's secretions from this species.

Coagulopathy e Dispholidus typus, R. subminiatus, R. tigrinus, T. capensis, T. kirtlandii May be delayed, asymptomatic, and, occasionally, initially undetected without

laboratory investigations. However, often severe and accompanied by hemorrhage
and profuse bleeding.

Systemic
hemorrhage/DIC

D. typus, R. subminiatus, R. tigrinus, T. capensis, T. kirtlandii All of the well-documented bites from R. subminiatus occurred while handling

captive specimens.

Death D. typus, R. tigrinus, T. capensis, T. kirtlandii There are no reported deaths from R. subminiatus bites. There are probably a

number of unrecorded deaths among agricultural workers bitten (and other regions)
by D. typus in Kenya.

a Included are only summarized serious signs/symptoms that were reported after qualified medical review, and caused prolonged distress and/or serious injury to the victim.
b This table omits reported cases of “respiratory difficulty” or ptosis linked to pediatric patients bitten by Boiga irregularis on Guam, as well as alleged systemic effects attributed in a single case to a bite
from a Hydrodynastes gigas . Further confirmation of the etiology of the observed effects in these cases is desirable (see Section 4.4).
c For common names, see Table 4.1 and relevant text.
d Only cases that contain descriptions of clinically extensive or significantly progressive ecchymoses or edema are included. Therefore, this summarized list does not include all of the cases listed in Table 4.1.
e There is a single documented report of “mild coagulopathy” after a P. patagoniensis bite, as has been made regarding a bite from Sibynomorphus mikanii . There are also several anecdotally referenced