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is little current evidence of any substantial risk of such effects from bites from this spe-
cies. In addition, an occasional report of nausea, dizziness, and/or vomiting associated
with patients presenting with
Philodryas
sp. bites (e.g., in a 2-year-old patient bitten by
P. olfersii
, Ribeiro et al., 1999, and in 7 out of 297 patients bitten by
P. patagoniensis
, de
Medeiros et al., 2010), cannot be accepted as sole evidence of systemic effects as snake-
bites of any kind are frequently accompanied by autonomic symptoms related to anxiety
or somatosensory amplification (White and Dart, 2008; Section 4.5).
4.4.4.3 Conclusion and Assessment of
P. o. latirostris
There are few cases of bites from
Philodryas
spp. that are assigned to subspecies.
As was noted in considering the medical importance of the genus,
Philodryas
spp.,
medically significant bites from
P. olfersii
most frequently result in mild-to-moderate
local effects. Most bites are likely medically insignificant, although uncommon cases
of extensive ecchymoses have been documented (see Section 4.2). The reviewed case
includes an unsupported presumptive connection between a medically insignificant
bite from a specimen of
P. o. latirostris
and a vestibular syndrome most likely due
to a vestibular neuronitis or BPPV. In fact, these appear unrelated and are probably
coincidental. Therefore, the patient's presentation should not be assigned to what
by all available information was an inconsequential bite. There are no current data
supporting systemic effects from this subspecies. However, as stated previously, it
is reasonable to carefully assess victims of
Philodryas
spp. bites due to the uncom-
mon risk of systemic effects that to date have been limited to extensive ecchymoses,
as well as the possible clinical role of fibrinogenolytic enzymes and myotoxins that
have been isolated from Duvernoy's secretions of these snakes (Section 4.2).
Assessment of
P. o. latirostris
based on available evidence: Hazard Level 3
(see
Table 4.3
).
4.4.5
Platyceps (Coluber) najadum
: A Fatal Case of Progressive
Neuropathy from a Colubrid Bite?
4.4.5.1 Analysis and Critique of an Aberrant Report
The single clinically documented case of a purported
P. najadum
(family Colubridae,
sub-family Colubrinae; Plate 4.13A-C) bite occurred in Greece and presents a con-
cerning clinical history of segmental muscle spasms that progressed to flaccid quad-
riplegia and a fatal outcome in less than 6 months (Chroni et al., 2005;
Table 4.1
). The
patient, a 67-year-old woman, reported receiving multiple bites on the lower extremi-
ties from an approximately 80 cm
P. najadum
. The authors did not indicate how the
identification of the snake was established and/or if it was verified by a qualified indi-
vidual. Therefore, this case must be considered one of presumed identity. The patient
was initially treated with antibiotics and steroids, and provided with tetanus toxoid.
It is noteworthy that the authors commented, “
…
antivenom therapy was not consid-
ered necessary
…
” (Chroni et al., 2005) as there is no reason to have any antivenom
available for snakes of this genus (see Section 4.2;
Table 4.1
), and therefore there is no
