Biology Reference
In-Depth Information
excessively personalize their own symptoms and signs. Cases should be prepared by
trained medical professionals (even if properly trained, the senior author should not be
the victim/patient), and reviewed by appropriately medically qualified referees.
Due to space constraints and an unfortunate lack of interest, most medical jour-
nals do not accept these case reports. Since many of these reports describe clinically
insignificant bites, this is to some extent understandable. Journals must devote most
of their content to cases of greater interest, excitement, and general importance.
However, a body of reports for a given species, even if indicating only minimal or
minor effects of negligible medical significance, are very valuable in establishing
the correct risk profile for that species. This will direct appropriate management of
future cases and can be just as worthy of publication as cases showing severe enven-
oming. Regrettably, editors of medical journals may not fully comprehend this.
Regardless of this prejudice, case reports should be submitted to clinical toxicology/
toxinology journals, as these periodicals will provide review by qualified medical
professionals familiar with envenomation.
4.5.1.4 Lack of Established Linkage Between Reported Serious Symptoms
and the Snakebite
Any snakebite case study that describes serious or life-threatening signs/symptoms
should provide data/clinically confirmed observations that support a causal rela-
tionship between the bite and the reported effects. In the vast majority of published
reports describing serious envenoming inflicted by viperids, elapids, and atractas-
pidids such linkage is well established based on the temporal relationship between
the bite and ensuing evolution of clinical features of envenomation. Envenomation
from these snakes produces unmistakably serious effects such as coagulopathy, pare-
sis, myotoxicity, vasculotoxicity, and many others (Minton, 1974; Russell, 1980;
Warrell, 1995a, 1995b, 2004; White and Dart, 2008). Envenoming from Burmese
(Myanmarese) populations of Russell's viper (
Daboia russelii
) can produce specifi-
cally distinctive pathology, such as pituitary infarct resulting in panhypopituitarism
(Sheehan's syndrome; Warrell, 1995a).
In contrast, very few colubroids of the former colubrid assemblage have an estab-
lished linkage between reported serious signs/symptoms and their bites. The local
effects that usually occur after bites by most non-front-fanged colubroids are medically
insignificant. Some species may rarely inflict bites causing moderate local effects that
can resemble mild-to-moderate crotaline envenomation (Plates 4.24D-J and 4.40A and
B). However, these effects are not clinically comparable to the severity of moderate-to-
severe crotaline envenomation (
Plate 4.92A-F
). Only cases involving several members
of the tribe, Dispholidini, and family, Natricidae, exhibit a clearly established link-
age between reported life-threatening effects and their bites (see Section 4.3;
Tables
4.1 and 4.3
). Other species are associated through multiple reports with serious signs/
symptoms, but without clear causal relationship established between the bite and
reported effects (e.g.,
B. irregularis
; see Section 4.4.1 and
Table 4.1
). Furthermore, the
literature contains occasional reports of bites with serious effects inflicted by species of
unknown medical importance (
Table 4.1
; Section 4.4). Several examples summarized
below highlight significant flaws in these reports.
