Abstract
BackgroundYamakagashi (Rhabdophis tigrinus) is a species of pit viper present throughout Russia and Eastern Asia. Although R. tigrinus venom is known to induce life-threatening hemorrhagic symptoms, the clinical characteristics and effective treatment of R. tigrinus bites remain unknown. The present study aimed to clarify these issues.MethodsRecords in the Japan Snake Institute between 2000 and 2013 were retrospectively investigated. The following were determined: patient characteristics, coagulation and fibrinolytic system abnormalities, effect of antivenom treatment, and outcomes.ResultsNine patients (all males; median age, 38 years) with R. tigrinus bites were identified. On admission, the median levels of fibrinogen and fibrinogen degradation products, and platelet counts were 50 mg/dL, 295 μg/mL, and 107,000/mm3, respectively. The median (minimum–maximum) disseminated intravascular coagulation (DIC) score defined by the Japanese Association of Acute Medicine was 8 (1–8). Antivenom was administered to seven patients, with a median interval of 35 h between bite and antivenom administration. All patients treated with antivenom survived, and the in-hospital mortality rate was 11%.ConclusionsPatients with R. tigrinus bites presented with DIC of a fibrinolytic phenotype, which can result in life-threatening injury unless appropriate antivenom and DIC treatment are provided.
Highlights
Yamakagashi (Rhabdophis tigrinus) is a species of pit viper present throughout Russia and Eastern Asia
The disseminated intravascular coagulation (DIC) diagnostic criteria for critically ill patients were used, as outlined by the Japanese Association of Acute Medicine (JAAM criteria) [8]; DIC was defined as a total score of ≥4
The area where R. tigrinus bites were reported was limited to four regions: Kanto, Chubu, Shikoku, and Kyusyu (Figure 1)
Summary
Yamakagashi (Rhabdophis tigrinus) is a species of pit viper present throughout Russia and Eastern Asia. R. tigrinus venom is known to induce life-threatening hemorrhagic symptoms, the clinical characteristics and effective treatment of R. tigrinus bites remain unknown. Yamakagashi (Rhabdophis tigrinus) is a species of pit viper. It is present throughout Russia and Eastern Asia, including China, Taiwan, Korea, and Japan, but excluding Ryukyu Islands [1]. R. tigrinus venom is known to induce life-threatening hemorrhagic symptoms similar to those of the rattlesnake and other crotaline snakes [2,3,4]. The clinical characteristics and effective treatment of R. tigrinus bites remain unknown. This study aimed to elucidate the clinical characteristics of R. tigrinus bites and to clarify the effectiveness of antivenom treatment
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