Hump-nosed viper bite: an important but under-recognized cause of systemic envenoming.

Mitrakrishnan Shivanthan,Senaka Rajapakse,Rayno Navinan,Jevon Yudhishdran

doi:10.1186/1678-9199-20-24

Abstract

Hump-nosed viper bites are common in the Indian subcontinent. In the past, hump-nosed vipers (Hypnale species) were considered moderately venomous snakes whose bites result mainly in local envenoming. However, a variety of severe local effects, hemostatic dysfunction, microangiopathic hemolysis, kidney injury and death have been reported following envenoming by Hypnale species. We systematically reviewed the medical literature on the epidemiology, toxin profile, diagnosis, and clinical, laboratory and postmortem features of hump-nosed viper envenoming, and highlight the need for development of an effective antivenom.

Highlights

Hump-nosed viper (Hypnale) bite is an important yet under-recognized cause of morbidity and mortality in Southern India and Sri Lanka, where three species have been identified, namely Hypnale hypnale, H. zara and H. nepa
H. hypnale has been reported from Sri Lanka and the Western Ghats of South India, while the other two species are endemic to Sri Lanka alone [1]
Clinical manifestations of systemic envenoming by this snake include acute kidney injury, hematological manifestations, and other organ involvement, in some cases leading to death

Summary

Introduction

Hump-nosed viper (Hypnale) bite is an important yet under-recognized cause of morbidity and mortality in Southern India and Sri Lanka, where three species have been identified, namely Hypnale hypnale, H. zara and H. nepa. In this study there were large numbers of unidentified snakebites that did not result in envenoming Another recent prospective hospital-based clinical study in Sri Lanka of proven HNV bites identified 114 definite cases [2]. In a recent paper on syndromic diagnosis of snakebite, the authors suggested that coagulopathy was present in 39% of 302 patients with HNV bite, making it the second commonest manifestation after local envenoming [19]. In a prospective observational study carried out at the Nephrology Unit, Kandy, Sri Lanka from October 2010 to October 2011, out of 11 patients with acute kidney injury following HNV bites, all required renal replacement therapy, seven developed thrombotic microangiopathy with evidence of microangiopathic hemolytic anemia (MAHA), thrombocytopenia and severe anemia necessitating multiple blood transfusions, and two progressed to chronic renal failure [6]. The currently used polyvalent antivenom is ineffective in the treatment

Conclusions

29. Isbister GK

Findings

38. Fernando M