Tetanus After White-Lipped Green Pit Viper ( Trimeresurus albolabris) Bite

Abstract

Snakebite is a common medical emergency in Thailand. The fatality rate due to snakebites, however, has declined from more than 200 cases per year in the 1940s1 to fewer than 20 cases per year in the 1980s.2 The green pit vipers (Trimeresurus spp) are responsible for the great majority of venomous snakebites in Thailand.3–5 Severe coagulation abnormalities from green pit viper bites are uncommon and, if present, respond readily to the administration of fresh frozen plasma, platelets, and antivenom.6 Almost all patients survive and some eventually develop secondary bacterial infection at bite sites. There have been a few reports of tetanus complicating snakebite.7–9 But no tetanus has been reported after green pit viper bites. Tetanus prophylaxis is not routinely recommended in Thailand during the early period after bites from hematotoxic snakes because there is a risk of bleeding at the injection site. We report the first case of tetanus in a patient with white-lipped green pit viper (Trimeresurus albolabris) bite. We also investigated whether Clostridium tetani, the causative agent of tetanus, are present in the oral cavity of T albolabris.