Trimeresurus Malabaricus Bites: Need of Species-specific Management for Snakebites.

Abstract

Dear Editor, Apart from the “big four” species of venomous snakes, the pit vipers (hump nosed, Malabar, bamboo) and banded kraits are the other types seen in Kerala. Malabar pit viper (Trimeresurus malabaricus) is an elusive species, seen in the forests of the Western Ghats. We have come across the case of a 54-year-old healthy female after a snakebite. On examination, she had a bite mark on the right parietal region of the scalp, with swelling and tenderness in the surrounding area extending to the neck. She also had multiple tender lymph nodes in the right jugulodigastric and posterior auricular groups [Figure 1a]. She had no features of neurotoxicity. Her 20-min whole blood clotting test (WBCT) was prolonged. The snake was later identified and confirmed to be a Malabar pit viper [Figure 1b]. 20-min WBCT and coagulation profiles repeated periodically for the next 48 hr were normal. Even though characteristics of pit viper bites have been previously profiled,[12] the incidence of Malabar pit viper bites is less. Envenomation following Malabar pit viper bites results in significant local reaction and hematotoxicity, along with milder forms of renal impairment. The Polyvalent anti-snake venom (ASV) used in India does not contain antibodies against pit viper venom and since cross neutralization with venoms of other species of snakes has not been proven,[3] its use is considered futile the treatment. With snakebites other than the “big four” snakes covered by the polyvalent ASV on the rise, the need for newer techniques for identification of snakes and development of species and region-specific antivenom is the need of the hour.Figure 1: (a) Enlarged right jugulodigastric lymph node with swelling seen on the right neck. (b) Photograph of the offending snake Malabar pit viper (Trimeresurus malabaricus) on the tree branchDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.