A Tropical Kiss by a Malabar Pit Viper

Abstract

Snakebite in India is often attributed to the "big 4," for which polyvalent anti-snake venom is effective. Also significant and less known is the burden of other venomous snakes, one of which is Trimeresurus malabaricus. We report a bite to the face of a tree climber by Trimeresurus malabaricus in the Western Ghats of India, which caused severe local envenomation in the form of facial edema and systemic signs of envenomation, including coagulopathy and hypotension. We discuss the role of thromboelastogram, infrared thermography, and routine diagnostics in this case, which led to the administration of Indianmade polyvalent anti-snake venom. The patient recovered and was discharged without any clinically evident physiological or physical dysfunction.

Surgical Management of Animal and Human Maxillofacial Bites: A Comprehensive Review

“…The items included are from every inhabited continent except Central America. Thirteen studies were from Africa, 13,17,19,20,22,23,[36][37][38][39][40][41][42] 17 from Asia, 32,33,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] 17 from Europe 2,7,11,12,14,15,24,27,28,34,35,[58][59][60][61][62][63] , 14 from North America, 4,10,16,18,25,…”

“…43,48 Venomous animal bites are more associated with lower limb bites, but some reports of facial bites have been included, notably scorpions 33,52 and snakes. 46,55,57,58 Despite fewer in number, maxillofacial stings have been associated with bees 13 and insects. 59 Even marine animals have been implicated in these injuries, notably two jellyfish envenomation reports.…”

“…46 Fang fragments and stings must be sought and removed because of the risk of contamination. 13,55,[57][58][59] Imaginological studies could help surgeons in their search for these fragments. 58 Scorpion stings are not fatal in most cases but are very painful.…”

“…33 A recent trend is the development of rapid diagnostic kits, in order to identify animal species and develop antivenoms as early as possible. 55 Cardiac examination and blood pressure as well as monitoring of airway permeability are essential in cases of envenomation. 44,71 Some articles have proposed a classification of maxillofacial injuries 2,14,19 but Lackmann´s classification (Table 1) 76 has been used most frequently in articles to describe this type of injury.…”

Fangs in the Ghats: Preclinical Insights into the Medical Importance of Pit Vipers from the Western Ghats

“…While the arboreal, camouflaged C. malabaricus, is known to be a major threat to cultivation and plantation workers in the Western Ghats [26,27], C. gramineus is not perceived as medically important. A recent report from a hospital in Karnataka suggested that the number of C. malabaricus envenomings surpassed those of the common krait and saw-scaled viper [28]. Envenoming from this species is known to induce myotoxicity, resulting in physical distortion, cellulitis, gangrene, haemotoxicity, hypotension and mild impairment of renal function [28,29].…”