Clinical characteristics of yamakagashi (Rhabdophis tigrinus) bites: a national survey in Japan, 2000–2013

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.

Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report

“…Several cases of Rhabdophis tigrinus bites have been reported in Japan but very few cases of Rhabdophis subminiatus bites have been reported (3) (4) . The bites of colubrid snakes can lead to severe envenoming, but the symptoms of such bites might be delayed for hours or days after the actual bite (2) .…”

Potentially fatal coagulopathy secondary to yamakagashi (Rhabdophis tigrinus) bites that completely recovered with antivenom treatment

“…1 Although R. tigrinus bites induces lifethreatening injuries, their mechanism and treatment have not been examined because of the extremely rare incidence of severe cases (nine cases reported over the past 13 years), compared with that of bites from G. blomhoffii and P. flavoviridis. 1,3,4 Our former survey indicated that the pathophysiology of R. tigrinus bites was considered disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype; however, the details of coagulation markers remain unknown. Moreover, although antivenom therapy prepared from hyperimmunized horses (antivenin serum therapy) is established against R. tigrinus bites, sufficient information regarding antivenom therapy has not been provided in clinical practice.…”

“…Moreover, although antivenom therapy prepared from hyperimmunized horses (antivenin serum therapy) is established against R. tigrinus bites, sufficient information regarding antivenom therapy has not been provided in clinical practice. 3,5 Here we describe the trends of coagulations markers in the case of R. tigrinus bites and highlight the antivenom therapy for R. tigrinus.…”

“…The median time from R. tigrinus bites to antivenom treatment in our previous survey was 35 h due to both the inconvenient supply of antivenom and the delays in diagnosis. 3 Compared with the more common G. blomhoffii bites, which are typically rapidly progressive, there appears to be a longer therapeutic window for administering R. tigrinus antivenom. However, because R. tigrinus antivenom only neutralizes the unbound venom, and cannot restore organ function, antivenom should be given as early as possible.…”

A national survey examining recognition, demand for antivenom, and overall level of preparedness for redback spider bites in Japan

“…For example, Rhabdophis tigrinus (Yamakagashi snake) bites or gas gangrene require an immediate administration of the antivenom to save the patient's life. However, inadequate supply planning has resulted in insufficient storage sites, which in turn leads to delays in the delivery of medication to patients …”