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Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis

Liao-Chun Chiang1,2,3,4,5, Wei-Jen Tsai4, Po-Yu Liu6,7, Cheng-Hsuan Ho2,8, Hung-Yuan Su9,10, Chih-Sheng Lai11, Kuo-Lung Lai12, Wen-Loung Lin13, Chi-Hsin Lee14,15,16, Yi-Yuan Yang14,15,16, Uyen Vy Doan17, Tri Maharani18, Yan-Chiao Mao2,3,4,5 [ + show more ]

J Venom Anim Toxins incl Trop Dis, 2020, 26:e20200043
Received: 31 March 2020 | Accepted: 02 September 2020 | Published online: 18 September 2020


Background: Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by Tsstejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of Tsstejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of Tsstejnegeri bite.


Keywords: Trimeresurus stejnegeri stejnegeri; Snakebites; Snake antivenom; Chinese green tree viper; Stejneger’s bamboo pitviper

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