Skip to main content
  1. Terrestrial snakes
  2. Central and Southern Africa
  3. Biomedical Database
  4. Vipers
  5. Clinical entry: Atractaspis sp.

Clinic: Atractaspis sp.

Examine for venom effects

Autopharmacological effects

  • Nausea, vomiting
  • Sweating
  • Urticaria, angiooedema
  • Arterial hypotension / hypovolaemic shock (transient, recurrent; immediate; delayed (CLS))
  • Diarrhoea
  • Bronchospasm 

Local Effects

  • Pain
  • Tender local (spreading) swelling
  • Blistering
  • Lymphangiopathy and lymphadenopathy
  • Necrotic skin

Neurological effects

Autonomic nervous system effects

    • Vomiting, increased peristalsis, diarrhoea, abdominal pain; profuse sweating; pupil constriction. Bradycardia, arterial hypotension, shock. Hypersalivation; increased bronchial secretion, bronchospasm, respiratory failure. 
    • Pupil dilatation, tachycardia, arrhythmia, sarterial hypertension, myocardial failure, pulmonary oedema (cardiogenic + ?non-cardiogenic component), cardiac ischaemia, shock.  

Species-specific envenoming pattern

The assessment of the envenoming pattern is based on the data from publication in which the identification of the snakes is clearly specified and in accordance with accepted criteria.

   Local effects1

Neurological effects2
Autonomic nervous system dysfunction
Atractaspis sp.    

1Local effects

A. dahomeyensis, A. microlepidota (= Atractaspis micropholis or watsoni)
Local pain 9/9, commencing within 2 h after the bite. Local swelling starting within 0.5–3 h. 8/9 had at least mild swelling, either early or later. Only 4/9 patients had significant swelling (percentage increase in circumference: 4%, 5.3%, 2 × 9%). Swelling reached a maximum after 1 day, and had resolved completely within 1–9 days. Localhypoaesthesia andparaesthesia in the distribution area of skin nerves. Regional lymph node swelling 4/9. Blistering 2/9 on the 2nd and 6th day after the bite,respectively. Necroses (0/9) (Warrell et al. 1976c).

A. bibronii, A. engaddensis
Local necroses appear to occur more commonly than with other Atractaspis species (Warrell et al. 1976c).

A. bibronii
Local swelling, in some cases extending over the entire bitten extremity, 5/5; regional lymph node swelling 2/5. Local hypoaesthesia and paraesthesia in the distribution area of skin nerves (Blaylock 1982a).

Haematological effects

Maybe mildly abnormal blood coagulation. In the study of Warrell et al. (1976c) none was observed.

Haematocrit
Anaemia 0/9 (Warrell et al. 1976c).

2Neurological effects
Autonomic nervous system dysfuntion

Rapid clinical course of the fatal bites caused by A. microlepidota (3 cases) (Corkill and Kirk 1954) and A. irregularis (1 case) (Corkill et al. 1959). Death occurring within 45 min–6 h suggests that these venoms have a component that causes strong neurological effects (Warrell et al. 1976c).
Swallowing, protrusion of the tongue, eye movements and deep respiratory excursions painful. Muscle twitching (Blaylock 1982a).

A. engaddensis
Autonomic symptoms (hypertension, nausea, vomiting, diarrhoea, chest, abdominal and lumbar pain, sweating and profuse salivation) within minutes of the bite, severe dyspnoea with acute respiratory failure, weakness, impaired consciousness and transient hypertension (Abu Baker et al. 2022, Warrell et al. 1976c, Warrell 2023). 

Other effects

It is difficult to distiguish autopharmacological/anaphylactic from autonomic nervous system effects (for discussion see Tilbury and Verster 2016).
Electrocardiographic changes (ST–T changes and prolonged PR interval (observed by Kurnik et al. (1999) and various aetiologies discussed).
The most common systemic sign is fever (Warrell 2023). 

Morbidity

A. bibronii, A. engaddensis
Necroses.

Case fatality rate

Low.
One case is reported by Tilbury and Verster (2016). Case presenation and review of the literature of Atractaspis sp. envenoming.

Clinical management

First Aid

Local treatment

Pain control
Tetanus prophylaxis
Standard wound care
WHO (2010a,b) 

Systemic supportive treatment

A general understanding of emergency medicine is required, or can be found in emergency medicine guidelines, e.g. ABCDE approach, WHO-ICRC Basic Emergency Care.

Follow SAMPLE & ABCDE ApproAch

Obey atractaspis sp. - specific features

see

  • 'Species-specific envenoming pattern above'.

and

Specific treatment (antivenoms)

References

see also references in section 'species specific evidence' (below). 

  • Tilbury CR, Verster J. A fatal bite from the burrowing asp Atractaspis corpulenta (Hallowell 1854). Toxicon. 2016 Aug;118:21-6. Epub 2016 Apr 16. PMID: 27090012. https://doi.org/10.1016/j.toxicon.2016.04.035

  • WHO-ICRC Basic Emergency Care: approach tothe acutely ill and injured (2018)
    https://www.who.int/publications-detail-redirect/basic-emergency-care-approach-to-the-acutely-ill-and-injured
  • WHO ABCDE Approach
    https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/bec-quick-cards/becp-edu29-pdf-en-finl.pdf?sfvrsn=2532d61b_2
  • WHO (2010a) Guidelines for the prevention and clinical management of snakebite in Africa. https://www.who.int/publications/i/item/9789290231684
  • WHO (2010b) Wound and lymphoedema management. WHO/HTM/NTD/GBUI/20101 I. 2010. https://www.who.int/publications/i/item/9789241599139
  • WHO Snakebite Information and Data Platform
    https://www.who.int/teams/control-of-neglected-tropical-diseases/snakebite-envenoming/snakebite-information-and-data-platform
  • Warrell DA. Venomous and poisonous animals. In: Farrar J, Garcia PJ, Hotez T, Junghanss T, Kang G, Laloo D (eds.). Manson’s tropical diseases. 24th ed. Elsevier; 2023.
  • Warrell, D. A., L. D. Ormerod, N. Davidson (1976c) Bites by the Night adder (Causus maculatus) and Burrowing vipers (Genus Atractaspis) in Nigeria. Amer. J. trop. Med. Hyg. 25: 517-524
  •  Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet. 2023 Apr 22;401(10385):1382-1398. PMID: 36931290. https://doi.org/10.1016/s0140-6736(23)00002-8 

Species-specific evidence

A. dahomeyensis, A. microlepidota

(Atractaspis microlepidota = Atractaspis micropholis or watsoni) 

Nigeria

  • Warrell et al. (1976c)
    9 verified Atractaspis bites; identification: morphological: A. dahomeyensis (7/9); A. microlepidota (2/9).
    Classification
    Local envenoming:
      • Extent of the swelling (grade 1–6; scale of Warrell et al. 1974).

Atractaspis corpulenta

Democratic Republic of Congo

  • Tilbury and Verster (2016)  
    1 patient (fatal); identification: morphological
    Case presenation and review of the literature of  Atractaspis sp. envenoming.

Atractaspis engaddensis

Jordan

  • Abu Baker et al. (2022)
    4 patients; idedntification: "attributed to Atractaspis engaddensis.

Captive snakes

  • Kurnik et al. (1999)
    1 case (captive snake); identification: morphological. 

Further case reports

  • Corkill and Kirk (1954)
  • Alkan and Sukenik (1975)
  • Chajek et al. (1974)

Various Atractaspis sp.

Atractaspis aterrima

  • Schmidt (1923)

Atractaspis bibronii (taxonomic assignement to up to date taxonomy unclear)

  • Corkill and Kirk (1954)
  • Corkill et al. (1959)
  • Blaylock (1982a)
  • Cranko (1961)
  • Stewart (1965)

Atractaspis congica

  • Wagner et al. (2009)

Atractaspis corpulenta (taxonomic assignement to up to date taxonomy unclear)

  • Corkill and Kirk (1954)
  • Gunders et al. (1960)

Atractaspis dahomeyensis (taxonomic assignement to up to date taxonomy unclear)

  • Corkill and Kirk (1954)
  • Corkill et al. (1959)

Atractaspis irregularis (taxonomic assignement to up to date taxonomy unclear)

  • Corkill and Kirk (1954)
  • Corkill et al. (1959)

Atractaspis microlepidota (= A. watsoni?)

  • Corkill (1956)
  • Corkill and Kirk (1954)                 

 A. watsoni, A. micropholis, A. aterrima, A. corpulenta (taxonomic assignement to up to date taxonomy unclear)

  • Chippaux et al. (2024)
    12 patients; identification: A. watsoni, A. micropholis, A. aterrima, A. corpulenta; 7 unidentified.
    Mild to moderate local envenoming without necrosis.

 Atractaspis sp.

  • Visser and Chapman (1978)

References

  • Abu Baker MA, Al-Saraireh M, Amr Z, Amr SS, Warrell DA. Snakebites in Jordan: A clinical and epidemiological study. Toxicon. 2022 Mar;208:18-30.  Epub 2022 Jan 10. PMID: 35026216. https://doi.org/10.1016/j.toxicon.2022.01.005
  • Alkan, M. L., S. Sukenik (1975) Atrioventricular block in a case of snakebite inflicted by Atractaspis engaddensis. Trans. roy. Soc. trop. Med. Hyg. 69: 166
  • Blaylock, R. S. M. (1982a) Snake bites at Triangle Hospital January 1975 to June 1981. Centr. Afr. J. Med. 28: 1-11
  • Chajek, T., D. Rubinger, M. Alkan, R. M. Melmed, A. E. Gunders (1974) Anaphylactiod reaction and tissue damage following bite by Atractaspis engaddensis. Trans. roy. Soc. trop. Med. Hyg. 68: 333-337
  • Chippaux JP, Madec Y, Amta P, Ntone R, Noël G, Clauteaux P, Boum Y 2nd, Nkwescheu AS, Taieb F. Snakebites in Cameroon by Species Whose Effects Are Poorly Described. Trop Med Infect Dis. 2024 Dec 6;9(12):300. PMID: 39728827; PMCID: PMC11679889. https://doi.org/10.3390/tropicalmed9120300
  • Corkill, N. L. (1956) Snake poisoning in Sudan. In Buckley, E. E., N. Porges: Venoms, Amer. Assoc. Adv. Sci., Washington D. C. 44: 331-339
  • Corkill, N. L., R. Kirk (1954) Poisoning by the Sudan mole viper Atractaspis microlepidota Günther. Trans. roy. Soc. trop. Med. Hyg. 48: 376-384
  • Corkill, N. L., C. P. J. Inoides, C. R. S. Pitman (1959) Biting and poisoning by the Mole vipers of the genus Atractaspis. Trans. Roy. Soc. Trop. Med. Hyg. 53: 95-101
  • Cranko, J. A. (1961) A snake bite from a burrowing adder. Centr. Afr. J. Med. 7: 215-216
  • Gunders, A. E., H. J. Walter, E. Etzel (1960) Case of snake-bite by Atractaspis corpulenta. Trans. roy. Soc. trop. Med. Hyg. 54: 279-280
  • Kurnik D, Haviv Y, Kochva E. A snake bite by the Burrowing Asp, Atractaspis engaddensis. Toxicon. 1999 Jan;37(1):223-7.  PMID: 9920494. https://doi.org/10.1016/s0041-0101(98)00166-4
  • Schmidt, K. P. (1923) Contributions to the herpetology of Belgian Congo. Bull. Amer. Nat. Hist. 49: 1-146
  • Stewart, M. M. (1965) A bite by a burrowing adder, Atractaspis bibronii. J. herpetol. Ass. Rhodesia 23 / 24: 47-50
  • Tilbury CR, Verster J. A fatal bite from the burrowing asp Atractaspis corpulenta (Hallowell 1854). Toxicon. 2016 Aug;118:21-6. Epub 2016 Apr 16. PMID: 27090012. https://doi.org/10.1016/j.toxicon.2016.04.035
  • Wagner P, Townsend E, Barej M, Rödder D, Spawls S. First record of human envenomation by Atractaspis congica Peters, 1877 (Squamata: Atractaspididae). Toxicon. 2009 Sep 1;54(3):368-72. Epub 2009 Apr 23. PMID: 19393678.  https://doi.org/10.1016/j.toxicon.2009.04.019
  • Warrell, D. A., L. D. Ormerod, N. Davidson (1976c) Bites by the Night adder (Causus maculatus) and Burrowing vipers (Genus Atractaspis) in Nigeria. Amer. J. trop. Med. Hyg. 25: 517-524