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  5. Clinical entry: Causus sp.

Clinic: Causus sp.

Examine for venom effects

Local Effects

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

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
Causus sp.  

1Local effects

Causus maculatus
Local pain 10/10, onset within 30 min after the bite. Local swelling beginning within the same period 3/10. Sooner or later all patients had at least mild swelling. Substantial swelling in only 3/10 patients (percentage circumference increase: 2%, 8%, 12%). Swelling reached a maximum within a day and had resolved completely within 1–4 days. Regional lymph node swelling 4/10. Blistering 0/9, necroses 0/9 (Warrell et al. 1976c).

Intense local pain 3/3, which decreased within days. Local swelling 3/3 (percentage circumference increase: 5.4%, 7.6%, 10%), onset within 15 min (Pugh and Theakston 1987a).

Causus defilippii
Mild local swelling 7/8, local swelling that extended to the knee 1/8, necrosis 0/8 (Blaylock 1982a). 

Other effects

Causus maculatus
Arterial hypotension, tachycardia (cause?) (1/10) (Warrell et al. 1976c). 
Causus rhombeatus
Haematuria (no indication of concurrent schistosomiasis) 2/3 (Corkill 1956).
Causus resimus
Haematuria (no indication of concurrent schistosomiasis) 1/2 (Corkill 1956).
Haematuria at the time of hospitalisation (2/3) which disappeared spontaneously (no remarks regarding the exclusion of schistosomiasis) (Pugh and Theakston 1987a). 
Haemostasis
Causus maculatus 
CT in normal range 10/10, platelets in normal range 10/10, FSP in normal range (Warrell et al. 1976c). 
Causus maculatus
Atonic musculature and reduced deep tendon reflexes 1/10 (Warrell et al. 1976c). 

Morbidity

No lasting sequelae after a bite, as long as the wound is well cared for.

Case fatality rate

Although bites from this species are common, fatalities are extremely rare. The only fatality reported in connection with a C. rhombeatus bite was most likely due to an anaphylactic reaction with oedema of the larynx/pharynx from sucking venom out of the wound (FitzSimons 1912, cited in: Warrell et al. 1976c).

Clinical management

See also Clinical Management: Central and Southern Africa

for advice on post-First Aid measures, diagnosis (clinical, laboratory) and treatment (supportive, antivenom).

First Aid

Any type of tourniquet follow link above.

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 causus sp. - specific features

see

  • 'Species-specific envenoming pattern above'.

and

Specific treatment (antivenoms)

References

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

  • 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

Causus maculatus

Nigeria

  • Warrell et al. (1976c)
    10 verified Causus maculatus bites; identification: morphological.
    Classification
    Local envenoming:
      • Extent of the swelling (grade 1–6; scale of Warrell et al. 1974).
      • Intensity of the swelling (according to the method of Reid et al. 1963c).
  • Pugh and. Theakston (1987a)
    3 C. maculatus bites; identification: ELISA.

Cameroon

  • Chippaux et al. (2024)
    11 cases; identification: 1 dead snake, the other 10 not commeneted on. 
    5 dry bites; 6 local (oedema) envenoming.

Various Causus sp. 

Sudan


C. rhombeatus

  • Corkill (1956)


C. resimus

  • Corkill (1956)

Southeast Zimbabwe


C. defilippii

  • Blaylock (1982a) 

References

  •  Blaylock, R. S. M. (1982a) Snake bites at Triangle Hospital January 1975 to June 1981. Centr. Afr. J. Med. 28: 1-11
  • 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/
  • 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
  • Pugh, R. N. H., R. D. G. Theakston (1987a) A clinical study of viper bite poisoning. Ann. trop. Med. Parasitol. 81: 135-149
  • 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