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  4. Pit Vipers
  5. Clinical entry: Bothriechis sp.

Clinic: Bothriechis 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

Haematological effects 

  • Clotting disturbances:
    • Bleeding from the fang marks and from injuries, in particular ones that are not located in the region in which venom application occurred.
    • Bleeding into the skin (ecchymosis, petechiae)
    • Gingival bleeding, bleeding from the nose, conjunctiva, haematemeis, bleeding per rectum, including melaena, haematuria, haemoptysis.
    • Oliguria, anuria (VICC / AKI)
  • Bleeding and/or haemolytic anaemia:
    • Arterial hypotension (haemorrhagic shock)
    • Acute abdomen (intra-abdominal bleeding!)
    • Loin pain/renal bed sensitive to percussion (ischaemia, renal haemorrhage!)
    • Local neurological signs, meningism, coma (intracranial bleeding!)
    • Pale sclera (bleeding, haemolysis!)
    • Oliguria, anuria (arterial hypotension / AKI!)

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.

  

Autopharma-
cological 
effects1
 

 Local
effects2		 Haematological effects
Bleeding3  Coagulopathy4
Bothriechis schlegelii        

1Autopharmacological effects
Bothriechis schlegelii

  • Not mentioned (Cañas et al. 2024).

2Local effects 
Bothriechis schlegelii

  • Local pain, oedema, ecchymosis, paraesthesia (Cañas et al. 2024).


Haematological effects 
3Bleeding
Bothriechis schlegelii

  • No systemic bleeding (Cañas et al. 2024). 

Type of haemostatic defect
4Coagulopathy
Bothriechis schlegelii
"Pseudo-procoagulant venom activity, forming weak clots that rapidly break down, thereby depleting fibrinogen levels and thus contributing to a net anticoagulant state." (Youngman et al. 2022).

Haemostatic parameters
Bothriechis schlegelii
The most common systemic findings were hypofibrinogenemia and prolonged prothrombin time (Cañas et al. 2024). 

Cañas et al. (2024) refer to the "National guidelines for “bothropic type” envenomation" (Cañas et al. 2016):

Grade 0: Patient free of local or systemic symptoms or signs 6 h after the bite. 
Grade I: Local edema of less than 20 cm. Moderate local pain; no systemic symptoms or signs. No changes were observed in the coagulation test results. 
Grade II: Edema greater than 20 cm. Local pain and bleeding and mild systemic symptoms. Fibrinogen levels are between 150 and 200 mg/dL. 
Grade III: Marked local and systemic symptoms, emesis, diarrhea, systemic bleeding, and abnormal renal function (creatinine levels greater than 1.3 mg/dL) and coagulation test results. Fibrinogen levels are between 50 and 150 mg/dL. 
Grade IV: Edema with rapid proximal progression reaching the trunk, shock, oliguria, anuria, no detection of plasma fibrinogen, and prothrombin time (PT) and activated partial thromboplastin time (aPTT) >150 and 340 s, respectively. 
See also Malaque and Gutiérrez (2017) refering to the "Bothrops syndrome":

"The so-called Bothrops group includes the genera Atropoides, Bothrops, Bothriechis, Bothriopsis, Bothrocophias, and Porthidium, although snakes of the Bothrops genus itself are responsible for more bites than are those of the other genera. Although there is little information about snakebites caused by Agkistrodon, Atropoides, Bothriechis, Bothriopsis, Bothrocophias, and Porthidium, the available data indicate that envenomation by species belonging to any of these genera provoke manifestations similar to those observed in individuals with Bothrops envenomation. Therefore, the term “Bothrops syndrome” will be used to refer to such manifestations, collectively" (Malaque and Gutiérrez 2017).

Clinical management

See also (depending on the origin of the culprit)

Clinical Management: South America and the West Indies

Clinical Management: Mexico and Central America

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

First Aid

Release of any type of tourniquet follow links above.

Local treatment

Pain control
Tetanus prophylaxis
Standard wound care
WHO (2010, 2016) 

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 Bothriechis - specific features

see 'Species-specific envenoming pattern' above.

Key issues

see footnotes above.

Specific treatment (antivenoms)

References

  • Cañas CA, Castro-Herrera F, Castaño RS. Serpientes venenosas: lecciones aprendidas desde Colombia. Fundación Valle del Lili; 2016.
  • Cañas CA, Erazo-Martinez V, Pérez-Uribe V, Castaño-Valencia S, Castro-Herrera F. Envenomation by Eyelash Viper Bothriechis schlegelii (Berthold, 1846) in Southwestern Colombia. Wilderness Environ Med. 2024 Mar;35(1):30-35. dEpub 2024 Jan 10. PMID: 38379478. https://doi.org/10.1177/10806032231222353
  • 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 (2010) 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 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 
  • Youngman NJ, Peng YH, Harris RJ, Jones L, Llinas J, Haworth M, Gillett A, Fry BG. Differential coagulotoxic and neurotoxic venom activity from species of the arboreal viperid snake genus Bothriechis (palm-pitvipers). Comp Biochem Physiol C Toxicol Pharmacol. 2022 Jun;256:109326.  Epub 2022 Mar 4. PMID: 35248757. https://doi.org/10.1016/j.cbpc.2022.109326

Species-specific evidence

Bothriechis schlegelii

Columbia

  • Cañas et al. (2024)
    8 patients; identification: by photographic registries or by direct evaluation of the living or dead specimens.
  •  Otero et al. (2002)
    1 case; no envenoming

Bothriechis sp.

Panama

  • Carroll (1927)
    1 case; identification probably morphological; local swelling.

References

  • Cañas CA, Erazo-Martinez V, Pérez-Uribe V, Castaño-Valencia S, Castro-Herrera F. Envenomation by Eyelash Viper Bothriechis schlegelii (Berthold, 1846) in Southwestern Colombia. Wilderness Environ Med. 2024 Mar;35(1):30-35. dEpub 2024 Jan 10. PMID: 38379478. https://doi.org/10.1177/10806032231222353
  • Carroll (1927) Cases of snake-bite treated in Almirante Hospital Panama, during the year 1927. United Fruit Company, Med. Dept. 16th annual report: 276-279
  • Otero R, Gutiérrez J, Beatriz Mesa M, Duque E, Rodríguez O, Luis Arango J, Gómez F, Toro A, Cano F, María Rodríguez L, Caro E, Martínez J, Cornejo W, Mariano Gómez L, Luis Uribe F, Cárdenas S, Núñez V, Díaz A. Complications of Bothrops, Porthidium, and Bothriechis snakebites in Colombia. A clinical and epidemiological study of 39 cases attended in a university hospital. Toxicon. 2002 Aug;40(8):1107-114. PMID: 12165312.