Skip to main content
  1. Terrestrial snakes
  2. South America and the West Indies
  3. Biomedical Database
  4. Pit Vipers
  5. Clinical entry: Bothrops sp.

Clinic: Bothrops sp.

Examine for venom effects

Autopharmacological effects

  • Nausea, vomiting
  • Sweating
  • Urticaria, angiooedema
  • Generalized oedema
  • Arterial hypotension / hypovolaemic shock (transient, recurrent)
  • Diarrhoea
  • Bronchospasm 

Local Effects

  • Pain
  • Tender local (spreading) swelling
  • Blistering
  • Lymphangiopathy and lymphadenopathy
  • Necrotic skin; can include muscle locally.

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
    • Oliguria, anuria (acute kidney injury - AKI)

Neurological effects

 Myokymia

    • Clinically, myokymia manifests itself as spontaneous continuous undulating fine contractions of multiple individual motor units. The clinical appearance is similar to fasciculations but more arrhythmic. (Lewis and Gutmann 2004; video: Ramacharan et al. 2016). 

(Muscular effects)

  • Generalized rhabdomyolysis:
    • Muscles pain and tenderness, painful on passive stretching, muscle stiffness, trismus
    • Bulbar and respiratory muscle weakness.
    • Dark brown urine. 
    • Renal failure (AKI)
    • Laboratory: Generalized rhabdomyolysis: defined by a serum creatine kinase level > 10,000 U/l
    • ECG: Signs of hyperkalaemia. 

Cardiac Effects

  • Bradycardia, tachycardia, arrhythmias
  • Arterial hypotension
  • Heart failure
  • ECG: Tachyarrhythmias, sinus bradycardia, ST-T wave changes, varying degrees of atrioventricular block, and evidence of hyperkalaemia.

Renal effects

  • Acute kidney injury:
  • Loin pain (lower back pain)
  • Renal bed sensitive to percussion
  • Haematuria, haemoglobinuria, myoglobinuria
  • Oliguria (< 400 ml of urine / 24 h), anuria
  • Uraemia (nausea, acidotic breathing, hiccups,pleuritic chest pain, encephalopathy)

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    Renal
effects6		 Other
effects7
 Bleeding3  Coagulopathy4 

Thrombotic
microangio-
pathy (TMA)5
Bothrops asper                    
Bothrops atrox      
Bothrops erythromelas      
Bothrops jararaca /
jararacussu		      
Bothrops lanceolatus      in situ arterial
thromosis8
Bothrops moojeni      
Bothrops neuwiedi      
Bothrops venezuelensis      

Table 1 in Malaque and Gutiérrez (2017) compares the clinical features based on data of Otero et al. (1996) [Bothrops asper], Pardal et al. (2004) [B. atrox], Milani et al. (1997) [Bothrops jararacussu], Hospital Vital Brazil [Bothrops jararaca], Kouyoumdjian et al. (1989) [Bothrops moojeni].

“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 provokes manifestations similar to those observed in individuals with Bothrops envenomation. Therefore, the term “Bothrops syndrome” will be used in order to refer to such manifestations, collectively.” (Malaque and Gutiérrez 2017)

“Envenomation by Bothrops bites is characterized by local signs such as intense pain, rapidly expanding oedema, haemorrhage and sometimes muscle necrosis. The local inflammatory and haemorrhagic damage is related to the enzymatic activities of the toxins contained in the venom (metallo-proteinases, disintegrins, and phospholipases A2, in particular). At the systemic level, venom serine proteases and metalloproteinases activate the coagulation cascade by multiple mechanisms (activation of coagulation factors X and V and of protrombin, thrombin-like and fibrinogenolytic enzymatic properties) and are responsible for the collapse of coagulation factors making the blood incoagulable. The metalloproteinases "hemorrhagins" destroy the vessel wall and are the cause of locoregional and systemic hemorrhage.” (https://clinicaltrials.gov/study/NCT06304714) 

1Autopharmacological effects

May occur within minutes of bites by Bothrops species (Warrell 2004, 2009, 2023). 

2Local effect

Pain, redness, swelling, ecchymosis, bleeding, blisters. Necrosis (Albuquerque Barbosa et al. 2024, Cardoso et al. 1993, Malaque and Gutiérrez 2017, Warrell 2004). Occasionally, compartmental syndrome may develop (Malaque and Gutiérrez 2017). 

Hematological effects

3Bleeding

Systemic bleeding

Severe bleeding has been reported, it is, however, rare; ecchymosis distal from bite site (Cardoso et al. 1993,Oliveira et al. 2019, Malaque and Gutiérrez 2017, Warrell 2004).

Intracarnial bleeding

(Bentes et al. 2024, Martínez-Villota et al. 2022, Mosquera et al. 2003) 

4Coagulopathy

Type of haemostatic defect

Venom-induced consumption coagulopathy (VICC) (Kamiguti et al. 1991, Larréché et al. 2021). 

In situ arterial thrombosis

Bothrops lanceolatus envenoming, see footnote 8. 

5Thrombotic micro-angiopathy (TMA)

Bothrops atrox (Duarte et al. 2025, Warrell 2009).

Bothrops erythromelas (Mota et al. 2020).

Bothrops jararaca (Amaral et al. 1985, Bucaretchi et al. 2019, Malaque et al. 2019)

Bothrops lanceolatus (Malbranque et al. 2008).

“TMA include disseminated intravascular coagulation, microangiopathic haemolytic anaemia diagnosed by finding schistocytes in peripheral blood films, thrombocytopenia, and acute kidney injury associated with arteriolar and capillary microthrombi. TMA with acute kidney injury is increasingly recognised in patients envenomed by Russell’s vipers and a variety of other species.” (Warrell and Williams 2023).

See also Noutsos et al. (2020, 2022). 

6Renal effects

AKI results from a combination of factors, possibly including direct action of the venom (Malaque and Gutiérrez 2017; Pinho et al. 2008, Sitprija 2006; Warrell 2004, 2023). 

7Other effects

Neurological effects

Myokymia

“Myokymia, a slower and more regular form of fine contractions than fasciculations that is distinguishable from fasciculations electrophysiologically, is reversible with intravenous calcium chloride. It occurs in envenoming by some species of North American rattlesnakes (eg, Crotalus horridus, Crotalus scutellatus, Crotalus lutosus, and Crotalus helleri) and the common lancehead pit viper (Bothrops atrox) in Trinidad" (Warrell and Willimas 2023; cit Lewis and Gutmann 2004).

Bothrops atrox (Ramcharan et al. 2016).

Bothrops asper (Delgado and Del Brutto 2012) 

Muscular effects

… “despite the high concentration of myotoxic PLA 2s in some of these venoms (15 –25% of venom proteins in the cases of B. asper and B. jararacussu, systemic myotoxicity is rarely described in these patients.” (Gutiérrez and Ownby 2003; Cintra-Francischinelli et al. 2010).

Local myonecrosis

Bothrops asper (representative of myotoxins present in many Bothrops spp., as well as in many other species belonging to different snake genera) (Cintra-Francischinelli et al. 2010). 

Cardiac effects

“Cardiac alterations are not a frequent outcome but are highly linked to severe cases”. A range of mechanism can explain the pathogenesis of cardiac disorders in Bothrops envenoming one of which is a direct effect of venom components on the heart (B. atrox, Sartim et al. 2025). 

8Bothrops lanceolatus

Martinique

“In situ arterial thrombosis (cerebral, pulmonary, coronary, etc.) is an important feature of envenoming by the ‘fer-de-lance’ (B. lanceolatus) of Martinique (Warrell 2023). See: Malbranque et al. (2008), Resiere et al. (2023), Warrell (2004).

“Envenomations by bites of Bothrops lanceolatus in Martinique have particular characteristics. Despite the genetic similarity with their congeners in French Guiana, envenomation by bites of Bothrops lanceolatus is characterized by the development of very intense local inflammatory signs (little haemorrhage) and the occurrence of thrombotic complications such as cerebral, pulmonary or myocardial infarction. The mechanisms behind this thrombotic presentation are not known. The large amount of metalloproteinases in the composition of Bothrops lanceolatus venom is believed to be responsible for destruction of vascular endothelium and pro-thrombotic state. Bothrops lanceolatus bite envenomations have been reported to be frequently complicated by generalized infections, disseminated intravascular coagulation and the occurrence of multi-visceral failure syndrome. This observation suggests abnormalities in endothelial function in which changes in Willebrand factor expression have been implicated.” (https://clinicaltrials.gov/study/NCT06304714)

Diffuse thrombotic microangiopathy (Malbranque et al 2008). 

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
Necroses: debridement; split-thickness skin grafting
Systemic antibiotics: standard indications
WHO (2010) 

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 Bothrops sp. - specific features

see

  • 'Species-specific envenoming pattern above'

Key issues

see footnotes above.

Specific treatment (antivenoms)

Rehabilitation

Post-traumatic stress disorder

(Millán-González et al. 2023) 

Species-specific evidence

Bothrops alternatus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops ammodytoides

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops andianus (= Bothrocophias Andianus)

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops asper

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Colombia

  • 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. https://doi.org/10.1016/s0041-0101(02)00104-6
  • Otero-Patiño R. Epidemiological, clinical and therapeutic aspects of Bothrops asper bites. Toxicon. 2009 Dec 1;54(7):998-1011. Epub 2009 Jul 8. PMID: 19591857. https://doi.org/10.1016/j.toxicon.2009.07.001
  • Otero-Patiño R, Segura A, Herrera M, Angulo Y, León G, Gutiérrez JM, Barona J, Estrada S, Pereañez A, Quintana JC, Vargas LJ, Gómez JP, Díaz A, Suárez AM, Fernández J, Ramírez P, Fabra P, Perea M, Fernández D, Arroyo Y, Betancur D, Pupo L, Córdoba EA, Ramírez CE, Arrieta AB, Rivero A, Mosquera DC, Conrado NL, Ortiz R. Comparative study of the efficacy and safety of two polyvalent, caprylic acid fractionated [IgG and F(ab')2] antivenoms, in Bothrops asper bites in Colombia. Toxicon. 2012 Feb;59(2):344-55. Epub 2011 Nov 29. PMID: 22146491. https://doi.org/10.1016/j.toxicon.2011.11.017

Costa Rica

  • Millán-González R, Monge-Morales LF, De La Cruz-Villalobos N, Bonilla-Murillo F, Gutiérrez JM.Bothrops asper bite and post-traumatic stress disorder in Costa Rica: Report of two cases. Toxicon. 2023 Aug 1;231:107199. Epub 2023 Jun 14. PMID: 37328114. https://doi.org/10.1016/j.toxicon.2023.107199

Ecuador

  • Delgado ME, Del Brutto OH.Reversible posterior leukoencephalopathy in a venomous snake (Bothrops asper) bite victim. Am J Trop Med Hyg. 2012 Mar;86(3):496-8. PMID: 22403325; PMCID: PMC3284370. https://doi.org/10.4269/ajtmh.2012.11-0610

Bothrops atrox

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Brazil

  • Albuquerque Barbosa FB, Raad RS, Santos Ibiapina HN, Freire Dos Reis M, Neves JCF, Andrade RV, Nascimento TP, Valle FF, Casewell NR, Sachett J, Sartim MA, Monteiro W, Costa AG, Lima Ferreira LC. Dermatopathological findings of Bothrops atrox snakebites: A case series in the Brazilian Amazon.PLoS Negl Trop Dis. 2024 Dec 26;18(12):e0012704. PMID: 39724013; PMCID: PMC11670982. https://doi.org/10.1371/journal.pntd.0012704
  • Duarte LRA, Carvalho É, Melo TFC, Barbosa FBA, de Andrade RV, Sartim M, Araújo FQ, Sachett J, Pivoto G, de Lima Ferreira LC, Monteiro W. Fatal Bothrops atrox snakebite with thrombotic microangiopathy, hemorrhagic stroke and acute kidney injury.Toxicon. 2025 Oct 8;268:108610. Epub ahead of print. PMID: 41072773. https://doi.org/10.1016/j.toxicon.2025.108610
  • Moura-da-Silva AM, Contreras-Bernal JC, Cirilo Gimenes SN, Freitas-de-Sousa LA, Portes-Junior JA, da Silva Peixoto P, Kei Iwai L, Mourão de Moura V, Ferreira Bisneto P, Lacerda M, Mendonça da Silva I, de Lima Ferreira LC, Silva de Oliveira S, Hui Wen F, de Almeida Gonçalves Sachett J, Monteiro WM. The relationship between clinics and the venom of the causative Amazon pit viper (Bothrops atrox).PLoS Negl Trop Dis. 2020 Jun 8;14(6):e0008299. PMID: 32511239; PMCID: PMC7302866. https://doi.org/10.1371/journal.pntd.0008299
  • Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, Tomy SC, Sano-Martins IS, de Sousa-e-Silva MC, Colombini M, Kodera NF, Moura-da-Silva AM, Cardoso DF, Velarde DT, Kamiguti AS, Theakston RD, Warrell DA.Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004 Jan;98(1):28-42. PMID: 14702836. https://doi.org/10.1016/s0035-9203(03)00005-1
  • Sartim MA, Raimunda da Costa M, Bentes KO, Mwangi VI, Pinto TS, Oliveira S, Mota Cordeiro JS, Wilson do Nascimento Corrêa J, Ferreira JMBB, Cardoso de Melo G, Sachett J, Monteiro WM. Myocardial injury and its association with venom-induced coagulopathy following Bothrops atrox snakebite envenomation. Toxicon. 2025 Apr;258:108312. Epub 2025 Mar 7. PMID: 40058470. https://doi.org/10.1016/j.toxicon.2025.108312

Colombia

  • Otero R, Gutiérrez JM, Núñez V, Robles A, Estrada R, Segura E, Toro MF, García ME, Díaz A, Ramírez EC, Gómez G, Castañeda J, Moreno ME. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia. The Regional Group on Antivenom Therapy Research (REGATHER). Trans R Soc Trop Med Hyg. 1996 Nov-Dec;90(6):696-700. PMID: 9015522. https://doi.org/10.1016/s0035-9203(96)90442-3

Suriname

  • Warrell DA. Commissioned article: management of exotic snakebites. QJM. 2009 Sep;102(9):593-601. Epub 2009 Jun 17. PMID: 19535618.

https://doi.org/10.1093/qjmed/hcp075

Trinidad

  • Ramcharan K, Abdool K, Persad N, Alexander A. Snake bite-induced myoclonus, myokymia and myospasm with leukoencephalopathy: a video presentation. BMJ Case Rep. 2016 Apr 19;2016:10.1136/bcr-2016-214963. PMID: 27095811; PMCID: PMC4840739. https://doi.org/10.1136/bcr-2016-214963

Bothrops barnetti

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops brazili

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops caribbaeus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops cotiara

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops erythromelas

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Brazil

  • Mota SMB, Albuquerque PLMM, Silva Júnior GBD, Daher EF. Thrombotic microangiopathy due to Bothrops erythromelas: a case report in Northeast Brazil. Rev Inst Med Trop Sao Paulo. 2020;62:e53. Epub 2020 Jul 24. PMID: 32725056; PMCID: PMC7384591. https://doi.org/10.1590/s1678-9946202062053

Bothrops jararaca and Bothrops jararacussu

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Brazil (São Paulo)

  • Amaral CF, Da Silva OA, Goody P, Miranda D. Renal cortical necrosis following Bothrops jararaca and B. jararacussu snake bite. Toxicon. 1985;23(6):877-85. PMID: 4095703. https://doi.org/10.1016/0041-0101(85)90379-4
  • Bucaretchi F, Pimenta MMB, Borrasca-Fernandes CF, Prado CC, Capitani EM, Hyslop S. Thrombotic microangiopathy following Bothrops jararaca snakebite: case report. Clin Toxicol (Phila). 2019 Apr;57(4):294-299. Epub 2018 Nov 16. PMID: 30444155. https://doi.org/10.1080/15563650.2018.1514621
  • Cardoso JL, Fan HW, França FO, Jorge MT, Leite RP, Nishioka SA, Avila A, Sano-Martins IS, Tomy SC, Santoro ML, et al. Randomized comparative trial of three antivenoms in the treatment of envenoming by lance-headed vipers (Bothrops jararaca) in São Paulo, Brazil. Q J Med. 1993 May;86(5):315-25. PMID: 8327649.
  • França FO, Barbaro KC, Fan HW, Cardoso JL, Sano-Martins IS, Tomy SC, Lopes MH, Warrell DA, Theakston RD; Butantan Institute Antivenom Study Group. Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital. Trans R Soc Trop Med Hyg. 2003 May-Jun;97(3):312-7. PMID: 15228251. https://doi.org/10.1016/s0035-9203(03)90158-1
  • Jorge MT, Cardoso JL, Castro SC, Ribeiro L, França FO, de Almeida ME, Kamiguti AS, Santo-Martins IS, Santoro ML, Mancau JE, et al. A randomized 'blinded' comparison of two doses of antivenom in the treatment of Bothrops envenoming in São Paulo, Brazil. Trans R Soc Trop Med Hyg. 1995 Jan-Feb;89(1):111-4. PMID: 7747293. https://doi.org/10.1016/0035-9203(95)90678-9
  • Malaque CMS, Duayer IF, Santoro ML.Acute kidney injury induced by thrombotic microangiopathy in two cases of Bothrops envenomation. Clin Toxicol (Phila). 2019 Mar;57(3):213-216. Epub 2018 Nov 15. PMID: 30430871. https://doi.org/10.1080/15563650.2018.1510129
  • Milani Júnior R, Jorge MT, de Campos FP, Martins FP, Bousso A, Cardoso JL, Ribeiro LA, Fan HW, França FO, Sano-Martins IS, Cardoso D, Ide Fernandez C, Fernandes JC, Aldred VL, Sandoval MP, Puorto G, Theakston RD, Warrell DA. Snake bites by the jararacuçu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in São Paulo State, Brazil. QJM. 1997 May;90(5):323-34. PMID: 9205667. https://doi.org/10.1093/qjmed/90.5.323
  • Santoro ML, Sano-Martins IS, Fan HW, Cardoso JL, Theakston RD, Warrell DA; Butantan Institute Antivenom Study Group. Haematological evaluation of patients bitten by the jararaca, Bothrops jararaca, in Brazil. Toxicon. 2008 Jun 15;51(8):1440-8. Epub 2008 Mar 25. PMID: 18471839. https://doi.org/10.1016/j.toxicon.2008.03.018

Bothrops lanceolatus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Martinique

  • Malbranque S, Piercecchi-Marti MD, Thomas L, Barbey C, Courcier D, Bucher B, Ridarch A, Smadja D, Warrell DA. Fatal diffuse thrombotic microangiopathy after a bite by the "Fer-de-Lance" pit viper (Bothrops lanceolatus) of Martinique. Am J Trop Med Hyg. 2008 Jun;78(6):856-61. PMID: 18541759.
  • Resiere D, Kallel H, Florentin J, Houcke S, Mehdaoui H, Gutiérrez JM, Neviere R. Bothrops (Fer-de-lance) snakebites in the French departments of the Americas (Martinique and Guyana): Clinical and experimental studies and treatment by immunotherapy.PLoS Negl Trop Dis. 2023 Feb 28;17(2):e0011083. PMID: 36854042; PMCID: PMC9974124. https://doi.org/10.1371/journal.pntd.0011083

Bothrops leucurus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops lojanus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops marajoensis

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops moojeni

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Brazil (São Paulo)

  • Kouyoumdjian JA, Polizelli C, Lobo SM, Guimares SM. Fatal extradural haematoma after snake bite (Bothrops moojeni). Trans R Soc Trop Med Hyg. 1991 Jul-Aug;85(4):552. PMID: 1755073. https://doi.org/10.1016/0035-9203(91)90257-y

Bothrops nasutum (= Porthidium nasutum)

  • 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. https://doi.org/10.1016/s0041-0101(02)00104-6

Bothrops neuwiedi

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.
  • Dempfle CE, Kohl R, Harenberg J, Kirschstein W, Schlauch D, Heene DL. Coagulopathy after snake bite by Bothrops neuwiedi: case report and results of in vitro experiments. Blut. 1990 Dec;61(6):369-74. PMID: 2291986. https://doi.org/10.1007/bf01738552
  • Jorge MT, Ribeiro LA. Envenoming by the South American pit viper Bothrops neuwiedi Wagler. Ann Trop Med Parasitol. 2000 Oct;94(7):731-4. PMID: 11144814. https://doi.org/10.1080/00034980020011741

Bothrops pictus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops punctatus

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.
  • 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. https://doi.org/10.1016/s0041-0101(02)00104-6

Bothrops roedingeri

  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.

Bothrops venezuelensis

  • Fuchs J, Faber K, Tuchscherer DT, Tsakiris DA, Weiler S, Hofer KE.Bite by a juvenile Bothrops venezuelensis (Venezuelan lancehead) resulting in severe envenomation: A case report. Toxicon. 2020 Jun;180:39-42. Epub 2020 Apr 11. PMID: 32289355. https://doi.org/10.1016/j.toxicon.2020.04.002

References

Publications reporting broadly on Bothrops sp. envenoming

Larréché et al. (2021), Martínez-Villota et al. (2022), Mosquera et al. (2003), Malaque and Gutiérrez (2017); Warrell (2004).

All references

  • Albuquerque Barbosa FB, Raad RS, Santos Ibiapina HN, Freire Dos Reis M, Neves JCF, Andrade RV, Nascimento TP, Valle FF, Casewell NR, Sachett J, Sartim MA, Monteiro W, Costa AG, Lima Ferreira LC. Dermatopathological findings of Bothrops atrox snakebites: A case series in the Brazilian Amazon.PLoS Negl Trop Dis. 2024 Dec 26;18(12):e0012704. PMID: 39724013; PMCID: PMC11670982. https://doi.org/10.1371/journal.pntd.0012704
  • Amaral CF, Da Silva OA, Goody P, Miranda D. Renal cortical necrosis following Bothrops jararaca and B. jararacussu snake bite. Toxicon. 1985;23(6):877-85. PMID: 4095703. https://doi.org/10.1016/0041-0101(85)90379-4
  • Bentes KO, de Amorim RLO, Barbosa FBA, Ratis da Silva VCP, Valente J, Almeida-Val F, Sachett JAG, Monteiro W, Sartim MA. Long-term disability after cerebral ischemic stroke following a Bothrops atrox snakebite in the Brazilian Amazon. Toxicon. 2024 Aug 28;247:107793. Epub 2024 Jun 3. PMID: 38838861. https://doi.org/10.1016/j.toxicon.2024.107793
  • Bucaretchi F, Pimenta MMB, Borrasca-Fernandes CF, Prado CC, Capitani EM, Hyslop S. Thrombotic microangiopathy following Bothrops jararaca snakebite: case report. Clin Toxicol (Phila). 2019 Apr;57(4):294-299. Epub 2018 Nov 16. PMID: 30444155. https://doi.org/10.1080/15563650.2018.1514621
  • Cardoso JL, Fan HW, França FO, Jorge MT, Leite RP, Nishioka SA, Avila A, Sano-Martins IS, Tomy SC, Santoro ML, et al. Randomized comparative trial of three antivenoms in the treatment of envenoming by lance-headed vipers (Bothrops jararaca) in São Paulo, Brazil. Q J Med. 1993 May;86(5):315-25. PMID: 8327649.
  • Cintra-Francischinelli M, Caccin P, Chiavegato A, Pizzo P, Carmignoto G, Angulo Y, Lomonte B, Gutiérrez JM, Montecucco C. Bothrops snake myotoxins induce a large efflux of ATP and potassium with spreading of cell damage and pain. Proc Natl Acad Sci U S A. 2010 Aug 10;107(32):14140-5. Epub 2010 Jul 26.PMID: 20660736; PMCID: PMC2922586. https://doi.org/10.1073/pnas.1009128107
  • Delgado ME, Del Brutto OH.Reversible posterior leukoencephalopathy in a venomous snake (Bothrops asper) bite victim. Am J Trop Med Hyg. 2012 Mar;86(3):496-8. PMID: 22403325; PMCID: PMC3284370. https://doi.org/10.4269/ajtmh.2012.11-0610
  • Dempfle CE, Kohl R, Harenberg J, Kirschstein W, Schlauch D, Heene DL.Coagulopathy after snake bite by Bothrops neuwiedi: case report and results of in vitro experiments. Blut. 1990 Dec;61(6):369-74. PMID: 2291986. https://doi.org/10.1007/bf01738552
  • Duarte LRA, Carvalho É, Melo TFC, Barbosa FBA, de Andrade RV, Sartim M, Araújo FQ, Sachett J, Pivoto G, de Lima Ferreira LC, Monteiro W. Fatal Bothrops atrox snakebite with thrombotic microangiopathy, hemorrhagic stroke and acute kidney injury. Toxicon. 2025 Oct 8;268:108610. Epub ahead of print. PMID: 41072773. https://doi.org/10.1016/j.toxicon.2025.108610
  • França FO, Barbaro KC, Fan HW, Cardoso JL, Sano-Martins IS, Tomy SC, Lopes MH, Warrell DA, Theakston RD; Butantan Institute Antivenom Study Group. Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital. Trans R Soc Trop Med Hyg. 2003 May-Jun;97(3):312-7. PMID: 15228251. https://doi.org/10.1016/s0035-9203(03)90158-1
  • Fuchs J, Faber K, Tuchscherer DT, Tsakiris DA, Weiler S, Hofer KE.Bite by a juvenile Bothrops venezuelensis (Venezuelan lancehead) resulting in severe envenomation: A case report. Toxicon. 2020 Jun;180:39-42. Epub 2020 Apr 11. PMID: 32289355. https://doi.org/10.1016/j.toxicon.2020.04.002
  • Gutiérrez JM, Ownby CL. Skeletal muscle degeneration induced by venom phospholipases A2: insights into the mechanisms of local and systemic myotoxicity. Toxicon. 2003 Dec 15;42(8):915-31. doi: 10.1016/j.toxicon.2003.11.005. PMID: 15019491. https://doi.org/10.1016/j.toxicon.2003.11.005
  • Jorge MT, Ribeiro LA. Envenoming by the South American pit viper Bothrops neuwiedi Wagler. Ann Trop Med Parasitol. 2000 Oct;94(7):731-4. PMID: 11144814. https://doi.org/10.1080/00034980020011741
  • Jorge MT, Cardoso JL, Castro SC, Ribeiro L, França FO, de Almeida ME, Kamiguti AS, Santo-Martins IS, Santoro ML, Mancau JE, et al. A randomized 'blinded' comparison of two doses of antivenom in the treatment of Bothrops envenoming in São Paulo, Brazil. Trans R Soc Trop Med Hyg. 1995 Jan-Feb;89(1):111-4. PMID: 7747293. https://doi.org/10.1016/0035-9203(95)90678-9
  • Kamiguti AS, Cardoso JL, Theakston RD, Sano-Martins IS, Hutton RA, Rugman FP, Warrell DA, Hay CR. Coagulopathy and haemorrhage in human victims of Bothrops jararaca envenoming in Brazil. Toxicon. 1991;29(8):961-72. PMID: 1949067. https://doi.org/10.1016/0041-0101(91)90079-7
  • Kouyoumdjian JA, Polizelli C. Acidentes ofídicos causados por Bothrops moojeni: correlação do quadro clíníco com o tamanho da serpente [Snake bites by Bothrops moojeni: correlation of the clinical picture with the snake size]. Rev Inst Med Trop Sao Paulo. 1989 Mar-Apr;31(2):84-90. Portuguese. PMID: 2602805. https://doi.org/10.1590/s0036-46651989000200004
  • Kouyoumdjian JA, Polizelli C, Lobo SM, Guimares SM. Fatal extradural haematoma after snake bite (Bothrops moojeni). Trans R Soc Trop Med Hyg. 1991 Jul-Aug;85(4):552. PMID: 1755073. https://doi.org/10.1016/0035-9203(91)90257-y
  • Larréché S, Chippaux JP, Chevillard L, Mathé S, Résière D, Siguret V, Mégarbane B. Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders. Int J Mol Sci. 2021 Sep 6;22(17):9643. PMID: 34502548; PMCID: PMC8431793.
  • Lewis RL, Gutmann L. Snake venoms and the neuromuscular junction.Semin Neurol. 2004 Jun;24(2):175-9. PMID: 15257514. https://doi.org/10.1055/s-2004-830904
  • Malaque, C.M., Gutiérrez, J.M. (2017). South and Central American Snakes. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham.https://doi.org/10.1007/978-3-319-17900-1_146
  • Malaque CMS, Duayer IF, Santoro ML. Acute kidney injury induced by thrombotic microangiopathy in two cases of Bothrops envenomation. Clin Toxicol (Phila). 2019 Mar;57(3):213-216. Epub 2018 Nov 15. PMID: 30430871. https://doi.org/10.1080/15563650.2018.1510129
  • Malbranque S, Piercecchi-Marti MD, Thomas L, Barbey C, Courcier D, Bucher B, Ridarch A, Smadja D, Warrell DA. Fatal diffuse thrombotic microangiopathy after a bite by the "Fer-de-Lance" pit viper (Bothrops lanceolatus) of Martinique. Am J Trop Med Hyg. 2008 Jun;78(6):856-61. PMID: 18541759.
  • Martínez-Villota VA, Mera-Martínez PF, Portillo-Miño JD. Massive acute ischemic stroke after Bothrops spp. envenomation in southwestern Colombia: Case report and literature review. Biomedica. 2022 Mar 1;42(1):9-17. PMID: 35471166; PMCID: PMC9045098. https://doi.org/10.7705/biomedica.6114
  • Milani Júnior R, Jorge MT, de Campos FP, Martins FP, Bousso A, Cardoso JL, Ribeiro LA, Fan HW, França FO, Sano-Martins IS, Cardoso D, Ide Fernandez C, Fernandes JC, Aldred VL, Sandoval MP, Puorto G, Theakston RD, Warrell DA. Snake bites by the jararacuçu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in São Paulo State, Brazil. QJM. 1997 May;90(5):323-34. PMID: 9205667. https://doi.org/10.1093/qjmed/90.5.323
  • Millán-González R, Monge-Morales LF, De La Cruz-Villalobos N, Bonilla-Murillo F, Gutiérrez JM.Bothrops asper bite and post-traumatic stress disorder in Costa Rica: Report of two cases. Toxicon. 2023 Aug 1;231:107199. Epub 2023 Jun 14. PMID: 37328114. https://doi.org/10.1016/j.toxicon.2023.107199
  • Mosquera A, Idrovo LA, Tafur A, Del Brutto OH.Stroke following Bothrops spp. snakebite. Neurology. 2003 May 27;60(10):1577-80. PMID: 12771244. https://doi.org/10.1212/01.wnl.0000061614.52580.a1
  • Mota SMB, Albuquerque PLMM, Silva Júnior GBD, Daher EF. Thrombotic microangiopathy due to Bothrops erythromelas: a case report in Northeast Brazil. Rev Inst Med Trop Sao Paulo. 2020;62:e53. Epub 2020 Jul 24. PMID: 32725056; PMCID: PMC7384591. https://doi.org/10.1590/s1678-9946202062053
  • Moura-da-Silva AM, Contreras-Bernal JC, Cirilo Gimenes SN, Freitas-de-Sousa LA, Portes-Junior JA, da Silva Peixoto P, Kei Iwai L, Mourão de Moura V, Ferreira Bisneto P, Lacerda M, Mendonça da Silva I, de Lima Ferreira LC, Silva de Oliveira S, Hui Wen F, de Almeida Gonçalves Sachett J, Monteiro WM.The relationship between clinics and the venom of the causative Amazon pit viper (Bothrops atrox).PLoS Negl Trop Dis. 2020 Jun 8;14(6):e0008299. PMID: 32511239; PMCID: PMC7302866. https://doi.org/10.1371/journal.pntd.0008299
  • Noutsos T, Currie BJ, Lek RA, Isbister GK.Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis.PLoS Negl Trop Dis. 2020 Dec 8;14(12):e0008936. PMID: 33290400; PMCID: PMC7748274. https://doi.org/10.1371/journal.pntd.0008936
  • Noutsos T, Currie BJ, Wijewickrama ES, Isbister GK.Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice. Toxins (Basel). 2022 Jan 14;14(1):57. PMID: 35051033; PMCID: PMC8778654. https://doi.org/10.3390/toxins14010057
  • Oliveira SS, Alves EC, Santos AS, Pereira JPT, Sarraff LKS, Nascimento EF, de-Brito-Sousa JD, Sampaio VS, Lacerda MVG, Sachett JAG, Sano-Martins IS, Monteiro WM. Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon. Toxins (Basel). 2019 Jan 7;11(1):22. PMID: 30621001; PMCID: PMC6356762. https://doi.org/10.3390/toxins11010022
  • Otero-Patiño R. Epidemiological, clinical and therapeutic aspects of Bothrops asper bites. Toxicon. 2009 Dec 1;54(7):998-1011. Epub 2009 Jul 8. PMID: 19591857. https://doi.org/10.1016/j.toxicon.2009.07.001
  • Otero R, Gutiérrez JM, Núñez V, Robles A, Estrada R, Segura E, Toro MF, García ME, Díaz A, Ramírez EC, Gómez G, Castañeda J, Moreno ME. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia. The Regional Group on Antivenom Therapy Research (REGATHER). Trans R Soc Trop Med Hyg. 1996 Nov-Dec;90(6):696-700. PMID: 9015522. https://doi.org/10.1016/s0035-9203(96)90442-3
  • 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. https://doi.org/10.1016/s0041-0101(02)00104-6 
  • Otero-Patiño R, Segura A, Herrera M, Angulo Y, León G, Gutiérrez JM, Barona J, Estrada S, Pereañez A, Quintana JC, Vargas LJ, Gómez JP, Díaz A, Suárez AM, Fernández J, Ramírez P, Fabra P, Perea M, Fernández D, Arroyo Y, Betancur D, Pupo L, Córdoba EA, Ramírez CE, Arrieta AB, Rivero A, Mosquera DC, Conrado NL, Ortiz R. Comparative study of the efficacy and safety of two polyvalent, caprylic acid fractionated [IgG and F(ab')2] antivenoms, in Bothrops asper bites in Colombia. Toxicon. 2012 Feb;59(2):344-55. Epub 2011 Nov 29. PMID: 22146491. https://doi.org/10.1016/j.toxicon.2011.11.017
  • Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, Tomy SC, Sano-Martins IS, de Sousa-e-Silva MC, Colombini M, Kodera NF, Moura-da-Silva AM, Cardoso DF, Velarde DT, Kamiguti AS, Theakston RD, Warrell DA. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004 Jan;98(1):28-42. PMID: 14702836. https://doi.org/10.1016/s0035-9203(03)00005-1
  • Pinho FMO, Yu L, Burdmann EA. Snakebite-induced acute kidney injury in Latin America. Semin Nephrol. 2008 Jul;28(4):354-362. PMID: 18620958. https://doi.org/10.1016/j.semnephrol.2008.04.004
  • Ramcharan K, Abdool K, Persad N, Alexander A. Snake bite-induced myoclonus, myokymia and myospasm with leukoencephalopathy: a video presentation. BMJ Case Rep. 2016 Apr 19;2016:10.1136/bcr-2016-214963. PMID: 27095811; PMCID: PMC4840739. https://doi.org/10.1136/bcr-2016-214963 
  • Resiere D, Kallel H, Florentin J, Houcke S, Mehdaoui H, Gutiérrez JM, Neviere R. Bothrops (Fer-de-lance) snakebites in the French departments of the Americas (Martinique and Guyana): Clinical and experimental studies and treatment by immunotherapy.PLoS Negl Trop Dis. 2023 Feb 28;17(2):e0011083. PMID: 36854042; PMCID: PMC9974124. https://doi.org/10.1371/journal.pntd.0011083
  • Santoro ML, Sano-Martins IS, Fan HW, Cardoso JL, Theakston RD, Warrell DA; Butantan Institute Antivenom Study Group. Haematological evaluation of patients bitten by the jararaca, Bothrops jararaca, in Brazil. Toxicon. 2008 Jun 15;51(8):1440-8. Epub 2008 Mar 25. PMID: 18471839. https://doi.org/10.1016/j.toxicon.2008.03.018
  • Sartim MA, Raimunda da Costa M, Bentes KO, Mwangi VI, Pinto TS, Oliveira S, Mota Cordeiro JS, Wilson do Nascimento Corrêa J, Ferreira JMBB, Cardoso de Melo G, Sachett J, Monteiro WM. Myocardial injury and its association with venom-induced coagulopathy following Bothrops atrox snakebite envenomation. Toxicon. 2025 Apr;258:108312. Epub 2025 Mar 7. PMID: 40058470. https://doi.org/10.1016/j.toxicon.2025.108312
  • Sitprija V. Snakebite nephropathy. Nephrology (Carlton). 2006 Oct;11(5):442-8. PMID: 17014559. https://doi.org/10.1111/j.1440-1797.2006.00599.x
  • Warrell DA. Epidemiology, clinical features and management of snakebites in Central and South America. In: Campbell J, Lamar WW, editors. Venomous Reptiles of the Western Hemisphere. Ithaca: Cornell University Press; 2004. p. 709–61.
  • Warrell DA. Commissioned article: management of exotic snakebites.QJM. 2009 Sep;102(9):593-601. Epub 2009 Jun 17. PMID: 19535618. https://doi.org/10.1093/qjmed/hcp075
  • 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
  • WHO-ICRC Basic Emergency Care: approach to the acutely ill and injured https://www.who.int/publications-detail-redirect/basic-emergency-care-approach-to-the-acutely-ill-and-injured; 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