Clinic
Case reports
Cerastes vipera
Israel
Ben-Baruch et al. 1986: 7 cases.
Zimmerman et al. 1981: 2 cases.
Cerastes cerastes
Prod'hom, Stahel, Thiebaud 1987, pers. comm.
Lifshitz et al. 2000: 1 case. Identification: morphological.
Lifshitz et al. 2002: 1 case. Identification: morphological.
Schneemann et al. 2004: 2 cases. Identification: morphological.
Signs & symptoms
Autopharmacological effects
C. vipera
Stridor and bronchospasm 3 h after the bite (1/8); patient with known hymenoptera venom allergy and a history of several snakebites, including vipers (Ben-Baruch et al. 1986).
Local effects
C. vipera
Minor local swelling 6/8, small haematoma in the region of the swelling 6/8 (Ben-Baruch et al. 1986).
Local pain 1/2, local swelling 2/2 (Zimmerman et al. 1981).
C. cerastes
Local pain, local swelling (the patient had incised the wound himself and tried to suck out the venom) (Prod'hom, Stahel, Thiebaud 1987, pers. comm.).
Haemorrhagic vesicle, marked swelling of the entire leg (Lifshitz et al. 2000).
Haemorrhagic wound, marked swelling of the entire hand extending to the wrist (Lifshitz et al. 2002).
Local pain 2/2, local swelling extending to the entire bitten limb. Local necrosis 1/2 (Schneemann et al. 2004).
Haemostatic / haemolytic effects
Severe bleeding (bleeding from the venipuncture sites, haematemesis, rectal bleeding) starting 24h after being bitten and lasted 5 days requiring repeated blood transfusions and blood products (Lifshitz et al. 2000).
Bleeding from the venipuncture sites (Lifshitz et al. 2002).
Intracerebral haemorrhage 1/2. Haemolysis 2/2 (Schneemann et al. 2004).
Renal effects
Renal failure requiring haemodyalisis 2/2 (Schneemann et al. 2004).
Case fatality rate
No known fatalities.
Laboratory and physical investigations
1. Haemostasis
Type of haemostatic defect
Procoagulative and fibrinolytic activity of C. cerastes and C. vipera venom has been demonstrated (Labib et al. 1981).
Haemostatic parameters
| Overview haemostasis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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A
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C
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H | CT | (FSP) | Tc | PT | aPTT | TT | I | FSP | D | II | V | VIII | X | XIII | PC | ATIII | PI | tPA | α2AP | |||||||||||||||||||||||||||||||||||||||||||
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D
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B
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Essential bed-side tests |
Tests for full clinical assessment | Tests for research purposes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| A |
PT C. cerastes Prolonged 1/1 (Lifshitz et al. 2000). Prolonged 1/1 (Lifshitz et al. 2002). Prolonged 2/2 (Schneemann et al. 2004). |
| B |
Fibrinogen 0.28 g/l (Lifshitz et al. 2000). 0.54 g/dl (Lifshitz et al. 2002). undetectable (1/2), 0.45 g/dl (1/2) (Schneemann et al. 2004). |
| C |
FSP > 2000 mg/dl (Lifshitz et al. 2000). 17.6 μ/ml (1/2), 128 μ/ml (1/2) (Schneemann et al. 2004). |
| D |
Platelets 48 000/μl (Lifshitz et al. 2000). 98 000/μl (Lifshitz et al. 2002). 13 000/μl (1/2), 42 000/μl (1/2) (Schneemann et al. 2004). |
| E |
Factor V 2% (1/2) (Schneemann et al. 2004). |
2. Haemolysis
Micro-angiopathic haemolysis (Schneemann et al. 2004).
3. Leucocytes
Leucocytosis 1/2 (Zimmerman et al. 1981).
Treatment (symptomatic)
Haemodyalisis, blood transfusion (Lifshitz et al. 2000, 2002, Schneemann et al. 2004).
Treatment (specific)
Favirept, Pasteur Mérieux Lyon-France antivenom (Bitis, Echis, Naja, Cerastes, Macrovipera) 1/2 and polyspecific antivenom Behringwerke Near and Middle East 1/2: with large doses curtailing effect on coagulopathy, but did not prevent the evolution of profound renal failure (Schneemann et al. 2004).