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Poisonous animals
 
Cnidarians (Jellyfish, Corals and Anemones)
 
Venomous fish
 
Scorpions
 
Spiders
 
Hymenopterans (Bees, Wasps and Ants)
 
Sea snakes
 
Terrestrial snakes
 
Miscellaneous animals
 
North America
 
Mexico and Central America
 
South America and the West Indies
 
Europe
 
North Africa, Near and Middle East
 
Central and Southern Africa
 
The Far East
 
Indian Subcontinent and Southeast Asia
 
Australia and the Pacific Islands
 
 
 
 
 
 
 
 

Clinic

 

Lachesis sp.

Studies

Colombia

Patino et al. 1993: 5 Lachesis muta bites; identification: morphological; the patients reached hospital on average 15.6 h (1–25 h) after the bite.

Case reports

Brazil
Haad 1980/81: 2 Lachesis muta muta bites; identification: morphological.
Jorge et al. 1993: 1 Lachesis muta muta bite; identification: criteria not mentioned.


French Guiana
Hulin et al. 1982: 4 Lachesis muta (=Lachesis muta muta) bites; identification: morphological.


Costa Rica
Bolanos et al. 1982: 4 Lachesis muta stenophrys (=Lachesis stenophrys) bites; identification morphological 3/4; recognition of the snake that had caused the accident 1/4.


Panama
Clark 1928: 1 Lachesis muta (=Lachesis stenophrys or L. acrochordata) bite; identification: morphological.

Signs & symptoms

Autopharmacological effects

Arterial hypotension (Kamiguti and Cardoso 1989).

Vomiting 1/2, diarrhoea 2/2, colicky abdominal pain 2/2, arterial hypotension 2/2 (systolic 50 mmHg; 60/40 mmHg). Commencing within 15 min after the bite, persisting over a period of several hours, bradycardia 2/2 (49/min, 50/min) (Haad 1980/81).
Arterial hypotension 2/4 (Bolanos et al. 1982).
Nausea 1/5, sweating 3/5, arterial hypotension 1/5, tachycardia 1/5 (Patino et al. 1993).
Diarrhoea (5 episodes), vomiting (15 episodes) (Jorge et al. 1993).

Local effects

Strong local pain 3/4, local swelling 3/4, necrosis 2/4, of whom 1/2 had a severe deformity in the form of an ankle ankylosis as a consequence (Hulin et al. 1982).

Strong local pain 2/2, marked local oedema 2/2, blistering 1/2, heavy bleeding from the site of the bite 2/2 (Haad 1980/81).

Very strong local pain and marked local swelling that involved the entire bitten extremity (Bolanos et al. 1982).

Local swelling 5/5, bleeding from the site of the bite 4/5, blistering 2/5, soft tissue necrosis (skin and musculature) 3/5 (Patino et al. 1993).

Local pain (immediately following the bite), local swelling, bleeding from the site of the bite, regional lymphadenopathy, blistering (24 h after the bite) (Jorge et al. 1993).

Haemostatic effects

Bleeding from fresh wounds outside the region of the bite 1/2, bloody diarrhoea 1/2 (Haad 1980/81).

Haematuria 2/5, epistaxis 1/5 (severe systemic bleeding is rare) (Patino et al. 1993).

Renal effects

Acute renal insufficiency 2/4 (Hulin et al. 1982).
Acute renal failure 3/5 (Patino et al. 1993).

Morbidity

Necrosis 2/4, of whom 1/2 had a severe deformity as a consequence. This patient developed sepsis. Duration of hospital stay 60 days (Hulin et al. 1982).

Acute renal insufficiency 2/4. Duration of hospital stay 26 and 45 days (Hulin et al. 1982).

Necroses 3/4 (Bolanos et al. 1982).

Necroses (skin and musculature) 3/5 (Patino et al. 1993).

Case fatality rate

3/4 (Bolanos et al. 1982).
0/5, all had received antivenom (Patino et al. 1993).

Laboratory and physical investigations

1. Haemostasis
Type of haemostatic defect
Defibrinogenation (fibrinogen-coagulating activity via a "thrombin-like" enzyme?) (Kamiguti and Cardoso 1989).

Haemostatic parameters

Overview haemostasis
   
A
 
  
G
        
D
 
                      
 
 H CT (FSP) Tc PT aPTT TT I FSP D II V VIII X XIII PC ATIII PI tPA α2AP
         
 
B
    
 
C
                      
 
F
 

Essential

bed-side

tests

 Tests for full clinical assessment Tests for research purposes
H haemorhagic effects
+ definite evidence in
human envenoming
CT full blood clotting test
(FSP)  FSP rapid test
Tc platlets
PT prothrombin time
aPTT partial thromboplastin time
TT thrombin time
I fibrinogen
FSP  fibrinogen split products
D D-dimer
II, V, VII, X, XIII
  clotting factors
PC protein C
ATIII antithrombin III
PI plasminogen
tPA tissue plasmin activator
α2AP α2-antiplasmin
 
In this overview, the deviations from normal
are recorded for those haemostasis para-
meters only, for which good evidence is
documented in the literature.
 
A Clotting time: incoagulable blood 2/4 (Hulin et al. 1982); incoagulable 1/2 (Haad 1980/81); incoagulable 5/5 (Patino et al. 1993).
B PT, aPTT: PT 30% 1/4 (Hulin et al. 1982).
C Fibrinogen: decreased 3/4 (Hulin et al. 1982); decreased (80 mg/100 ml) 1/2 (Haad 1980/81); 1.05 g/l (Jorge et al. 1993).
D FSP, D-dimers: FSP 48 μg/ml, D-dimers 8 μg/ml (Jorge et al. 1993).
E Clotting factors: in the normal range (Jorge et al. 1993).
F α2-Antiplasmin: 20% (suggests activation of fibrinolytic system) (Jorge et al. 1993).
G Platelets: in the normal range 4/4 (Hulin et al. 1982); in the normal range 2/2 (Haad 1980/81); in the normal range (Jorge et al. 1993).

2. Leucocytes
12,600/μl (Haad 1980/81).

3. Haemoglobin
8.3 mg% (Haad 1980/81).

Treatment (symptomatic)

  1. Debridement and split-thickness skin grafting 2/5 (Patino et al. 1993).
  2. Haemodialysis 1/5 (Patino et al. 1993).
  3. Fluid replacement (physiological salt solution) (Jorge et al. 1993).

Treatments (specific)

Antivenom
Antilaquetico, Instituto Butantan, São Paulo, Brazil.

Studies
There are no clinical studies on the efficacy of the available antivenom or adverse reactions to it.

Efficacy

With regard to the haemostatic defect: Antilaquetico, Instituto Butantan: 8 vials 2 h after the bite: all abnormal haemostatic parameters (see above) returned to normal within 12 h after antivenom administration (Jorge et al. 1993).