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Clinic

 

Atractaspis sp.

Studies

A. dahomeyensis, A. microlepidota (= Atractaspis micropholis or watsoni) (Nigeria)
Warrell et al. 1976c: 9 verified Atractaspis bites; identification: morphological: A. dahomeyensis (7/9); A. microlepidota (2/9).

Classification

Local envenoming:

  1. Extent of the swelling (grade 1–6; scale of Warrell et al. 1974).
  2. Intensity of the swelling (measurement method of Reid et al. 1963c).

Case reports

Atractaspis microlepidota (= A. watsoni)
Corkill 1956, Corkill and Kirk 1954


Atractaspis dahomeyensis
Corkill and Kirk 1954, Corkill et al. 1959


Atractaspis irregularis
Corkill and Kirk 1954, Corkill et al. 1959

                     
Atractaspis engaddensis
Corkill and Kirk 1954, Chajek et al. 1974, Alkan and Sukenik 1975


Atractaspis corpulenta
Corkill and Kirk 1954, Gunders et al. 1960


Atractaspis bibronii
Corkill and Kirk 1954, Corkill et al. 1959, Cranko 1961, Stewart 1965, Blaylock 1982a


Atractaspis aterrima
Schmidt 1923


Atractaspis sp.
Visser and Chapman 1978

Signs & symptoms

Local effects

A. dahomeyensis, A. microlepidota (= Atractaspis micropholis or watsoni)
Local pain 9/9, commencing within 2 h after the bite. Local swelling starting within 0.5–3 h. 8/9 had at least mild swelling, either early or later. Only 4/9 patients had significant swelling (percentage increase in circumference: 4%, 5.3%, 2 × 9%). Swelling reached a maximum after 1 day, and had resolved completely within 1–9 days. Local hypoaesthesia and paraesthesia in the distribution area of skin nerves. Regional lymph node swelling 4/9. Blistering 2/9 on the 2nd and 6th day after the bite, respectively. Necroses (0/9) (Warrell et al. 1976c).


A. bibronii, A. engaddensis
Local necroses appear to occur more commonly than with other Atractaspis species (Warrell et al. 1976c).


A. bibronii
Local swelling, in some cases extending over the entire bitten extremity, 5/5; regional lymph node swelling 2/5. Local hypoaesthesia and paraesthesia in the distribution area of skin nerves (Blaylock 1982a).

Haemostatic effects

To date there has been no convincing evidence that burrowing vipers induce spontaneous haemorrhage (Warrell et al. 1976c).

Neurological effects

The rapid clinical course of the fatal bites caused by A. microlepidota (3 cases) (Corkill and Kirk 1954) and A. irregularis (1 case) (Corkill et al. 1959) – death occurred within 45 min–6 h – suggests that these venoms have a component that causes strong neurological effects (Warrell et al. 1976c).

Swallowing, protrusion of the tongue, eye movements and deep respiratory excursions painful. Muscle twitching 1/5 (Blaylock 1982a) (interpretation as a primary neurological effect of the venom?).

Morbidity

Necroses.

Case fatality rate

A. microlepidota (= A. watsoni)
3/12 (Corkill 1956, Corkill et al. 1959).


A. irregularis
1/11 (Corkill et al. 1959).

Laboratory and physical investigations

1. Haemostasis
Studies
A. dahomeyensis, A. microlepidota (= Atractaspis micropholis or watsoni) (Nigeria)
Warrell et al. 1976c

  1. CT in normal range 10/10 (Warrell et al. 1976c).
  2. Platelets in normal range 10/10 (Warrell et al. 1976c).
  3. FSP in normal range (Warrell et al. 1976c).


2. Leucocytes

> Normal range 3/9 (Warrell et al. 1976c).

3. Haematocrit
Anaemia 0/9 (Warrell et al. 1976c).

Treatment (symptomatic)

  1. Immobilisation of the bitten extremity (Warrell et al. 1976c).
  2. Paracetamol or codeine phosphate for pain (Warrell et al. 1976c).

Treatment (specific)

Antivenoms
No specific antivenom available.