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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

 

Cerastes sp.

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

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

PT
C. vipera
Prolonged 1/8 (Ben-Baruch et al. 1986, Zimmerman et al. 1981).

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
C. vipera
Decreased 1/8 (Ben-Baruch et al. 1986).
C. cerastes
0.8 g/l (Prod'hom, Stahel, Thiebaud 1987, pers. comm.).

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
C. cerastes
Increased (Prod'hom, Stahel, Thiebaud 1987, pers. comm.).

> 2000 mg/dl (Lifshitz et al. 2000).

17.6 μ/ml (1/2), 128 μ/ml (1/2) (Schneemann et al. 2004).

D

Platelets
C. cerastes
Thrombopaenia (Prod'hom, Stahel, Thiebaud 1987, pers. comm.).

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
C. cerastes

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).