Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 167
Trimeresurus malabaricus bites: Need of species-specific management for snakebites


1 Department of General Medicine, Government Medical College, Kannur, Kerala, India
2 Department of Emergency Medicine, Government Medical College, Kannur, Kerala, India

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Date of Submission22-Jan-2020
Date of Acceptance03-Feb-2020
Date of Web Publication10-Jun-2020
 

How to cite this article:
Harikrishnan M, Rohan K V, Ayyan S M. Trimeresurus malabaricus bites: Need of species-specific management for snakebites. J Emerg Trauma Shock 2020;13:167

How to cite this URL:
Harikrishnan M, Rohan K V, Ayyan S M. Trimeresurus malabaricus bites: Need of species-specific management for snakebites. J Emerg Trauma Shock [serial online] 2020 [cited 2020 Oct 1];13:167. Available from: http://www.onlinejets.org/text.asp?2020/13/2/167/286231




Dear Editor,

Apart from the “big four” species of venomous snakes, the pit vipers (hump nosed, Malabar, bamboo) and banded kraits are the other types seen in Kerala. Malabar pit viper (Trimeresurus malabaricus) is an elusive species, seen in the forests of the Western Ghats. We have come across the case of a 54-year-old healthy female after a snakebite. On examination, she had a bite mark on the right parietal region of the scalp, with swelling and tenderness in the surrounding area extending to the neck. She also had multiple tender lymph nodes in the right jugulodigastric and posterior auricular groups [Figure 1]a. She had no features of neurotoxicity. Her 20-min whole blood clotting test (WBCT) was prolonged. The snake was later identified and confirmed to be a Malabar pit viper [Figure 1]b. 20-min WBCT and coagulation profiles repeated periodically for the next 48 hr were normal. Even though characteristics of pit viper bites have been previously profiled,[1],[2] the incidence of Malabar pit viper bites is less. Envenomation following Malabar pit viper bites results in significant local reaction and hematotoxicity, along with milder forms of renal impairment. The Polyvalent anti-snake venom (ASV) used in India does not contain antibodies against pit viper venom and since cross neutralization with venoms of other species of snakes has not been proven,[3] its use is considered futile the treatment. With snakebites other than the “big four” snakes covered by the polyvalent ASV on the rise, the need for newer techniques for identification of snakes and development of species and region-specific antivenom is the need of the hour.
Figure 1: (a) Enlarged right jugulodigastric lymph node with swelling seen on the right neck. (b) Photograph of the offending snake Malabar pit viper (Trimeresurus malabaricus) on the tree branch

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kumar KS, Narayanan S, Udayabhaskaran V, Thulaseedharan NK. Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites – An analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. Int J Gen Med 2018;11:209-16.  Back to cited text no. 1
    
2.
Hijaz PT, Kumar CA, John BM. A study on clinical and laboratory features of pit viper envenomation from Central Kerala, India. Int J Adv Med 2018;5:644.  Back to cited text no. 2
    
3.
Senji Laxme RR, Khochare S, de Souza HF, Ahuja B, Suranse V, Martin G, et al. Beyond the 'big four': Venom profiling of the medically important yet neglected Indian snakes reveals disturbing antivenom deficiencies. PLoS Negl Trop Dis 2019;13:e0007899.  Back to cited text no. 3
    

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Correspondence Address:
S Manu Ayyan
Department of Emergency Medicine, Government Medical College, Kannur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_3_20

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