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Life-threatening envenoming by the Saharan horned viper (Cerastes cerastes) causing micro-angiopathic haemolysis, coagulopathy and acute renal failure: clinical cases and review

Schneemann, M., Cathomas, R., Laidlaw, S. T., El Nahas, A. M., Theakston, R.David G. and Warrell, David A. (2004) 'Life-threatening envenoming by the Saharan horned viper (Cerastes cerastes) causing micro-angiopathic haemolysis, coagulopathy and acute renal failure: clinical cases and review'. Qjm-an International Journal of Medicine, Vol 97, Issue 11, pp. 717-727.

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Abstract

Background: The desert horned vipers (Cerastes cerastes and C. gasperettii) are the most familiar snakes of the great deserts of North Africa and the Middle East, including the plains of Iraq. They are responsible for many human snake bites. In Western countries, they are popular among exotic-snake keepers.
Aim: To investigate mechanisms of life-threatening envenoming and treatment.
Design: Clinical investigation.
Methods: Clinical and laboratory studies with measurement of serum venom antigen concentrations by enzyme immunoassay.
Results: Two men bitten while handling captive Saharan horned vipers (Cerastes cerastes) in Europe developed extensive local swelling and life-threatening systemic envenoming, characterized by coagulopathy, increased fibrinolysis, thrombocytopenia, micro-angiopathic haemolytic anaemia and acute renal failure. The clinical picture is explicable by the presence in C. cerastes venom of several thrombin-like, Factor-X-activating, platelet-aggregating, haemorrhagic and nephrotoxic components. In one case, prophylactic use of subcutaneous epinephrine may have contributed to intracranial haemorrhage. The roles in treatment of heparin (rejected) and specific antivenom (recommended) are discussed.
Discussion: Cerastes cerastes is capable of life-threatening envenoming in humans. Optimal treatment of envenoming is by early administration of specific antivenom, and avoidance of ineffective and potentially-dangerous ancillary methods.

Item Type: Article
Uncontrolled Keywords: disseminated intravascular coagulation snake antivenom uremic syndrome tunisian viper venom cerastocytin envenomation heparin trial bite Cerastes cerastes
Subjects: WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Animal Poisons > WD 400 General works
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Animal Poisons > WD 410 Reptiles
WJ Urogenital System > WJ 20 Research (General)
Faculty: Department: Groups (2002 - 2012) > Molecular & Biochemical Parasitology Group
Digital Object Identifer (DOI): https://doi.org/10.1093/qjmed/hch118
Depositing User: Sarah Lewis-Newton
Date Deposited: 21 Jun 2012 06:36
Last Modified: 06 Feb 2018 13:03
URI: http://archive.lstmed.ac.uk/id/eprint/2220

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