Philodryas (Serpentes: Dipsadidae) Envenomation, a Neglected Issue in Chile

Shedding Light on the Dentition and Venom Delivery System of the Rear-Fanged Snake, Galvarinus chilensis chilensis (Serpentes: Dipsadidae: Tachymenini) from Chile

Although the rear-fanged snake Galvarinus chilensis chilensis (formerly named Tachymenis ch. chilensis) causes ophidian accidents with clinical importance in Chile, the anatomical and histological characterizations of the venom delivery system (venom gland and fang) of this species still remain unknown. This study describes the dentition and characteristics of fangs and their ontogenetic variations in G. ch. chilensis. Moreover, histological and histochemistry analyses of the venom glands of this species are presented. Using micro-computed tomography and scanning electron microscopy, the dentitions of neonates, juveniles, and adults were analyzed, and no ontogenetic variations in teeth length and number present in the dentary and maxilla were observed. Moreover, we found three types of basic teeth, with distributional patterns conserved in all ontogenetic categories. The fangs exhibited a groove from the base to the middle. At the end of the groove, prominent ridges are formed. The fang and groove lengths were significantly distinct between ontogenetic categories. No differences between females and males were observed. Histologically, we found that the venom gland is close to the fangs and has a seromucous composition. Our results describe, for the first time, the distributional pattern and characteristics of the dentition and venom delivery system of the poorly studied snake G. ch. chilensis.

Cytotoxicity and inflammation induced by Philodryas patagoniensis venom

The Green racer Philodryas patagoniensis is a snake species from South America and accidents with this genus are often neglected. Therefore, this study aimed to evaluate the toxicological, cytotoxic, and inflammatory potential of P. patagoniensis venom (PpV). The experimental model Artemia salina was used to determine toxicity through the median lethal dose (LD₅₀). Cell viability and genotoxicity were evaluated in human mononuclear cells using the Trypan blue test and the Comet assay, respectively. To assess inflammation, mice had the ventral surface of the right hind paw injected with saline, formalin, and three different concentrations of venom (1, 1.5, and 2 μg. 50 μL^-1). LD₅₀ in A. salina was 461 μg. mL^-1. PpV caused a significant increase in cell death and genotoxicity in human mononuclear cells at two concentrations (575 and 1150 μg. mL^-1). PpV shown also to be a strong agent causing nociception in mice. Paw edema totaled four days at 1.5 μg. 50 μL^-1. The hyperalgesia caused by the venom had a long duration in mice, lasting eight days at all concentrations evaluated. Thus, we evaluated for the first time the toxicological potential of PpV in A. salina model and in leukocytes. We concluded that systemic oxidative stress, which we infer to be in the genesis of cytotoxicity and genotoxicity observed in vitro, and the inflammatory process are part of the pathways that trigger the venom damage cascades. Relevant data for both scientific research and clinical medicine. Nonetheless, studies are needed to elucidate these mechanisms.

Cerebral Complications of Snakebite Envenoming: Case Studies

There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.

First reports of envenoming by South American water snakes Helicops angulatus and Hydrops triangularis from Bolivian Amazon: A one-year prospective study of non-front-fanged colubroid snakebites

Although snakebite incidence is underestimated in Bolivia, the Amazon region presents the highest incidence of these accidents. The local effects of bites by some non-front-fanged colubroid (NFFC) snakes are usually confused with that of viperids, resulting in the improper use of antivenoms and medications. Since there is scarce information on clinical treatment and management of NFFC bites from Bolivian Amazon, we conducted a prospective study of NFFC snakebites by reviewing the records of patients admitted with a snakebite diagnosis at Hospital Central Ivirgarzama, Bolivia. Snakebites were recorded for 12 months (December 2019-November 2020), including information about the sex and age of the patient, snakebite date, and treatment. Eight (5.7 %) of 152 patients were bitten by NFFC Helicops angulatus, Hydrops triangularis, and Erythrolamprus sp. Our results showed that 5/7 patients had prolonged clotting time and INR, as well as local edema and mild pain, suggesting systemic envenoming. Previously non-documented mild coagulopathy was observed for H. angulatus and H. triangularis bites. In some cases, incorrect first-aid measures, and inappropriate use of bothropic/lachesic antivenom were administrated. All the patients received supportive therapy and antihistamine drugs. Unsupported use of non-evidence-based treatments for snakebites such as corticoids, non-steroidal anti-inflammatory drugs (NSAIDs), and prophylactic antibiotic prescription were recorded. In conclusion, we describe the first formally documented snakebite cases produced by NFFC from Bolivia, highlighting the urgent need for training of the medical team in the snake identification, clinical management of snakebite, and the existence of a human-snake conflict involving NFFC species.