Venomous snakebites in Serbia are neither too frequent nor extremely dangerous. Nevertheless, some can lead to complications or even death. On December 24, 2023, a young man was admitted to hospital after being bitten by a snake, believed to be Vipera ammodytes. He was in a state of shock, unconscious, with unmeasurable blood pressure. Having received the proper treatment, the patient fully recovered. The case described herein was the most severe clinical manifestation resulting from snakebite treated in the Užice General Hospital thus far and one of the most severe among the rare published cases of snakebites in Serbia. In our country, barely any information is available regarding venomous snake bites, so every peculiar case should be made public. We consider publishing this case even more important because it occurred at the beginning of winter when snakes should be inactive. To ensure better prevention and more efficient treatment of snakebites, appropriate transdisciplinary education has to be provided both to laypeople and medical workers.
References
1.
Curić I, Curić S, Bradarić I. Snakebites in Mostar region, Bosnia and Herzegovina. Coll Anthropol. 2009;33(Suppl. 2):93–8.
2.
Milišić D, Aleksić N, Milišić N. Kritički osvrt na terapijske postupke ujeda zmije [A critical review of snakebite therapeutic procedures. Vojnosanit Pregl. 1983;40(5):352–4.
3.
Liapis K, Charitaki E, Psaroulaki A. Case Report: Spherocytic Hemolytic Anemia after Envenomation by Long-Nosed Viper (Vipera ammodytes). The American Journal of Tropical Medicine and Hygiene. 2019;101(6):1442–5.
4.
Kurtović T, Karabuva S, Grenc D, Dobaja Borak M, Križaj I, Lukšić B, et al. Intravenous Vipera berus Venom-Specific Fab Fragments and Intramuscular Vipera ammodytes Venom-Specific F(ab’)2 Fragments in Vipera ammodytes-Envenomed Patients. Toxins. 13(4):279.
5.
Avella I, Calvete JJ, Sanz L, Wüster W, Licata F, Quesada-Bernat S, et al. Interpopulational variation and ontogenetic shift in the venom composition of Lataste’s viper (Vipera latastei, Boscá 1878) from northern Portugal. Journal of Proteomics. 2022;263:104613.
6.
Greene S, Gilbert M, Wolk B, Campleman S, Ruha AM. Geographic variation in the clinical features of Mohave rattlesnake (Crotalus scutulatus) envenomations reported to the North American Snakebite Registry. Toxicon: X. 2024;21:100171.
7.
Smith CF, Nikolakis ZL, Ivey K, Perry BW, Schield DR, Balchan NR, et al. Snakes on a plain: biotic and abiotic factors determine venom compositional variation in a wide-ranging generalist rattlesnake. BMC Biology. 21(1).
8.
Gubenšek F, Sket D, Turk V, Lebez D. Fractionation of Vipera ammodytes venom and seasonal variation of its composition. Toxicon. 1974;12(2):167–8.
9.
Latifi M. Variation in yield and lethality of venoms from Iranian snakes. Toxicon. 1984;22(3):373–80.
10.
Gregory-Dwyer VM, Egen NB, Bosisio AB, Righetti PG, Russell FE. An isoelectric focusing study of seasonal variation in rattlesnake venom proteins. Toxicon. 1986;24(10):995–1000.
11.
Kang S, Moon J, Chun B. Does the traditional snakebite severity score correctly classify envenomated patients? Clinical and Experimental Emergency Medicine. 3(1):34–40.
12.
Kobolkuti L, Cadar D, Czirjak G, Niculae M, Kiss T, Sandru C, et al. The Effects of Environment and Physiological Cyclicity on the Immune System ofViperinae. The Scientific World Journal. 2012;2012:1–6.
13.
Čudo na Zlatiboru, invazija poskoka used zime: Iskusni planinari nikada nisu videli ovoliki broj zmija u ovo doba godine [A phenomenon on Zlatibor, viper invasion in winter: Experienced mountaineers have never seen so many snakes at this time of year. Internet] RINA, Regional Information News Agency.
14.
Đorđević S. The nose-horned viper awakened from under the snow. Ecol Mont. 2015;3:62–3.
15.
Cvitanović V, Pocs G. Toksični šok posle ujeda poskoka [Toxic shock after a nose-horned viper bite. Medicinski Pregled. 1980;33(9–10):407–10.
16.
Filipović J, Ostojić-Bakotin V. Ujedi zmija u splitskom gravitacijskom području [Snake bites in the Split area. Liječnički Vjesnik. 1981;103:538–44.
17.
Karabuva S, Vrkić I, Brizić I, Ivić I, Lukšić B. Venomous snakebites in children in southern Croatia. Toxicon. 2016;112:8–15.
18.
Radonić V, Budimir D, Bradarić N, Luksić B, Sapunar D, Vilović K. Envenomation by the Horned Viper (Vipera ammodytes L.). Military Medicine. 1997;162(3):179–82.
19.
Nori J, Carrasco PA, Leynaud GC. Venomous snakes and climate change: ophidism as a dynamic problem. Climatic Change. 2014;122(1–2):67–80.
20.
Zacarias D, Loyola R. Climate change impacts on the distribution of venomous snakes and snakebite risk in Mozambique. Climatic Change. 2019;152(1):195–207.
21.
Bhaumik S, Beri D, Jagnoor J. The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare. Journal of Family Medicine and Primary Care. 2022;11(10):6147–58.
22.
Rugiero L, Milana G, Petrozzi F, Capula M, Luiselli L. Climate-change-related shifts in annual phenology of a temperate snake during the last 20 years. Acta Oecologica. 2013;51:42–8.
23.
is the hottest year on record, with global temperatures close to the 1.5°C limit [Internet. 2024;
24.
D’Hoore L, Anseeuw K. Preparing for venomous snake bites in Europe. European Journal of Emergency Medicine. 2020;27(4):247–8.
25.
Williams DJ, Faiz MA, Abela-Ridder B, Ainsworth S, Bulfone TC, Nickerson AD, et al. Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming. PLOS Neglected Tropical Diseases. 13(2):e0007059.
26.
Nikolić S, Radonjić I, Miloradović Z. What do mountaineers and their guides in Serbia know about venomous snakes: A pilot questionnaire analysis. Turizam. 2023;27(1):12–32.
27.
Ruiz de Castañeda R, Bolon I, Gutiérrez JM. A transdisciplinary approach to snakebite envenoming. Toxicon: X. 2022;13:100088.
28.
Gutiérrez JM, Bolon I, Borri J, Ruiz de Castañeda R. Broadening the research landscape in the field of snakebite envenoming: Towards a holistic perspective. Toxicon. 2023;233:107279.
29.
Ferraz CR, Arrahman A, Xie C, Casewell NR, Lewis RJ, Kool J, et al. Multifunctional Toxins in Snake Venoms and Therapeutic Implications: From Pain to Hemorrhage and Necrosis. Frontiers in Ecology and Evolution. 7.
30.
Seifert SA, Armitage JO, Sanchez EE. Snake Envenomation. New England Journal of Medicine. 2022;386(1):68–78.
31.
Rhua A, Pizon A. Native (US) venomous snakes and lizards. In: Goldfrank’s toxicologic emergencies. 2015. p. 1537–46.
32.
Sadeghi M, Barazandeh M, Zakariaei Z, Davoodi L, Tabaripour R, Fakhar M, et al. Massive cutaneous complications due to snakebite: A case report and literature review. Clinical Case Reports. 2021;9(5).
33.
Chippaux JP. Epidemiology of snakebites in Europe: A systematic review of the literature. Toxicon. 2012;59(1):86–99.
34.
Dobaja Borak M, Babić Ž, Caganova B, Grenc D, Karabuva S, Kolpach Z, et al. Viper envenomation in Central and Southeastern Europe: a multicentre study. Clinical Toxicology. 2023;61(9):656–64.
35.
Nikolić S. VENOMOUS SNAKEBITES IN SERBIA THROUGH 125 YEARS: WHAT WE DO (NOT) KNOW IN COMPARISON WITH NEIGHBORING COUNTRIES. A LITERATURE REVIEW. Acta Medica Medianae. 2020;59(04):95–103.
36.
Nikolic S, Antic M, Pavic A, Ajtic R, Pavic S. Analysis of the venomous snakebite patients treated in the Uzice General Hospital (Western Serbia) between 2006 and 2018. Srpski arhiv za celokupno lekarstvo. 2021;149(3–4):189–95.
37.
Di Nicola MR, Pontara A, Kass GEN, Kramer NI, Avella I, Pampena R, et al. Vipers of Major clinical relevance in Europe: Taxonomy, venom composition, toxicology and clinical management of human bites. Toxicology. 2021;453:152724.
38.
Red book of fauna of Serbia II -Reptiles. 2015.
39.
Tomović L, Anđelković M, Krizmanić I, Ajtić R, Urošević A, Labus N, et al. Distribution of three Vipera species in the Republic of Serbia. Bulletin of the Natural History Museum. 2019;(12):217–42.
40.
Lakušić M, Bjelica V, Tomović L. Record size for the Nose-horned viper, Vipera ammodytes (Linnaeus, 1785), from Serbia. Herpetol Notes. 2021;14:605–7.
41.
Leaflet VIEKVIN® P. Torlak" Institute of Virology, Vaccines and Sera.
42.
BOVIATSIS EJ, KOUYIALIS AT, PAPATHEODOROU G, GAVRA M, KORFIAS S, SAKAS DE. MULTIPLE HEMORRHAGIC BRAIN INFARCTS AFTER VIPER ENVENOMATION. The American Journal of Tropical Medicine and Hygiene. 2003;68(2):253–7.
43.
Martín G, Yáñez-Arenas C, Rangel-Camacho R, Murray KA, Goldstein E, Iwamura T, et al. Implications of global environmental change for the burden of snakebite. Toxicon: X. 2021;9–10:100069.
44.
Gopcevic K, Karadzic I, Izrael-Zivkovic L, Medic A, Isakovic A, Popović M, et al. Study of the venom proteome of Vipera ammodytes ammodytes (Linnaeus, 1758): A qualitative overview, biochemical and biological profiling. Comparative Biochemistry and Physiology Part D: Genomics and Proteomics. 2021;37:100776.
45.
Malhotra A, Wüster W, Owens JB, Hodges CW, Jesudasan A, Ch G, et al. Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base. Toxicon: X. 2021;12:100081.
46.
Zhang Y. Why do we study animal toxins? Dongwuxue Yanjiu. 2015;36(4):183–222.
47.
Gutiérrez JM, Calvete JJ, Habib AG, Harrison RA, Williams DJ, Warrell DA. Snakebite envenoming. Nature Reviews Disease Primers. 3(1).
48.
Paolino G, Di Nicola MR, Pontara A, Didona D, Moliterni E, Mercuri SR, et al. Vipera snakebite in Europe: a systematic review of a neglected disease. Journal of the European Academy of Dermatology and Venereology. 2020;34(10):2247–60.
49.
Di Nicola MR, Crevani M, Avella I, Cerullo A, Dorne JLCM, Paolino G, et al. A Guide to the Clinical Management of Vipera Snakebite in Italy. Toxins. 16(6):255.
50.
Chowdhury A, Zdenek CN, Lewin MR, Carter R, Jagar T, Ostanek E, et al. Venom-Induced Blood Disturbances by Palearctic Viperid Snakes, and Their Relative Neutralization by Antivenoms and Enzyme-Inhibitors. Frontiers in Immunology. 12.
51.
Latinović Z, Leonardi A, Šribar J, Sajevic T, Žužek MC, Frangež R, et al. Venomics of Vipera berus berus to explain differences in pathology elicited by Vipera ammodytes ammodytes envenomation: Therapeutic implications. Journal of Proteomics. 2016;146:34–47.
52.
Šribar J, Kovačič L, Oberčkal J, Ivanušec A, Petan T, Fox JW, et al. The neurotoxic secreted phospholipase A2 from the Vipera a. ammodytes venom targets cytochrome c oxidase in neuronal mitochondria. Scientific Reports. 9(1).
53.
Marinov I, Atanasov VN, Stankova E, Duhalov D, Petrova S, Hubenova A. Severe coagulopathy after Vipera ammodytes ammodytes snakebite in Bulgaria: A case report. Toxicon. 2010;56(6):1066–9.
54.
Lukšić B, Bradarić N, Prgomet S. Venomous snakebites in Southern Croatia. Coll Antropol. 2006;30(1):191–7.
55.
Stojanović M, Stojanović D, Lj Ž. Hemoragijski sindrom kod zmijskog ujeda [Hemorrhagic syndrome in snake bite. Apollineum Medicum et Aesculapium. 2007;5(1–2):8–10.
56.
Popović N, Baljošević S, Katanić R. Klinička slika bolesti nastale ujedom zmije otrovnice -naša iskustva [Clinical picture of the disease caused by the bite of a venomous snake -our experiences. Acta Infectologica Yugoslavica. 1998;3:109–16.
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