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Differences in Clinical Profiles of Patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri Envenoming in Taiwan

Envenoming by Protobothrops mucrosquamatus and Viridovipera stejnegeri accounts for the majority of venomous snakebites in Taiwan. We conducted a retrospective study to systematically examine the clinical manifestations and responses to antivenom therapy after P. mucrosquamatus and V. stejnegeri envenoming. Information on demographic characteristics, treatments, and systemic/local complications were abstracted from medical charts between 1991 and 2006. One hundred forty-nine patients with P. mucrosquamatus envenoming and 51 with V. stejnegeri envenoming were eligible for the final analysis, and they differed in terms of patient age, bite site, local bruising, proportion of patients needing 3 vials of antivenom, and mean hospital stay. Univariate analysis revealed that P. mucrosquamatus envenoming had a higher risk of developing rhabdomyolysis, cellulitis, necrosis, and skin graft. Our findings suggested that P. mucrosquamatus envenoming was associated with a greater risk of severe clinical events, and monitoring for major clinical complications would be recommended.

Received April 7, 2008. Accepted for publication September 30, 2008.

Acknowledgment: We thank Susan S. Sheu for her critical review and editing of the manuscript.

^* Address correspondence to Chen-Chang Yang, Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road Sec. 2, Taipei 112, Taiwan. E-mail: ccyang{at}vghtpe.gov.tw

Authors’ addresses: Yen-Wen Chen, Department of Respiratory Therapy, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, Republic of China, Tel: 886-933-241-960, E-mail: albert6369{at}gmail.com. Min-Hui Chen, Center for Drug Evaluation, Taiwan, 1F, No. 15-1, Section 1, Hang-Jou Southern Road, Taipei, Taiwan 100, Republic of China, Tel: 886-2-2322-4567, Fax: 886-2-2327-9135, E-mail: chen.minhui{at}gmail.com. Yen-Chia Chen, David Hung-Tsang Yen, Chun-I Huang, and Chen-Hsen Lee, Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, Republic of China, Tel: 886-2-2875-7628, Fax: 886-2-2873-8013, E-mail: ycchen4{at}gmail.com, hjyen{at}vghtpe.gov.tw, cihuang{at}vghtpe.gov.tw, and chlee{at}vghtpe.gov.tw. Dong-Zong Hung, Toxicology Center of China Medical University Hospital, 2 Yuh-Der Road, Taichung, Taiwan, 404, Republic of China, Tel: 886-4-2205-2121, Fax: 886-4-2233-1584, E-mail: dzhung{at}mail.cmu.edu.tw. Chien-Kuang Chen, Department of Surgery, Taoyuan Veterans Hospital, No. 100, Section 3, Cheng-Kung Road, Tao-Yuan 330, Taiwan, Republic of China, Tel: 886-932-364-872. Lee-Min Wang, Department of Emergency Medicine, Taichung Veterans General Hospital, No. 160, Section 3, Chung-Kang Road, Taichung, Taiwan, Republic of China, Tel: 886-4-2359-2525, E-mail: lmwang{at}vghtc.gov.tw. Chen-Chang Yang, Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road Sec. 2, Taipei 112, Taiwan, Tel: 886-2-28757525, Fax: 886-2-28739193, E-mail: ccyang{at}vghtpe.gov.tw.

Reprint requests: Chen-Chang Yang, Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road Sec. 2, Taipei 112, Taiwan, E-mail: ccyang{at}vghtpe.gov.tw.