Volume 99, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



() is a medically important species of pit viper with a wide geographic distribution in Southeast Asia. Bites by mostly involve the extremities. Little is known about the toxic effects of envenoming to the head because of the infrequency of such occurrence. To better delineate the clinical manifestations of envenoming to the head, we report three patients who suffered from bites to the head and were treated successfully. All three patients developed progressive soft tissue swelling extending from head to neck, with two patients expanding further onto the anterior chest wall. Mild thrombocytopenia was noted in two patients. One patient had transient acute renal impairment and airway obstruction, necessitating emergent intubation. All three patients received high doses of species-specific antivenom with recovery within 1 week. No adverse reactions to antivenom were observed.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Guo P, Liu Q, Wen T, Xiao R, Fang M, Zhong G, Truong NQ, Zhu F, Jadin RC, Li C, , 2016. Multilocus phylogeny of the Asian lance-headed pitvipers (Squamata, Viperidae, Protobothrops). Zootaxa 4093: 382390. [Google Scholar]
  2. Terada K, , 2011. The distribution, population density and controls of Protobothrops mucrosquamatus, Protobothrops elegans, Elaphe taeniura friesei, 3 snake species established on Okinawa Island. Bull Herpetol Soc Jpn 2: 161168. [Google Scholar]
  3. Vasaruchapong T, Laoungbua P, Tangrattanapibul K, Tawan T, Chanhome L, , 2017. Protobothrops mucrosquamatus (Cantor, 1839), a highly venomous species added to the snake fauna of Thailand (Squamata: Viperidae). Trop Nat Hist 17: 111115. [Google Scholar]
  4. Hung DZ, , 2004. Taiwan’s venomous snakebite: epidemiological, evolution and geographic differences. Trans R Soc Trop Med Hyg 98: 96101. [Google Scholar]
  5. Chen YW, Chen MH, Chen YC, Hung DZ, Chen CK, Yen DH, Huang CI, Lee CH, Wang LM, Yang CC, , 2009. Differences in clinical profiles of patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri envenoming in Taiwan. Am J Trop Med Hyg 80: 2832. [Google Scholar]
  6. Warrell D, , 2010. WHO Guidelines for the Production, Control and Regulation of Snake Antivenom Immunoglobulins. Geneva, Switzerland: WHO Press.
  7. Liao WB, Lee CW, Tsai YS, Liu BM, Chung KJ, , 2000. Influential factors affecting prognosis of snakebite patients management: Kaohsiung Chang Gung Memorial Hospital experience. Chang Gung Med J 23: 577583. [Google Scholar]
  8. Luo GP, Yue DY, Xu ZQ, , 2012. Clinical analysis of delayed hemorrhage following Trimeresurus mucrosquamatus bite. J Snake 24: 254257. [Google Scholar]
  9. Gerkin R, Sergent KC, Curry SC, Vance M, Nielsen DR, Kazan A, , 1987. Life-threatening airway obstruction from rattlesnake bite to the tongue. Ann Emerg Med 16: 813816. [Google Scholar]
  10. Bucaretchi F, Hyslop S, Mello SM, Vieira RJ, , 2007. Bothrops snakebite on the head: case report and review of the literature. Ann Trop Med Parasitol 101: 733743. [Google Scholar]
  11. Villalta M, 2012. Snake venomics and antivenomics of Protobothrops mucrosquamatus and Viridovipera stejnegeri from Taiwan: keys to understand the variable immune response in horses. J Proteomics 75: 56285645. [Google Scholar]
  12. Hinze JD, Barker JA, Jones TR, Winn RE, , 2001. Life-threatening upper airway edema caused by a distal rattlesnake bite. Ann Emerg Med 38: 7982. [Google Scholar]
  13. Chen YC, Chen MH, Wang LM, Wu JJ, Huang CI, Lee CH, Yen DH, Yang CC, , 2007. Antivenom therapy for crotaline snakebites: has the poison control center provided effective guidelines? J Formos Med Assoc 106: 10571062. [Google Scholar]

Data & Media loading...

  • Received : 14 Mar 2018
  • Accepted : 02 May 2018
  • Published online : 25 Jun 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error