Case Report: Recent Case Reports of Levant Blunt-Nosed Viper Macrovipera lebetina obtusa Snakebites in Iran

Seyed Mahdi Kazemi Zagros Herpetological Institute, Qom, Iran;

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Ahmed Al-Sabi College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait;

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Chengbo Long Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China;

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Mahmoud I. Shoulkamy Guangdong Key Laboratory of Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, China;
Zoology Department, Faculty of Science, Minia University, El-Minia, Egypt;

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Tarek Mohamed Abd El-Aziz Zoology Department, Faculty of Science, Minia University, El-Minia, Egypt;
Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas

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ABSTRACT

Envenomation and death resulting from snakebites represent a significant public health problem worldwide, particularly in tropical and subtropical regions. The WHO has defined snakebite as a neglected tropical health concern. Bites from Macrovipera lebetina obtusa usually cause life-threatening systemic hemodynamic disturbances, reduced functionality of the kidneys, and other serious symptoms, including hypotension shock, edema, and tissue necrosis, at the bite site. Herein, we highlight five cases of M. l. obtusa envenomation that presented with wide-ranging manifestations. Many recovered cases were left with long-term musculoskeletal disabilities. In a particular case, a 15-year-old male patient was envenomed in his palm by an 80-cm M. l. obtusa. Within 12 hours, swelling extended to near the shoulder. Fasciotomy was performed on the forearm and part of the upper arm of this patient. Symptoms of severe localized pain and swelling, dizziness, weakness, low blood pressure, and itching around the bite area were documented. The patient remained in the hospital for 13 days.

Author Notes

Address correspondence to Tarek Mohamed Abd El-Aziz, Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900. E-mail: mohamedt1@uthscsa.edu

Disclosure: The present descriptive studies based on medical records of Valie Asr (Qazvin Province), Loghman Hakim (Tehran), Imam Khomeini (Kermanshah Province), Taleqani (Kermanshah Province), and Shahid Gholi Pur (West Azerbaijan) hospitals. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the National Committee for Ethics in Biomedical Research under protocol numbers IREC-9540005214 and IREC-85700003541. Written informed consent was obtained from the patients for their anonymized information to be published in this article.

Authors’ addresses: Seyed Mahdi Kazemi, Zagros Herpetological Institute, Qom, Iran, E-mail: kazemi_m1979@yahoo.com. Ahmed Al-Sabi, College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait, E-mail: ahmed.al-sabi@aum.edu.kw. Chengbo Long, Key Laboratory of bioactive peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China, E-mail: longchengbo@mail.kiz.ac.cn. Mahmoud I. Shoulkamy, Guangdong Key Laboratory of Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, and Zoology Department, Faculty of Science, Minia University, Egypt, E-mail: mahmoud.ibrahim1@mu.edu.eg. Tarek Mohamed Abd El-Aziz, Zoology Department, Faculty of Science, Minia University, Egypt, and Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, E-mail: mohamedt1@uthscsa.edu.

  • 1.

    Williams DJ et al. 2019. Strategy for a globally coordinated response to a priority neglected tropical disease: snakebite envenoming. PLoS Negl Trop Dis 13: e0007059.

    • Search Google Scholar
    • Export Citation
  • 2.

    GutiĆ©rrez JM, Williams D, Fan HW, Warrell DA, 2010. Snakebite envenoming from a global perspective: towards an integrated approach. Toxicon 56: 1223–1235.

    • Search Google Scholar
    • Export Citation
  • 3.

    Chippaux JP, 2017. Snakebite envenomation turns again into a neglected tropical disease. J Venom AniToxins Incl Trop Dis 23: 38.

  • 4.

    Warrell D, GutiƩrrez J, 2007. Rabies and Envenomings: A Neglected Public Health Issue: Report of a Consultative Meeting. Geneva, Switzerland: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 5.

    Calvete JJ, 2011. Proteomic tools against the neglected pathology of snake bite envenoming. Expert Rev Proteomics 8: 739–758.

  • 6.

    Lomonte B, FernĆ”ndez J, Sanz L, Angulo Y, Sasa M, GutiĆ©rrez JM, Calvete JJ, 2014. Venomous snakes of Costa Rica: biological and medical implications of their venom proteomic profiles analyzed through the strategy of snake venomics. J Proteomics 105: 323–339.

    • Search Google Scholar
    • Export Citation
  • 7.

    GutiĆ©rrez JM, Rucavado A, Escalante T, 2010. Snake venom metalloproteinases. Biological roles and participation in the pathophysiology of envenomation. In. Handbook of Venoms and Toxins of Reptiles. Mackessy SP, ed. Boca Raton, FL: CRC Press, 115–138.

    • Search Google Scholar
    • Export Citation
  • 8.

    Mohamed Abd El-Aziz T, Soares AG, Stockand JD, 2019. Snake venoms in drug discovery: valuable therapeutic tools for life saving. Toxins 11: 564.

    • Search Google Scholar
    • Export Citation
  • 9.

    Terribile L, de Oliveira G, Albuquerque F, Rodriguez M, Diniz-Filho JA, 2009. Global conservation strategies for two clades of snakes: combining taxon-specific goals with general prioritization schemes. Divers Distrib 15: 841–851.

    • Search Google Scholar
    • Export Citation
  • 10.

    Terribile LC, Olalla-TĆ”rraga MA, Morales-Castilla I, Rueda M, Vidanes RM, RodrĆ­guez MA, Diniz-Filho JA, 2009. Global richness patterns of venomous snakes reveal contrasting influences of ecology and history in two different clades. Oecologia 159: 617–626.

    • Search Google Scholar
    • Export Citation
  • 11.

    Safaei-Mahroo B et al. 2015. The herpetofauna of Iran: checklist of taxonomy, distribution and conservation status. Asian Herpetological Res 6: 257–290.

    • Search Google Scholar
    • Export Citation
  • 12.

    Kazemi SM, Hosseinzadeh M, 2020. High diversity and endemism of herpetofauna in the Zagros Mountains. ECOPERSIA 8: 221–229.

  • 13.

    Rezaie-Atagholipour M, Ghezellou P, Hesni MA, Dakhteh SMH, Ahmadian H, Vidal N, 2016. Sea snakes (Elapidae, Hydrophiinae) in their westernmost extent: an updated and illustrated checklist and key to the species in the Persian Gulf and Gulf of Oman. ZooKeys 622: 129–164.

    • Search Google Scholar
    • Export Citation
  • 14.

    Fatehi-Hassanabad Z, Fatehi M, 2004. Characterisation of some pharmacological effects of the venom from Vipera lebetina. Toxicon 43: 385–391.

    • Search Google Scholar
    • Export Citation
  • 15.

    Afroosheh M, 2011. Macrovipera lebetina Cernovi (Ophidia: Viperidae), a Newcomer to Iran. Abstract published in the 16th European Congress of Herpetology (SEH) and 47 Deutscher Herpetologentag (DGHT) at Luxembourg and Trier, Germany, 25–29 September 2011.

    • Search Google Scholar
    • Export Citation
  • 16.

    García-Arredondo A, Martínez M, Calderón A, Saldívar A, Soria R, 2019. Preclinical assessment of a new polyvalent antivenom (inoserp Europe) against several species of the subfamily viperinae. Toxins 11: 149.

    • Search Google Scholar
    • Export Citation
  • 17.

    Dehghani R, Fathi B, Shahi MP, Jazayeri M, 2014. Ten years of snakebites in Iran. Toxicon 90: 291–298.

  • 18.

    Dehghani R, Mehrpour O, Shahi MP, Jazayeri M, Karrari P, Keyler D, Zamani N, 2014. Epidemiology of venomous and semi-venomous snakebites (Ophidia: viperidae, colubridae) in the kashan city of the isfahan province in Central Iran. J Res Med Sci 19: 33–40.

    • Search Google Scholar
    • Export Citation
  • 19.

    Mallow D, Ludwig D, Nilson G, 2003. True Vipers: Natural History and Toxinology of Old World Vipers. Malabar, FL: Krieger Publishing Company.

  • 20.

    Oraie H, Rastegar Pouyani E, Khosravani A, Moradi N, Akbari A, Sehhatisabet M, Shafiei S, Stümpel N, Joger U, 2018. Molecular and morphological analyses have revealed a new species of blunt-nosed viper of the genus macrovipera in Iran. Salamandra 54: 233–248.

    • Search Google Scholar
    • Export Citation
  • 21.

    Stümpel N, 2012. Phylogenie und Phylogeographie eurasischer Viperinae unter besonderer Berücksichtigung der orientalischen Vipern der Gattungen Montivipera und Macrovipera. Braunschweig, Germany: Technische Universität Braunschweig.

    • Search Google Scholar
    • Export Citation
  • 22.

    GƶƧmen B, Arikan H, Mermer A, ƇiƧek K, 2006. Clinical, physiological and serological observations of a human following a venomous bite by Macrovipera lebetina lebetina (Reptilia: serpentes). Türkiye Parazitolojii Dergisi/Türkiye Parazitoloji Derneği = Acta Parasitologica Turcica/Turkish Soc Parasitol 30: 158–162.

    • Search Google Scholar
    • Export Citation
  • 23.

    Sharma LR, Lal V, Simpson ID, 2008. Snakes of medical significance in India: the first reported case of envenoming by the Levantine viper (Macrovipera lebetina). Wilderness Environ Med 19: 195–198.

    • Search Google Scholar
    • Export Citation
  • 24.

    Theakston RD, Warrell DA, 1991. Antivenoms: a list of hyperimmune sera currently available for the treatment of envenoming by bites and stings. Toxicon 29: 1419–1470.

    • Search Google Scholar
    • Export Citation
  • 25.

    Afshari R, Monzavi SM, 2017. AFSHARI’S Clinical Toxicology and Poisoning Emergency Care. Mashhad, Iran: Mashhad University of Medical Sciences Publishing Group.

    • Search Google Scholar
    • Export Citation
  • 26.

    Monzavi SM, Dadpour B, Afshari R, 2014. Snakebite management in Iran: devising a protocol. J ResMed Sci 19: 153.

  • 27.

    Latifi M, Leviton AE, Zug GR; Amphibians and Reptiles, 1991. The snakes of Iran. Society for the Study of Amphibians and Reptiles. Oxford, OH: Amphibia-Reptilia.

    • Search Google Scholar
    • Export Citation
  • 28.

    Dehghani R, Rabani D, Panjeh Shahi M, Jazayeri M, Sabahi Bidgoli M, 2012. Incidence of snake bites in Kashan, Iran during an eight year period (2004–2011). Arch Trauma Res 1: 67–71.

    • Search Google Scholar
    • Export Citation
  • 29.

    Amr ZS, Abu Baker MA, Warrell DA, 2020. Terrestrial venomous snakes and snakebites in the Arab countries of the Middle East. Toxicon 177: 1–15.

    • Search Google Scholar
    • Export Citation
  • 30.

    Warrell D, 2017. Clinical Toxicology of Snakebite in Africa and the Middle East/Arabian Peninsula.

  • 31.

    Siigur J, AaspƵllu A, Siigur E, 2019. Biochemistry and pharmacology of proteins and peptides purified from the venoms of the snakes Macrovipera lebetina subspecies. Toxicon 158: 16–32.

    • Search Google Scholar
    • Export Citation
  • 32.

    Esmaeili Jahromi H, Zare A, Kamalzadeh M, 2016. Evaluation of Iranian Snake ā€˜Macrovipera lebetina’ Venom Cytotoxicity in Kidney Cell Line HEK-293.

    • Search Google Scholar
    • Export Citation
  • 33.

    El-Aziz TMA et al. 2017. Efficient functional neutralization of lethal peptide toxins in vivo by oligonucleotides. Sci Rep 7: 7202.

  • 34.

    Taiwe GS et al. 2019. Aptamer Efficacies for in vitro and in vivo modulation of αc-conotoxin PrXA pharmacology. Molecules 24.

  • 35.

    Calvete JJ, Sanz L, Angulo Y, Lomonte B, GutiĆ©rrez JM, 2009. Venoms, venomics, antivenomics. FEBS Lett 583: 1736–1743.

  • 36.

    GutiĆ©rrez JM, León G, Lomonte B, Angulo Y, 2011. Antivenoms for snakebite envenomings. Inflamm Allergy Drug Targets 10: 369–380.

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