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Case Report: Management of an Uncommon Crotaline Snakebite (Ovophis makazayazaya)

Yi LuoLiuzhou Integrated Chinese and Western Medicine Snake Injury Treatment Center, Liuzhou Traditional Chinese Medicine Hospital, Liuzhou, Guangxi, China;

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Yan-Chiao MaoDivision of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;
College of Medicine, National Chung Hsing University, Taichung, Taiwan;

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Po-Yu LiuCollege of Medicine, National Chung Hsing University, Taichung, Taiwan;
Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;
Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan;

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Liao-Chun ChiangDivision of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;
College of Medicine, National Chung Hsing University, Taichung, Taiwan;
National Tsing Hua University, College of Life Sciences, Hsinchu, Taiwan;

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Chih-Sheng LaiCollege of Medicine, National Chung Hsing University, Taichung, Taiwan;
Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan;

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Wen-Loung LinTaichung Wildlife Conservation Group, Taichung, Taiwan

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Chia-Chun HuangDivision of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;
College of Medicine, National Chung Hsing University, Taichung, Taiwan;

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ABSTRACT.

Ovophis makazayazaya bite is an uncommon cause of snakebite that humans may sustain as a result of the continuous overexploitation of forest habitats and excessive development in Taiwan. Although the Taiwanese government has produced four antivenoms against medically important snakebite accidents, O. makazayazaya is not among the snakes for which an antivenom has been produced. A case of O. makazayazaya snakebite on a patient’s right foot, which later swelled into the hip, is reported. In vitro studies have reported that monovalent antivenoms for Gloydius brevicaudus and Trimeresurus albolabris, and polyvalent antivenom for Calloselasma rhodostoma, Daboia siamensis, and T. albolabris show reactivity toward Ovophis venoms. However, these antivenoms are unavailable in Taiwan. Thus, bivalent antivenom for Trimeresurus stejnegeri stejnegeri and Protobothrops mucrosquamatus was used, assuming similar immunoreactivity and a possible para-specific effect of green pit viper antivenom against this Ovophis venom. A favorable outcome was observed, without significant extension in prothrombin time and activated partial thromboplastin time. In addition, no systemic bleeding occurred. Nonetheless, further venom and antivenom evaluations should ascertain the efficacy of this para-specific antivenoms against this crotaline snakebite.

Author Notes

Address correspondence to Chia-Chun Huang, Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung 407219, Taiwan. E-mail: neighborhood9865@gmail.com

Financial support: This study was supported in part by Taichung Veterans General Hospital Research Funding (TCVGH-1117201C). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosure: Ethics approval to publish a case report is not mandatory at our institution. However, we took all precautions to protect the patient’s rights, and informed consent was obtained from the patient to publish clinical data and the photograph of the snake.

Authors’ addresses: Yi Luo, Liuzhou Integrated Chinese and Western Medicine Snake Injury Treatment Center, Liuzhou Traditional Chinese Medicine Hospital, Liuzhou, Guangxi, China, E-mail: 13877288998@163.com. Yan-Chiao Mao, Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, and College of Medicine, National Chung Hsing University, Taichung, Taiwan, E-mail: doc1385e@gmail.com. Po-Yu Liu, College of Medicine, National Chung Hsing University, Taichung, Taiwan, Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan, E-mail: idfellow@gmail.com. Liao-Chun Chiang, Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, College of Medicine, National Chung Hsing University, Taichung, Taiwan, and National Tsing Hua University, College of Life Sciences, Hsinchu, Taiwan, E-mail: axe956956@gmail.com. Chih-Sheng Lai, College of Medicine, National Chung Hsing University, Taichung, Taiwan, and Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, E-mail: laics@vghtc.gov.tw. Wen-Loung Lin, Taichung Wildlife Conservation Group, Taichung, Taiwan, E-mail: ketupaflavpes@yahoo.com.tw. Chia-Chun Huang, Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, and College of Medicine, National Chung Hsing University, Taichung, Taiwan, E-mail: neighborhood9865@gmail.com.

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