First clinical experiences about the neurotoxic envenomings inflicted by lowland populations of the Balkan adder, Vipera berus bosniensis

Malina Tamás; University of Debrecen, Department of Botany, Egyetem tér 1, H-4032 Debrecen, Hungary.
Krecsák Laszlo; Eötvös Loránd University, Department of Systematic Zoology and Ecology, Pázmány Péter s. 1/C, H-1117 Budapest, Hungary.
Jelić Dušan; State Institute for Nature Protection, Trg Mažuranića 5, 10000 Zagreb, Croatia.
Maretić Tomislav; University Hospital "Dr Fran Mihaljević", Department of Infectious Disease, Mirogojska 8, 10000 Zagreb, Croatia.
Tóth Tamás; Budapest Zoo, Venomous snake section, Állatkerti krt. 6-12, H-1146 Budapest, Hungary.
Šiško Marijan ; General Hospital "Dr Josip Benčević, Department of Infectious Disease, Ardrije Štampara 42, 35000 Slavonski Brod, Croatia
Pandak Nenad ; General Hospital "Dr Josip Benčević, Department of Infectious Disease, Ardrije Štampara 42, 35000 Slavonski Brod, Croatia

 

Puni tekst:
(Engleski)

Tip članka:
Orginalni znanstveni rad

Sažetak:
Venom variations documented at several European Vipera in the last decades and we reported for the first time this phenomenon at the Common Adder (Vipera berus). We retrospectively survey the clinical picture of human envenomings by lowland populations of the Balkan adder, Vipera berus bosniensis, through 53 patients, admitted in SW Hungary, NW and NE Croatia. The maximum severity grade of bites was: none 5 (9.4%), mild 24 (45.2%), moderate 12 (22.6%) and severe 12 (22.6%). We report first a fatal envenoming by the Balkan adder, which occurred in the early 1950s in SW Hungary. Antivenom therapy applied in 27 cases, the European Viper Venom Antiserum® at twenty-two, Viperfav® at four and the Pasteur ER at one victim. There is a high incidence of neurotoxicity (x=12, 20.7%) mainly cranial nerve disturbances. Other neurotoxic symptoms were lower limb paralysis and dyspnoea, which have never been observed at V.b. berus bites; these were only emphasized in the old works in V.b. bosniensis envenomings (i.e. 1930s). Further unusual features (i.e. hypertension and drowsiness) were also recorded. Hypokalaemia documented as a very unusual laboratory finding, it has never detected in the case of other European viper envenomation. Local symptoms are not as expressed as in the envenomings by C and N European adder populations. The systemic effects of bites by these lowland V. berus populations are highly different from those in C and N Europe, which supports the views that denote the Balkan populations as a separate taxonomic entity.

Ključne riječi
cranial nerve disturbances; ptosis; diplopia, neurotoxicity; autonomic disorders