Life-threatening envenoming by the Saharan horned viper (Cerastes cerastes) causing micro-angiopathic haemolysis, coagulopathy and acute renal failure: clinical cases and review.
BACKGROUND
The desert horned vipers (Cerastes cerastes and C. gasperettii) are the most familiar snakes of the great deserts of North Africa and the Middle East, including the plains of Iraq. They are responsible for many human snake bites. In Western countries, they are popular among exotic-snake keepers.


OBJECTIVE
To investigate mechanisms of life-threatening envenoming and treatment.


METHODS
Clinical investigation.


METHODS
Clinical and laboratory studies with measurement of serum venom antigen concentrations by enzyme immunoassay.


RESULTS
Two men bitten while handling captive Saharan horned vipers (Cerastes cerastes) in Europe developed extensive local swelling and life-threatening systemic envenoming, characterized by coagulopathy, increased fibrinolysis, thrombocytopenia, micro-angiopathic haemolytic anaemia and acute renal failure. The clinical picture is explicable by the presence in C. cerastes venom of several thrombin-like, Factor-X-activating, platelet-aggregating, haemorrhagic and nephrotoxic components. In one case, prophylactic use of subcutaneous epinephrine may have contributed to intracranial haemorrhage. The roles in treatment of heparin (rejected) and specific antivenom (recommended) are discussed.


CONCLUSIONS
Cerastes cerastes is capable of life-threatening envenoming in humans. Optimal treatment of envenoming is by early administration of specific antivenom, and avoidance of ineffective and potentially-dangerous ancillary methods.
Schneemann
M
M
Department of Medicine, University Hospital, Zürich, Switzerland.
Cathomas
R
R
Laidlaw
S T
ST
El Nahas
A M
AM
Theakston
R D G
RD
Warrell
D A
DA
D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000209:etiology*; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012909:Snake Bites / Q000150:complications* / Q000188:drug therapy; D014757:Viper Venoms / Q000276:immunology; D017819:Viperidae
D000997:Antivenins; D014757:Viper Venoms