title: [Exotic snakes in Europe. A case of Mexican Moccasin (Agkistrodon bilineatus) snakebite].
abstract: BACKGROUND
  In the last years exotic snakebite envenomations are increasingly reported. These cases are difficult to manage because of the limited experience of European physicians in the treatment of bites from such venomous snakes; moreover, specific antivenoms are unevenly stocked and they are difficult to find in case of a medical emergency.
  
  
  METHODS
  A 39-year-old herpetologist was bitten in his right hand by a mexican moccasin (Agkistrodon bilineatus) at the workplace, and presented in the Emergency Department 19 hours later. At admission, clinical evaluation showed local necrosis, swelling involving the entire limb up to the trunk, and severe pain. The specific antidote, not stocked in Italy, was sought abroad; its finding and routeing up to spot delivery required 12 hours. The antivenom, given 32 hours after the bite with no adverse reactions, was only partially effective. The clinical course was characterized by extensive edema with rhabdomyolysis. The necrotic wound at the bite site required after several days surgical debridement, and eventually skin graft. At 3 months follow-up, motor impairment of his right hand fingers with functional disability was still present.
  
  
  CONCLUSIONS
  The envenomation by Agkistrodon bilineatus has some clinical aspects in common with that by European viper species, although crotalid venom usually causes more severe manifestations. The antivenom supply from a foreign country may delay its administration. A specific legislation aimed to simplify antidotes importing procedures for professional snake handlers may improve antivenoms availability and allow their timely use, as soon as clinically indicated.
authors.affiliation: Centre antipoisons de Pavie, Centre national d'information toxicologique, IRCCS Fondation Maugeri et Université de Pavie, Italie. cnit@fsm.it
authors.forename: Davide
authors.initials: D
authors.lastname: Lonati
authors.forename: Raffaella
authors.initials: R
authors.lastname: Butera
authors.forename: Mauro
authors.initials: M
authors.lastname: Cima
authors.forename: Susanna
authors.initials: S
authors.lastname: Cozzio
authors.forename: Carlo
authors.initials: C
authors.lastname: Locatelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Manzo
mesh_terms: D000328:Adult; D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D003646:Debridement; D004487:Edema / Q000209:etiology; D006801:Humans; D008297:Male; D009336:Necrosis; D012206:Rhabdomyolysis / Q000209:etiology; D016038:Skin Transplantation; D012909:Snake Bites / Q000473:pathology* / Q000628:therapy*
chemical_list: D000997:Antivenins