Report of a Bite from a New Species of the Echis Genus--Echis omanensis.
BACKGROUND
Carpet vipers (Echis) are found across the semiarid regions of west, north, and east Africa; west, south, and east Arabia; parts of Iran and Afghanistan north to Uzbekistan; and in Pakistan, India, and Sri Lanka. Recently, a new species belonging to the Echis genus, Echis omanensis has been recognized in Oman. Not much is known about the clinical manifestations of envenomation from its bite.


METHODS
A 63-year-old snake keeper presented to the emergency department shortly after being bitten by an Oman carpet viper (E. omanensis). The incident occurred during expression of the venom at a research center. The patient complained of severe pain and swelling of the left index finger, which extended to the mid-forearm within 1 h. His vital signs remained stable, with no evidence of systemic manifestations. He was treated initially with analgesics and tetanus toxoid. Due to rapidly progressive swelling and the potential for a delayed coagulopathy, the Saudi National Guard polyvalent snake antivenom was administered according to the Ministry of Health protocol. The patient was admitted to the intensive care unit, remained hemodynamically stable, and had normal serial coagulation tests, with subsequent resolution of the swelling.


CONCLUSIONS
We report the first case of an E. omanensis bite in which the patient developed rapidly progressive local toxicity, which improved after administration of the Saudi polyvalent antivenom.
Emory University and the Georgia Poison Center, Atlanta, GA, USA, balhata@emory.edu.
Badria A
BA
Al Hatali
Said A
SA
Al Mazroui
Abdullah S
AS
Alreesi
Robert J
RJ
Geller
Brent W
BW
Morgan
Ziad N
ZN
Kazzi
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D001777:Blood Coagulation; D003422:Critical Care; D004487:Edema / Q000139:chemically induced; D005385:Fingers / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D012909:Snake Bites / Q000097:blood / Q000628:therapy*; D013745:Tetanus Toxoid / Q000627:therapeutic use; D016896:Treatment Outcome; D014757:Viper Venoms; D017819:Viperidae
D000701:Analgesics, Opioid; D000997:Antivenins; D013745:Tetanus Toxoid; D014757:Viper Venoms; D009020:Morphine