title: Clinical characteristics of yamakagashi (Rhabdophis tigrinus) bites: a national survey in Japan, 2000-2013.
abstract: BACKGROUND
  Yamakagashi (Rhabdophis tigrinus) is a species of pit viper present throughout Russia and Eastern Asia. Although R. tigrinus venom is known to induce life-threatening hemorrhagic symptoms, the clinical characteristics and effective treatment of R. tigrinus bites remain unknown. The present study aimed to clarify these issues.
  
  
  METHODS
  Records in the Japan Snake Institute between 2000 and 2013 were retrospectively investigated. The following were determined: patient characteristics, coagulation and fibrinolytic system abnormalities, effect of antivenom treatment, and outcomes.
  
  
  RESULTS
  Nine patients (all males; median age, 38 years) with R. tigrinus bites were identified. On admission, the median levels of fibrinogen and fibrinogen degradation products, and platelet counts were 50 mg/dL, 295 μg/mL, and 107,000/mm(3), respectively. The median (minimum-maximum) disseminated intravascular coagulation (DIC) score defined by the Japanese Association of Acute Medicine was 8 (1-8). Antivenom was administered to seven patients, with a median interval of 35 h between bite and antivenom administration. All patients treated with antivenom survived, and the in-hospital mortality rate was 11%.
  
  
  CONCLUSIONS
  Patients with R. tigrinus bites presented with DIC of a fibrinolytic phenotype, which can result in life-threatening injury unless appropriate antivenom and DIC treatment are provided.
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Toru Hifumi, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Japan Snake Institute, 3318 Yabutsuka, Ota, Gunma, 379-2301 Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakai
authors.affiliation: Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo, 208-0011 Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yamamoto
authors.affiliation: Department of Internal Medicine, Kaizuka Hospital, Hakosaki 7-7-27, Higashi-kuFukuoka, 812-0053 Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Murakawa
authors.affiliation: Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku-ku, Tokyo, 162-8640 Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ato
authors.affiliation: Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo, 208-0011 Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Shibayama
authors.affiliation: The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto, 860-8568 Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ginnaga
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Koido
authors.affiliation: Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506 Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Inoue
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Toru Hifumi, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Toru Hifumi, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Toru Hifumi, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hagiike
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Toru Hifumi, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
keywords: Antivenom; Disseminated intravascular coagulation; Fibrinolytic phenotype; Rhabdophis tigrinus; Yamakagashi