Hemoperitoneum after a Bothrops snakebite: Case report.

Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.

Segmental muscle twitching behaviour in the flanks of lancehead vipers Bothrops spp in response to human approach

Bothrops species are known to have a wide range of defensive behaviours against potential threats. Herein we show a frequently observed, but to date undocumented, behaviour in male and female Bothrops spp of varying sizes in newly arrived specimens from the wild, short-or long-term captives as well as in captive born individuals. The behaviour consists of irregular, synchronous or asynchronous muscular twitches in segments of the body flanks in otherwise motionless snakes. We named this ‘Segmental Muscle Twitching Behaviour’ (SMTB). We observed fifteen Bothrops spp from six species groups for incidence of this behaviour and made videos of snakes during the ‘alertness’ and ‘threatening’ phases of response to human approach. We found the behaviour in only five species, these belong to the monophyletic Bothrops jararacussu and Bothrops atrox species groups, suggesting a single evolutionary origin of this behaviour. Macroscopically, SMTB varied in the number of segments involved and the twitches had uneven intensities. Although recurrent and often replicable in similar situations during human approach, the behaviour was not displayed consistently. In addition, SMTB can be interrupted, stay inactive for quite some time and then restart. Hypotheses to explain this behaviour are suggested

Speciation process on brazilian continental islands, with the description of a new insular lancehead of the genus Bothrops (Serpentes, Viperidae)

Brazilian continental islands represent a natural laboratory to study speciation driven by recent phenotypic and genotypic divergence. The Bothrops jararaca species group is distributed in the Brazilian Atlantic Forest and on most of the Brazilian continental islands. The group is currently composed of the mainland common lancehead (B. jararaca) and four insular species (B. alcatraz, B. insularis, B. otavioi, and B. sazimai). Here, we evaluate mitochondrial DNA and morphological diversity of the B. jararaca species group and aim to provide additional evidence to understand insularization processes on the Brazilian coast. Our results, interpreted together with a comprehensive review of geomorphological data, provide a new conceptual framework for understanding the colonization process of the Brazilian continental islands. This framework suggests a history of multiple rounds of periodic isolation and reconnection between insular populations and their mainland relatives throughout the last 420,000 years. Furthermore, although some insular populations may have speciated prior to the last glacial maximum, other species likely diverged within the last 11,000 years. Additionally, the repeated evolution of size and dietary shift in the B. jararaca species group suggests a remarkable case of convergent adaptation. Our study provides evidence that the Bothrops from Ilha da Moela (Brazilian state of São Paulo) represents an undescribed species, presenting a distinct phenotype, and an exclusive history of isolation and adaptation. We describe this unique lancehead as a new species and we suggest it should be listed as critically endangered based on its endemicity to a small island that is severely impacted by constant and longstanding human presence.

Differential diagnosis between venomous (Bothrops jararaca, Serpentes, Viperidae) and “Nonvenomous” (Philodryas olfersii, Serpentes, Dipsadidae) snakebites: is it always possible?

Bites of “nonvenomous” snakes can sometimes be mistaken for the bites of venomous snakes. As an example of this confusion, this report describes confirmed bites by Philodryas olfersii and Bothrops jararaca. In the first case, a 55-y-old man with a history of controlled hypertension was bitten on his right forearm by P olfersii. Physical examination revealed extensive edema, erythema, and widespread ecchymoses throughout his right upper limb. Laboratory tests indicated leukocytosis and high D-dimer levels, but normal coagulation, suggestive of a resolved recent coagulopathy. He received only supportive treatment. In the second case, a healthy 35-y-old man was bitten by B jararaca. Although the anatomic region of the bite and the results of physical examination were similar to those in the first case, laboratory tests showed mild coagulopathy, leukocytosis, and high D-dimer levels. The patient was treated with antivenom. In both cases, the 20-min whole blood clotting test results were normal. Patients bitten by P olfersii may present with local symptoms resembling B jararaca envenomation. Without snake identification and the detection of venom-induced consumption coagulopathy, especially in places where the 20-min whole blood clotting test is the only clotting test available, it is almost impossible to establish an accurate and safe differential diagnosis. In this context, the best alternative is to take the risk of prescribing antivenom for a possible P olfersii bite rather than failing to do so for a real Bothrops bite. Late treatment for Bothrops bite can result in severe complications and sequelae.

An inventory of online reptile images.

No central online repository exists for the collection of animal images; hence it remains unclear how extensively species have been illustrated in the published literature or online. Here we compiled a list of more than 8000 reptile species (out of 11,341) that have photos in one of six popular online repositories, namely iNaturalist (6,349 species), the Reptile Database (5,144), Flickr (4,386), CalPhotos (3,071), Wikimedia (2,952), and Herpmapper (2,571). These sites have compiled over one million reptile photos, with some species represented by tens of thousands of images. Despite the number of images, many species have only one or a few images. This suggests that a considerable fraction of morphological and geographic variation is under documented or difficult to access. We highlight prominent gaps in amphisbaenians, lizards, and snakes, with geographic hotspots for species without images in Central Africa, Pacific Islands, and the Andes Mountains. We present a list of ~3,000 species without photos in any of the six databases and ask the community to fill the gaps by depositing images on one of these sites (preferably with minimal copyright restrictions).

An inventory of online reptile images

No central online repository exists for the collection of animal images; hence it remains unclear how extensively species have been illustrated in the published literature or online. Here we compiled a list of more than 8000 reptile species (out of 11,341) that have photos in one of six popular online repositories, namely iNaturalist (6,349 species), the Reptile Database (5,144), Flickr (4,386), CalPhotos (3,071), Wikimedia (2,952), and Herpmapper (2,571). These sites have compiled over one million reptile photos, with some species represented by tens of thousands of images. Despite the number of images, many species have only one or a few images. This suggests that a considerable fraction of morphological and geographic variation is under documented or difficult to access. We highlight prominent gaps in amphisbaenians, lizards, and snakes, with geographic hotspots for species without images in Central Africa, Pacific Islands, and the Andes Mountains. We present a list of ~3,000 species without photos in any of the six databases and ask the community to fill the gaps by depositing images on one of these sites (preferably with minimal copyright restrictions).

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon.

A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

Description of a second known Liotyphlops caissara specimen (Serpentes: Anomalepididae)

We recorded a second specimen of the poorly known insular blind snake Liotyphlops caissara. This new specimen expands the morphological variation of the number of dorsal scales in the genus Liotyphlops to 296 (vs. 304 in L. wilderi) and, considering the fact that the holotype of this species was destroyed, the present specimen represents the only available L. caissara individual in zoological collections. Also, this new record constitutes the first out of type locality and expands the distribution of the species in about 40 km to the northeastern. According to IUCN criteria (B1a, b [iii]), we suggest that L. caissara be included in the "Endangered" category, since it occurs in only two insular locations and exhibits an occurrence extension of <5,000 km² (about 355 km2).

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon

A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon

Abstract A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

Description of a second known Liotyphlops caissara specimen (Serpentes: Anomalepididae)

We recorded a second specimen of the poorly known insular blind snake Liotyphlops caissara. This new specimen expands the morphological variation of the number of dorsal scales in the genus Liotyphlops to 296 (vs. 304 in L. wilderi) and, considering the fact that the holotype of this species was destroyed, the present specimen represents the only available L. caissara individual in zoological collections. Also, this new record constitutes the first out of type locality and expands the distribution of the species in about 40 km to the northeastern. According to IUCN criteria (B1a, b [iii]), we suggest that L. caissara be included in the "Endangered" category, since it occurs in only two insular locations and exhibits an occurrence extension of <5,000 km² (about 355 km2).

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon

A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

Is the population of Crotalus durissus (Serpentes, Viperidae) expanding in Brazil?

Crotalus durissus are found from Mexico to northern Argentina in a highly disjunct distribution. According to some studies, this species is prone to occupy areas disturbed by human activities and floods comprise a plausible method of dispersal as inferred for some North American rattlesnakes. Based on the literature, it seems plausible that Crotalus durissus expanded their natural distribution in Brazil due to floods, but only in a few municipalities in Rio de Janeiro State. Data entries of Butantan Institute, in São Paulo, Brazil, from 1998 to 2012 show a declining tendency of snakes brought by donors. In addition, research shows no evidence of Crotalus durissus being an expanding species in the Brazilian territory.

Is the population of Crotalus durissus (Serpentes, Viperidae) expanding in Brazil?

Crotalus durissus are found from Mexico to northern Argentina in a highly disjunct distribution. According to some studies, this species is prone to occupy areas disturbed by human activities and floods comprise a plausible method of dispersal as inferred for some North American rattlesnakes. Based on the literature, it seems plausible that Crotalus durissus expanded their natural distribution in Brazil due to floods, but only in a few municipalities in Rio de Janeiro State. Data entries of Butantan Institute, in São Paulo, Brazil, from 1998 to 2012 show a declining tendency of snakes brought by donors. In addition, research shows no evidence of Crotalus durissus being an expanding species in the Brazilian territory.

Is the population of Crotalus durissus (Serpentes, Viperidae) expanding in Brazil?

Crotalus durissus are found from Mexico to northern Argentina in a highly disjunct distribution. According to some studies, this species is prone to occupy areas disturbed by human activities and floods comprise a plausible method of dispersal as inferred for some North American rattlesnakes. Based on the literature, it seems plausible that Crotalus durissus expanded their natural distribution in Brazil due to floods, but only in a few municipalities in Rio de Janeiro State. Data entries of Butantan Institute, in São Paulo, Brazil, from 1998 to 2012 show a declining tendency of snakes brought by donors. In addition, research shows no evidence of Crotalus durissus being an expanding species in the Brazilian territory.(AU)

Comparison of Bothropoides jararaca bites with and without envenoming treated at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil.

INTRODUCTION: This study analyses the cases of all bites (including dry bites) caused by Bothropoides jararaca attended at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil. METHODS: A retrospective study was conducted of patients bitten by Bothropoides jararaca (n=792) from January 1990 to December 2004. The characteristics of the snake specimen, data related to the accident and clinical manifestations on admission were obtained from patient medical records. RESULTS: The majority of the cases in this study were caused by female and juvenile snakes. No stomach contents were found in 93.4% of the snake specimens after dissection. No statistical difference was observed between the occurrence of dry bites and the maturity or sex of the snake. The median SVL of snakes in mild and moderate cases was 40.5 cm and in severe cases, SVL increased to 99 cm. Necrosis was more common in the digits of the feet and hands (4.8%) compared to the other body regions (1.8%). A significant difference was verified between severity and a time interval greater than six hours from the bite to hospital admission. A significant association was verified between gingival bleeding and abnormal blood coagulability. In accidents caused by adult snakes, necrosis was more frequent (7.2%) compared to accidents caused by juvenile snakes (1%). CONCLUSIONS: In this work, the association between certain epidemiological data and the evolution of biological parameters in the clinical course of Bothrops sensu latu accidents were highlighted, contributing to the improvement of snake bite assistance.

Comparison of Bothropoides jararaca bites with and without envenoming treated at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil / Comparação dos acidentes causados por Bothropoides jararaca com e sem envenenamento atendidos no Hospital Vital Brazil do Instituto Butantan, Estado de São Paulo

INTRODUCTION: This study analyses the cases of all bites (including dry bites) caused by Bothropoides jararaca attended at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil. METHODS: A retrospective study was conducted of patients bitten by Bothropoides jararaca (n=792) from January 1990 to December 2004. The characteristics of the snake specimen, data related to the accident and clinical manifestations on admission were obtained from patient medical records. RESULTS: The majority of the cases in this study were caused by female and juvenile snakes. No stomach contents were found in 93.4 percent of the snake specimens after dissection. No statistical difference was observed between the occurrence of dry bites and the maturity or sex of the snake. The median SVL of snakes in mild and moderate cases was 40.5cm and in severe cases, SVL increased to 99cm. Necrosis was more common in the digits of the feet and hands (4.8 percent) compared to the other body regions (1.8 percent). A significant difference was verified between severity and a time interval greater than six hours from the bite to hospital admission. A significant association was verified between gingival bleeding and abnormal blood coagulability. In accidents caused by adult snakes, necrosis was more frequent (7.2 percent) compared to accidents caused by juvenile snakes (1 percent). CONCLUSIONS: In this work, the association between certain epidemiological data and the evolution of biological parameters in the clinical course of Bothrops sensu latu accidents were highlighted, contributing to the improvement of snake bite assistance.

INTRODUÇÃO: Neste estudo, analisou-se todos os casos de picadas (incluindo picadas secas) causadas por Bothropoides jararaca atendidos no Hospital Vital Brazil do Instituto Butantan, São Paulo, Brasil. MÉTODOS: Estudo retrospectivo em que foram incluídos pacientes atendidos no Hospital Vital Brazil do Instituto Butantan, picados por serpentes da espécie Bothropoides jararaca (nº=792) entre 1990 a 2004. Os dados foram obtidos através de prontuários médicos. RESULTADOS: No presente estudo, a maioria dos acidentes foi causada por serpentes fêmeas e filhotes. Não havia presença de conteúdo estomacal em 93,4 por cento das serpentes dissecadas. Não houve diferença estatística entre a ocorrência de picada seca e o sexo da serpente. O comprimento rostro cloacal das serpentes nos casos leves e moderados foram 40,5cm e nos casos severos 99cm. Necrose foi mais comum nos dedos dos pés e das mãos (4,8 por cento) em comparação com outras regiões do corpo (1,8 por cento). Houve diferença estatística entre a gravidade e o intervalo de tempo entre a picada e a admissão hospitalar superior a seis horas. Encontramos uma associação significativa entre gengivorragia e incoagulabilidade sanguínea. Nos acidentes causados por serpentes adultas, a necrose foi mais frequente (7,2 por cento) quando comparado aos acidentes causados por serpentes filhotes (1 por cento). CONCLUSÕES: Neste estudo, destaca-se a associação entre os dados epidemiológicos e biológicos em relação à evolução do quadro clínico nos acidentes botrópicos, contribuindo para a melhoria da assistência nos acidentes ofídicos.