Hospital admissions due to snake envenomation in the Republic of Cyprus: a 7-year retrospective review.

BACKGROUND: Snake envenomation is a major neglected tropical disease, lacking data in many countries including Cyprus, a Mediterranean island inhabited by the medically important blunt-nosed viper (Macrovipera lebetina). Reviewing the 2013-2019 period, we present first-time epidemiological snakebite data in the Republic of Cyprus. METHODS: We obtained data on snake envenomation-related hospital admissions from the Ministry of Health, and population and rainfall data from the Statistical Service of Cyprus and Department of Meteorology websites. Human-viper conflict information was acquired from interviews with 12 representatives of Cypriot institutions. RESULTS: Between 2013 and 2019, 288 snake envenomation cases were admitted to public hospitals, averaging 41 people annually. The minimum was 29 cases (2017) and the maximum was 58 (2015). Snake envenomation incidence increased from 4.55 per 100,000 population (2013) to 6.84 (2015), but remained low since 2017 (3.49 in 2019). Between 2000 and 2018, the deaths of one man (73 years), and indirectly, one woman (77 years), were related to snake envenomation. While 266 cases (92%) happened between April and October (the blunt-nosed viper activity period), most envenomations occurred in September (cumulative for 2013-2019), with 88 cases (31%). Snakebite incidence peaked in the 60-69 years age group (9.19 per 100,000 population), and was higher in males (6.85) than in females (2.82). Of all admitted patients, 242 (84%) were discharged within 4 days. Mean hospital stay duration was 2.65 days, with one case of 13 days. Most patients were admitted to the general hospitals in Paphos (51%), Limassol (30%) and Nicosia (11%), which provide secondary healthcare, with the last one providing tertiary healthcare. CONCLUSIONS: Snakebite-related deaths are very rare in the Republic of Cyprus. Most envenomation cases happened in late summer (September). Short hospital stays indicate mostly non-severe clinical courses. The hospital admission data suggest that snake envenomation risk is highest in Paphos district. The statistical data hint at males and middle- to older-aged people being at highest risk, whereas from our interview data we assume that outdoor workers are at higher risk than other occupational groups.

Comparative Venom Proteomics of Iranian, Macrovipera lebetina cernovi, and Cypriot, Macrovipera lebetina lebetina, Giant Vipers.

Envenoming by Macrovipera lebetina subspecies causes severe life-threatening difficulties for people living in North Africa and the Middle East. To better understand the pathophysiology of envenoming and improve patient management, knowledge about the venom components of the subspecies is essential. Here, the venom proteomes of Macrovipera lebetina lebetina from Cyprus and Macrovipera lebetina cernovi from Iran were characterized using RP-HPLC separation of the crude venom proteins, SDS-PAGE of fractionated proteins, and LC-MS/MS of peptides obtained from in-gel tryptic digestion of protein bands. Moreover, we also used high-resolution shot-gun proteomics to gain more reliable identification, where the whole venom proteomes were subjected directly to in-solution digestion before LC-HR-MS/MS. The data revealed that both venoms consisted of at least 18 protein families, of which snake venom Zn2+-dependent metalloprotease (SVMP), serine protease, disintegrin, phospholipase A2, C-type lectin-like, and L-amino acid oxidase, together accounted for more than 80% of the venoms' protein contents. Although the two viper venoms shared mostly similar protein classes, the relative occurrences of these toxins were different in each snake subspecies. For instance, P-I class of SVMP toxins were found to be more abundant than P-III class in the venoms of M. l. cernovi compared to M. l. lebetina, which gives hints at a more potent myonecrotic effect and minor systemic hemorrhage following envenoming by M. l. cernovi than M. l. lebetina. Moreover, single-shot proteomics also revealed many proteins with low abundance (<1%) within the venoms, such as aminopeptidase, hyaluronidase, glutaminyl-peptide cyclotransferase, cystatin, phospholipase B, and vascular endothelial growth factor. Our study extends the in-depth understanding of the venom complexity of M. lebetina subspecies, particularly regarding toxin families associated with envenoming pathogenesis and those hard-detected protein classes expressed in trace amounts.

Morphometric characteristics and seasonal proximity to water of the Cypriot blunt-nosed viper Macrovipera lebetina lebetina (Linnaeus, 1758).

BACKGROUND: The blunt-nosed viper Macrovipera lebetina (Linnaeus, 1758) is a medically important snake species in the Middle East. Its nominate subspecies Macrovipera l. lebetina is confined to Cyprus, where it is the only dangerously venomous snake species and heavily pursued. Despite the viper's large size, data on its body mass and sex-specific morphological differences are scarce. It is commonly believed that M. l. lebetina prefers freshwater proximity during summer. Hence, we aimed at investigating M. l. lebetina sex-specific morphological differences and its possible attraction to freshwater bodies in late summer. METHODS: Morphometric characteristics, proximity to water and conservation status of M. l. lebetina were investigated in Paphos district (Cyprus) in 2014, 2015 and 2017. Vipers were caught in different habitats, examined morphologically for metric and meristic characters, and released back into their habitat. Additionally, local people were interviewed about the conservation situation of the species. RESULTS: Of 38 recorded blunt-nosed vipers, morphological characteristics were collected from 34 (10 adult males, 16 adult females, eight unsexed juveniles). Rounded total length (ToL) ranged from 23.5 cm to 133.0 cm and weight between 10 g and 1456 g. Adult males significantly exceeded adult females in tail length (TaL), ToL and head length (HL). No significant sex-specific differences were found in snout-vent length (SVL), head width (HW), weight or body condition index (BCI), nor for the ratios TaL / SVL, TaL / ToL, HL / SVL or HL / HW. Adult females from late summer (2015) had a significantly lower mean BCI than those from spring (2014).Distances of blunt-nosed vipers to the nearest water bodies (natural and artificial, respectively) did not differ significantly between spring (2014) and late summer (2015). There was also no significant difference between the distances of vipers to natural and to artificial water bodies in spring (and late summer). CONCLUSIONS: Adult male blunt-nosed vipers exceed adult females in TaL, ToL and HL. Adult females are likely in a more vulnerable body condition in late summer than in spring. Periodic drying out of freshwater bodies in summer probably does not affect the species' occurrence. Educational workshops and habitat conservation are recommended for reducing human-viper conflict.

Morphometric characteristics and seasonal proximity to water of the Cypriot bluntnosed viper Macrovipera lebetina lebetina (Linnaeus, 1758)

The blunt-nosed viper Macrovipera lebetina (Linnaeus, 1758) is a medically important snake species in the Middle East. Its nominate subspecies Macrovipera l. lebetina is confined to Cyprus, where it is the only dangerously venomous snake species and heavily pursued. Despite the viper's large size, data on its body mass and sex-specific morphological differences are scarce. It is commonly believed that M. l. lebetina prefers freshwater proximity during summer. Hence, we aimed at investigating M. l. lebetina sex-specific morphological differences and its possible attraction to freshwater bodies in late summer. Methods: Morphometric characteristics, proximity to water and conservation status of M. l. lebetina were investigated in Paphos district (Cyprus) in 2014, 2015 and 2017. Vipers were caught in different habitats, examined morphologically for metric and meristic characters, and released back into their habitat. Additionally, local people were interviewed about the conservation situation of the species. Results: Of 38 recorded blunt-nosed vipers, morphological characteristics were collected from 34 (10 adult males, 16 adult females, eight unsexed juveniles). Rounded total length (ToL) ranged from 23.5 cm to 133.0 cm and weight between 10 g and 1456 g. Adult males significantly exceeded adult females in tail length (TaL), ToL and head length (HL). No significant sex-specific differences were found in snout-vent length (SVL), head width (HW), weight or body condition index (BCI), nor for the ratios TaL / SVL, TaL / ToL, HL / SVL or HL / HW. Adult females from late summer (2015) had a significantly lower mean BCI than those from spring (2014). Distances of blunt-nosed vipers to the nearest water bodies (natural and artificial, respectively) did not differ significantly between spring (2014) and late summer (2015). There was also no significant difference between the distances of vipers to natural and to artificial water bodies in spring (and late summer). Conclusions: Adult male blunt-nosed vipers exceed adult females in TaL, ToL and HL. Adult females are likely in a more vulnerable body condition in late summer than in spring. Periodic drying out of freshwater bodies in summer probably does not affect the species' occurrence. Educational workshops and habitat conservation are recommended for reducing human-viper conflict.(AU)