Bothrops lanceolatus bites: guidelines for severity assessment and emergent management

Area of Science:

• Herpetology
• Toxicology
• Clinical Medicine

Background:

• Martinique faces 20-30 annual snakebite incidents, exclusively involving the endemic Fer-de-Lance (Bothrops lanceolatus).
• Fer-de-Lance envenomation presents with local symptoms like swelling and bleeding, and severe cases can lead to systemic thromboses and infarctions.

Purpose of the Study:

• To review the epidemiology, clinical presentation, diagnosis, and management of Bothrops lanceolatus snakebites in Martinique.
• To emphasize the effectiveness of early antivenom administration in preventing severe outcomes.

Main Methods:

• Review of snakebite cases in Martinique.
• Clinical assessment of envenomation severity using a 4-grade score.
• Evaluation of coagulation tests for diagnosis.
• Assessment of the efficacy and tolerance of equine anti-venom (Bothrofav®).

Main Results:

• Local envenomation signs include fang marks, swelling, pain, and bleeding.
• Severe envenomation can cause systemic thromboses (cerebral, myocardial, pulmonary infarctions) within 48 hours.
• Early administration of Bothrofav® within 6 hours is effective in preventing thrombosis and coagulopathy.
• The equine anti-venom demonstrates good tolerance.

Conclusions:

• Despite an increasing incidence of bites, no recent deaths have been reported in Martinique.
• Early diagnosis and prompt administration of specific antivenom are crucial for managing Fer-de-Lance envenomation and preventing fatalities.