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. 2014 Mar 6;2(1):19.
doi: 10.1186/2052-0492-2-19. eCollection 2014.

Clinical characteristics of yamakagashi (Rhabdophis tigrinus) bites: a national survey in Japan, 2000-2013

Toru Hifumi  1 , Atsushi Sakai  2 , Akihiko Yamamoto  3 , Masahiro Murakawa  4 , Manabu Ato  5 , Keigo Shibayama  3 , Akihiko Ginnaga  6 , Hiroshi Kato  7 , Yuichi Koido  7 , Junichi Inoue  8 , Yuko Abe  1 , Kenya Kawakita  1 , Masanobu Hagiike  1 , Yasuhiro Kuroda  1
Affiliations

Clinical characteristics of yamakagashi (Rhabdophis tigrinus) bites: a national survey in Japan, 2000-2013

Toru Hifumi et al. J Intensive Care. .

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.

Keywords: Antivenom; Disseminated intravascular coagulation; Fibrinolytic phenotype; Rhabdophis tigrinus; Yamakagashi.

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Figures

Figure 1
Figure 1
A map showing the relative locations of cases of Rhabdophis tigrinus bites. Tokyo, Saitama, Gunma, Aichi, Kochi, Fukuoka, Saga, and Nagasaki Prefectures.
See this image and copyright information in PMC

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