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Review
. 2020 Oct 22;12(11):668.
doi: 10.3390/toxins12110668.

Current Knowledge on Snake Dry Bites

Manuela B Pucca  1 , Cecilie Knudsen  2   3 , Isadora S Oliveira  4 , Charlotte Rimbault  2 , Felipe A Cerni  4 , Fan Hui Wen  5 , Jacqueline Sachett  6   7 , Marco A Sartim  8   9 , Andreas H Laustsen  2 , Wuelton M Monteiro  6   8
Affiliations
Review

Current Knowledge on Snake Dry Bites

Manuela B Pucca et al. Toxins (Basel). .

Abstract

Snake 'dry bites' are characterized by the absence of venom being injected into the victim during a snakebite incident. The dry bite mechanism and diagnosis are quite complex, and the lack of envenoming symptoms in these cases may be misinterpreted as a miraculous treatment or as proof that the bite from the perpetrating snake species is rather harmless. The circumstances of dry bites and their clinical diagnosis are not well-explored in the literature, which may lead to ambiguity amongst treating personnel about whether antivenom is indicated or not. Here, the epidemiology and recorded history of dry bites are reviewed, and the clinical knowledge on the dry bite phenomenon is presented and discussed. Finally, this review proposes a diagnostic and therapeutic protocol to assist medical care after snake dry bites, aiming to improve patient outcomes.

Keywords: antivenom; asymptomatic envenoming; dry bites; non-envenoming; snakebite; venom.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Snake venom delivery systems. Schematic anatomy of snake venom delivery systems. (A) Viperidae venom system: The venom gland is triangular and large; the lumen is voluminous and can store high quantities of venom; the lumen forms the primary duct, which is connected to an accessory gland and finally to the secondary duct and the fang. (B) Elapidae venom system: The venom gland is oval; the lumen is narrow, and the majority of venom is stored in the secretory cells rather than the lumen; the accessory gland is placed in the distal part of the venom gland and has only one duct.
Figure 2
Figure 2
Snakebite cases. (A) A case of juvenile Bothrops jararaca bite causing mild, local traumatic injury, along with gum bleeding and persistently bleeding chin. Patient also presented hemorrhage in the central nervous system. Patient from the Hospital Vital Brazil, São Paulo—SP. (B,C) Two cases of juvenile Bothrops atrox snakebite presenting only fang marks. No hemostasis disorder was detected. The comparison with the contralateral limb does not show the presence of edema or ecchymosis. The patients had no local or systemic complications at follow-up. Patients from the Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus—AM (ethical approval number 492.892/2013—FMT-HVD Ethical Board).
Figure 3
Figure 3
Snake-related causes of dry bites. Schematic representation of the main causes responsible for the dry bite phenomena.
Figure 4
Figure 4
Flow chart on diagnosis and treatment of snake envenomings and dry bites.
See this image and copyright information in PMC

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