Rhabdophis tigrinus (Yamakagashi) Bites in Japan Over the Last 50 Years: A Retrospective Survey

Abstract

Introduction:Rhabdophis snakes, which include 27 species, are rear-fanged venomous snakes that are widely distributed from India to East Asia and Russia. Severe envenomation by R. tigrinus (Yamakagashi snake) in Japan and R. subminiatus in Southeast Asia has been reported. The epidemiology of R. tigrinus bites, such as geographical features, the incidence, and changes in the number of bites over time have not been comprehensively examined. Hence, we intended to clarify the epidemiological features of R. tigrinus bites through a careful review of scientific data over the last 50 years in Japan. Methods: Patient records of R. tigrinus bites between 1971 and 2020 at the Japan Snake Institute were examined retrospectively. The following were ascertained: patient characteristics, clinical symptoms, laboratory data, treatment-related factors, and hospital mortality. These variables were compared in the antivenom and the without-antivenom groups. Results: Over the 50-year study period, 43 R. tigrinus bites, including five fatal cases, were encountered. Severe cases of R. tigrinus bites have been treated with antivenom since 1985; however, fatalities occurred in 2006 and 2020. R. tigrinus bite cases have been well-distributed in the western part of Japan since 2000. The mortality rate in the antivenom group was significantly lower in the patient group that was not administered the antivenom (0 vs. 23.8%, p = 0.048). Conclusion: This study clarified the epidemiology of R. tigrinus bites in Japan over a 50-year period. Almost all severe cases of R. tigrinus bites have been treated with the antivenom in the current situation, and fatalities occurred in cases not treated with the antivenom. It is important to diagnose R. tigrinus bites in the early phase of the clinical course. The antivenom, the definitive treatment for R. tigrinus bites, is an unapproved drug. Hence, approval needs to be obtained for the drug.

Keywords: Yamakagashi; antivenom; disseminated intravascular coagulation; neglected tropical disease; snake envenomation.

Figure 1

Geographical features of R. tigrinus bites. (A) All cases (from 1971 to 2020). (B) Cases after 2000. (C) Fatal cases.

Figure 2

Distribution of R. tigrinus bites in Japan. Trends in R. tigrinus bites over the last 50 years. The black regions indicate fatal cases. A single vertical bar indicates a 5-year period (1970–1974, 1975–1979, 1980–1984, 1985–1999, 2000–2004, 2005–2009, 2010–2014, 2015–2019, and 2020). Relationship between age and number of R. tigrinus bite cases. The black regions indicate fatal cases. A single vertical bar indicates a 10-year period (0–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80, and 81–90). (A,B) Number of Yamakagashi bites.

Figure 3

Trends in patients treated with the antivenom over the last 50 years. The black regions indicate the antivenom administrated cases. A single vertical bar indicates a 5-year period (1970–1974, 1975–1979, 1980–1984, 1985–1999, 2000–2004, 2005–2009, 2010–2014, 2015–2019, and 2020). Number of Yamakagashi bites.