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Case Reports
. 2022 Jul 18;14(7):500.
doi: 10.3390/toxins14070500.

Neurotoxicity and Other Clinical Manifestations of a Common European Adder (Vipera berus) Bite in Romania

Gabriela Viorela Nițescu  1   2 , Coriolan Emil Ulmeanu  1   2 , Maria-Dorina Crăciun  2   3 , Alina Maria Ciucă  2 , Alexandru Ulici  2   4 , Ioan Ghira  5 , Davide Lonati  6
Affiliations
Case Reports

Neurotoxicity and Other Clinical Manifestations of a Common European Adder (Vipera berus) Bite in Romania

Gabriela Viorela Nițescu et al. Toxins (Basel). .

Abstract

Most cases of envenomation by common European vipers (Vipera berus) have not been reported to have neurotoxic manifestations. However, these manifestations have been demonstrated in some cases of envenomation by subspecies of V. berus, found in the Carpathian Basin region of south-eastern Europe. Here, we report the case of a 5-year-old girl from the south of Romania who presented symptoms of neurotoxicity, as well as other systemic and local symptoms, after being bitten by an adder of the V. berus subspecies. Treatment consisted of monovalent antivenom, a corticosteroid, and prophylactic enoxaparin. Neurotoxic manifestations of envenomation as well as other local and systemic symptoms improved within 5 days of treatment. The presented case shows that venom from V. berus subspecies found in the Carpathian Basin can have neurotoxic effects. This case also confirmed the efficacy of monospecific antivenom treatment in bringing about rapid and complete remission, following envenomation.

Keywords: Berus Viper; child; common European viper; monospecific antivenom; neurotoxicity; south Romania.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Local signs of viper bite including swelling, erythema (lower calf and ankle); (b) image showing inferior displacement of the upper eyelid with associated narrowing of the vertical palpebral fissure (bilateral palpebral ptosis).
Figure 2
Figure 2
V. berus distribution in Romania [1]. Red dots: new records of V. berus after 1990; blue dots: records of V. berus before 1990.
See this image and copyright information in PMC

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