Reno School of Medicine, University of Nevada, Reno, NV, USA.
Southwestern Medical Center, University of Texas, Dallas, TX, USA.
Clin Toxicol (Phila). 2020 Mar;58(3):178-182. doi: 10.1080/15563650.2019.1627367. Epub 2019 Jun 13.
The majority of venomous snake exposures in the United States are due to snakes from the subfamily (pit vipers). There are three types of US pit vipers: rattlesnakes ( and spp.) copperheads (), and cottonmouths () also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium's (ToxIC) North American Snakebite Registry (NASBR) Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management. Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7-12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours. Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations. Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.
在美国，大多数毒蛇暴露事件是由亚科（坑蝮蛇）的蛇引起的。有三种美国坑蝮蛇：响尾蛇（和 spp.）铜头蛇（）和食鱼蝮（）也称为水蟒。与其他坑蝮蛇中毒相比，食鱼蝮咬伤的报告频率较低，而且有关食鱼蝮中毒的数据有限。我们的目的是使用向毒理学调查员联合会（ToxIC）北美蛇咬伤登记处（NASBR）报告的前瞻性数据描述食鱼蝮中毒的流行病学、临床表现和管理。对 2013 年 1 月 1 日至 2017 年 12 月 31 日期间向 NASBR 报告的食鱼蝮中毒病例进行了回顾。收集的变量包括患者人口统计学、咬伤部位、临床表现和管理。报告了 31 例食鱼蝮中毒。大多数咬伤发生在 7-12 岁的儿童（39%）。大多数咬伤涉及下肢（72%）。有三例（10%）是故意与蛇互动。肿胀是最常见的临床效应，发生在所有患者中。19%的患者报告有胃肠道症状，19%的患者出现凝血功能障碍。84%的患者使用了抗蛇毒血清治疗。19 名患者（61%）需要住院>24 小时。我们的研究代表了首次对食鱼蝮咬伤进行的系统前瞻性数据收集。我们的数据表明，食鱼蝮中毒主要引起局部效应，偶尔也会引起全身毒性。我们的研究还表明，根据已发表的指南和建议，抗蛇毒血清通常用于这些中毒。食鱼蝮中毒相对少见。然而，它们会引起严重的局部和全身毒性。本系列中大多数食鱼蝮中毒都使用了抗蛇毒血清治疗，并住院超过 24 小时。
