National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland.
National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland; Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH, Zürich, Switzerland.
Toxicon. 2019 Oct;168:76-82. doi: 10.1016/j.toxicon.2019.06.223. Epub 2019 Jun 26.
The African elapid snake genus Dendroaspis comprises four species, with D. polylepsis the most dangerous of them. D. viridis is believed to cause stronger neurotoxic symptoms than the potentially least toxic of the genus, D. angusticeps, but seems less toxic compared to either of the D. jamesoni species (D. j. jamesoni(TRAILL 1843) and D. j. kaimosae (Loveridge 1936)). We present three episodes of bites byD. viridis in the same patient, sustained on three different occasions, caused by three different and unrelated snakes. While the first bite remained oligosymptomatic with a slight tightness of the throat and speedy resolution of symptoms without specific therapy, episodes two and three resulted in the patient developing massive local swelling. However, the patient showed only minimal neurologic and systemic symptoms such as tightness of the throat and a tingling sensation of the body. Episode two resolved with fasciotomy after compartment syndrome was diagnosed with a measured intracompartmental pressure of 52 mmHg. In episode three, antivenom was administered with good resolution of symptoms. The clinical courses in this patient were remarkable as he displayed mainly local symptoms after three individual bites by a supposedly neurotoxic snake.
非洲树蛇属（Dendroaspis）包含四个物种，其中多线赤道蛇（Dendroaspis polylepsis）最为危险。与可能毒性最小的属成员绿树蛇（Dendroaspis angusticeps）相比，绿曼巴蛇（Dendroaspis viridis）被认为会引起更强的神经毒性症状，但与两种詹氏树蛇（Dendroaspis jamesoni）（D. j. jamesoni（TRAILL 1843）和 D. j. kaimosae（Loveridge 1936））相比毒性似乎较低。我们报告了同一患者被三条不同的、无关联的蛇咬伤三次的三个病例。第一次咬伤症状较轻，仅有轻微的喉咙发紧，症状迅速缓解，无需特殊治疗；第二次和第三次咬伤导致患者出现大面积局部肿胀。然而，患者仅表现出轻微的神经和全身症状，如喉咙发紧和身体刺痛感。第二次咬伤在诊断为间隔综合征后进行了筋膜切开术，测得的间隔内压力为 52mmHg。第三次咬伤时使用了抗蛇毒血清，症状得到了很好的缓解。该患者的临床病程显著，因为他在被一条据称具有神经毒性的蛇单独咬伤三次后主要表现为局部症状。
