Departamento de Moléstias Infecciosas e Parasitárias, Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil.
Toxicon. 2021 Jul 15;197:55-64. doi: 10.1016/j.toxicon.2021.04.014. Epub 2021 Apr 21.
Despite the biological relevance and abundance of non-front-fanged colubroid snakes, little is known about the medical significance of the majority these species. Herein, we described bites by two green racer species of colubroid snakes, with respect to clinical, epidemiological, and biological features. We retrospectively analyzed proven cases of Philodryas olfersii and Philodryas aestiva bites. Only cases in which the causative animal was brought and identified by an expert were included. Analysis included variables related to the snake, patient demographics, clinical findings, whole blood clotting time (WBCT20), and treatments. Total 155 medical records were analyzed, of which 141 and 14 patients each were bitten by P. olfersii and P. aestiva, respectively. Most bites occurred in spring and summer seasons, predominantly during daytime. Most snakes were female and adult. Bites by P. olfersii adults were more frequent in summer (p < 0.001) and spring (p < 0.001). The hands were most frequently bitten by P. olfersii (59.6%), while the feet and legs (71.4%) were most bitten by P. aestiva. The most common local signs or symptoms observed were pain, edema, erythema, and transitory local bleeding. Severe pain, extensive edema, ecchymosis, and paresthesia were present only in patients bitten by P. olfersii. Significant association was observed between local bleeding and adult snakes (p = 0.019), as well as between the snout-vent-length and pain (p = 0.018), extensive edema (p = 0.024), and erythema (p = 0.047). WBCT20 was normal in the 35 cases in which it was available. Two patients were wrongly treated with anti-Bothrops antivenom. These results indicated that most accidents caused by P. olfersii and P. aestiva present mild local symptomatology. Some bites of P. olfersii bites may present local symptoms, resembling bites by Bothrops-like snakes. Physicians should be informed about these kinds of accidents, to avoid unnecessary distress to the patient and over prescription of antivenom.
尽管无颊窝的游蛇科蛇类在生物学上具有相关性且数量丰富，但大多数这些物种的医学意义知之甚少。在此，我们描述了两种游蛇科绿蛇属蛇类的咬伤，涉及临床、流行病学和生物学特征。我们回顾性分析了 Philodryas olfersii 和 Philodryas aestiva 咬伤的确诊病例。仅包括由专家带来并鉴定的致病动物的病例。分析包括与蛇、患者人口统计学、临床发现、全血凝血时间（WBCT20）和治疗相关的变量。共分析了 155 份病历，其中 Philodryas olfersii 咬伤 141 例，Philodryas aestiva 咬伤 14 例。大多数咬伤发生在春季和夏季，主要发生在白天。大多数蛇为雌性和成年蛇。夏季（p<0.001）和春季（p<0.001）咬伤 P. olfersii 成年蛇的频率更高。P. olfersii 咬伤最常发生在手部（59.6%），而 P. aestiva 咬伤最常发生在脚部和腿部（71.4%）。最常见的局部体征或症状为疼痛、肿胀、红斑和一过性局部出血。仅在被 P. olfersii 咬伤的患者中观察到严重疼痛、广泛肿胀、瘀斑和感觉异常。观察到局部出血与成年蛇（p=0.019）以及吻肛长与疼痛（p=0.018）、广泛肿胀（p=0.024）和红斑（p=0.047）之间存在显著相关性。可获得的 35 例 WBCT20 均正常。有 2 例患者被错误地用抗 Bothrops 抗蛇毒血清治疗。这些结果表明，大多数由 P. olfersii 和 P. aestiva 引起的事故表现出轻度的局部症状。一些 P. olfersii 咬伤可能表现出局部症状，类似于响尾蛇科蛇类的咬伤。医生应了解这些类型的事故，以避免给患者带来不必要的痛苦和过度使用抗蛇毒血清。
