Gillissen A, Theakston R D, Barth J, May B, Krieg M, Warrell D A
Department of Pneumology and Allergology, Bergmannsheil University Clinic, Bochum, Germany.
Toxicon. 1994 Aug;32(8):937-44. doi: 10.1016/0041-0101(94)90372-7.
A young man in Germany was bitten by a large captive saw-scaled viper (Echis 'pyramidum'-complex) of Tunisian origin. During the first few hours after the bite he developed evidence of disseminated intravascular coagulation and fibrinolysis, and bled spontaneously. Despite being given a total of 310 ml of three different Echis-specific antivenoms (together with large amounts of fresh frozen plasma and concentrated clotting factors), venom antigenaemia (measured by enzyme immunoassay) and coagulopathy persisted for more than 10 days, and he developed a haemolytic anaemia and mild renal dysfunction. Transient bilateral ptosis was attributed to envenoming. The venom of the snake responsible for the bite was immunologically distinct from that of Nigerian E. ocellatus and was clearly not neutralised by the three monospecific antivenoms which had been administered. This case is another illustration of the geographical variation in snake venoms and the need for pooling venoms from snakes from different parts of the geographical range in the preparation of antivenoms. Envenoming by North African Echis species may not be reversible by available antivenoms.
一名德国青年被一条原产于突尼斯的大型圈养锯鳞蝰（锯鳞蝰属“pyramidum”复合种）咬伤。被咬后的最初几个小时内，他出现了弥散性血管内凝血和纤维蛋白溶解的迹象，并自发性出血。尽管总共注射了310毫升三种不同的锯鳞蝰特异性抗蛇毒血清（同时还输入了大量新鲜冷冻血浆和浓缩凝血因子），但毒液抗原血症（通过酶免疫测定法测量）和凝血病持续了10多天，并且他还出现了溶血性贫血和轻度肾功能不全。短暂的双侧上睑下垂归因于蛇毒中毒。导致此次咬伤的蛇的毒液在免疫学上与尼日利亚的眼斑锯鳞蝰不同，并且显然未被所注射的三种单特异性抗蛇毒血清中和。该病例再次说明了蛇毒的地理差异，以及在制备抗蛇毒血清时需要汇集来自地理分布不同地区的蛇的毒液。现有的抗蛇毒血清可能无法逆转北非锯鳞蝰属物种所致的蛇毒中毒。
