A Guide to the Clinical Management of Vipera Snakebite in Italy
Abstract
:1. Introduction
1.1. Italian Vipers: Venom Components and Activities
1.1.1. Nose-Horned Viper—Vipera ammodytes (Linnaeus 1758)
1.1.2. Asp Viper—Vipera aspis (Linnaeus 1758)
1.1.3. Common Adder—Vipera berus (Linnaeus 1758)
1.1.4. Meadow Viper—Vipera ursinii (Bonaparte 1835)
2. Results—Clinical Management of Vipera Envenomation
2.1. Identifying the Biting Snake
2.1.1. Distinguishing Vipers from other Italian Snakes
2.1.2. Which Viper Is It?
2.2. First Aid in the Field
2.3. Laboratory and Clinical Investigations
2.4. Supportive Treatment of Local Symptoms
2.5. Supportive Treatment of Systemic Symptoms
2.6. Specific Treatment: Antivenom Administration
2.7. Envenoming Grading Systems
3. Discussion
4. Materials and Methods
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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City | Hospital | Telephone Number |
---|---|---|
Bergamo | Azienda Ospedaliera Papa Giovanni XXIII | 800.88.33.00 |
Firenze | Azienda Ospedaliera Careggi | (+39) 055.794.7819 |
Foggia | Azienda Ospedaliera Universitaria di Foggia | 800.183.459 |
Milano | Ospedale Niguarda | (+39) 02.66.1010.29 |
Napoli | Azienda Ospedaliera A. Cardarelli | (+39) 081.545.3333 |
Pavia | Istituti Clinici Scientifici Maugeri | (+39) 0382.24.444 |
Roma | Ospedale Pediatrico Bambino Gesù | (+39) 06.6859.3726 |
Policlinico Umberto I | (+39) 06.4997.8000 | |
Policlinico A. Gemelli | (+39) 06.305.4343 | |
Verona | Azienda Ospedaliera Universitaria Integrata Verona | 800.011.858 |
Grade | French Grading System (GSS) | Swedish Grading System (Stockholm Criteria) |
---|---|---|
0—No envenoming | Fang marks with no oedema, no local reaction. | |
1—Minimal */mild ** | Local oedema around the bite site with no systemic symptoms or signs. | * Local swelling without systemic effects.** Local or more extensive oedema with or without gastrointestinal signs and symptoms but without other systemic effects. |
2—Moderate | Regional oedema and or haematoma. Moderate systemic symptoms/signs: Mild hypotension, vomiting, diarrhoea, neurotoxicity. | Extensive oedema. Shock lasting less than 2 h, other systemic features such as transient cardiac arrhythmia, neurotoxicity, pronounced gastrointestinal symptoms. |
3—Severe | Extensive oedema involving the trunk. Severe systemic symptoms/signs: prolonged hypotension, shock, bleeding complications, organ failure. | Oedema involving the trunk. Life-threatening systemic symptoms and signs. Shock lasting longer than 2 h. |
4 | Death |
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Di Nicola, M.R.; Crevani, M.; Avella, I.; Cerullo, A.; Dorne, J.-L.C.M.; Paolino, G.; Zattera, C. A Guide to the Clinical Management of Vipera Snakebite in Italy. Toxins 2024, 16, 255. https://doi.org/10.3390/toxins16060255
Di Nicola MR, Crevani M, Avella I, Cerullo A, Dorne J-LCM, Paolino G, Zattera C. A Guide to the Clinical Management of Vipera Snakebite in Italy. Toxins. 2024; 16(6):255. https://doi.org/10.3390/toxins16060255
Chicago/Turabian StyleDi Nicola, Matteo Riccardo, Marta Crevani, Ignazio Avella, Anna Cerullo, Jean-Lou C. M. Dorne, Giovanni Paolino, and Caterina Zattera. 2024. "A Guide to the Clinical Management of Vipera Snakebite in Italy" Toxins 16, no. 6: 255. https://doi.org/10.3390/toxins16060255
APA StyleDi Nicola, M. R., Crevani, M., Avella, I., Cerullo, A., Dorne, J. -L. C. M., Paolino, G., & Zattera, C. (2024). A Guide to the Clinical Management of Vipera Snakebite in Italy. Toxins, 16(6), 255. https://doi.org/10.3390/toxins16060255