Snakes of medical significance in India: the first reported case of envenoming by the Levantine viper (Macrovipera lebetina)

Wilderness & Environmental Medicine
Lekh R SharmaI D Simpson

Abstract

This article reports for the first time the medical significance of the Levantine viper (Macrovipera lebetina) in India. This snake is found in India in the mountainous regions of Jammu and Kashmir and is capable of causing necrosis and hemostatic manifestations, as seen in the case reported here. It is thus a class II snake of medical significance, as defined by the World Health Organization grading scale. This finding reinforces the recent decision by the Indian Government to abandon the term "Big Four" to describe important venomous species in India. Levantine viper venom is not included in the manufacture of Indian polyvalent anti-snake venom; thus, there is no current antidote for this species. Recommendations are to manage confirmed bites from this species without Indian anti-snake venom. In areas where this snake is found to be a significant contributor to envenomations, alternative anti-snake venoms can be sourced from outside India for use in high-risk groups. Continuing attention to preserving dead snakes brought with the victim for reliable identification remains a high priority.

References

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Apr 24, 2007·Wilderness & Environmental Medicine·Ian D Simpson, Robert L Norris
Sep 28, 2007·Wilderness & Environmental Medicine·Jeff J BoydRobert L Norris

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Citations

Nov 28, 2013·PloS One·Sakthivel VaiyapuriE Gail Hutchinson
Nov 30, 2011·Wiener klinische Wochenschrift·Robert KarloGoran Augustin
Jan 5, 2019·The Journal of Venomous Animals and Toxins Including Tropical Diseases·Daniel Jestrzemski, Irina Kuzyakova
Feb 15, 2011·Indian Pediatrics·Sheikh Mushtaq AhmedQazi Iqbal
Feb 4, 2010·PLoS Neglected Tropical Diseases·Emilie AlirolFrançois Chappuis
May 4, 2021·Plastic and Reconstructive Surgery. Global Open·Jeffrey J RussellJeffrey E Janis
Jul 20, 2021·Toxicon : Official Journal of the International Society on Toxinology·Ashis K Mukherjee, Stephen P Mackessy

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