Mozambique Spitter Bite – Caution GRAPHIC

This section will help you get first aid treatment protocols incase of an envenomation. This includes indigenous and exotic reptiles. Please do not use this forum for photo sharing, etc.

Mozambique Spitter Bite – Caution GRAPHIC

Postby Jen » Tue May 03, 2011 9:31 pm

Please note: this little girl’s mother gave me permission to photograph her daughter.

I have a success story to share. Although you may be shocked when you look at the pictures, the management of this little girl was spot on – I am so pleased!

She is 7 years old & was bitten by a Mozambique Spitter on the left hand on the 25th April 2011. She lives in Nongoma (far Northern KZN) and reached our hospital in Durban within a few hours. She had features of significant envenomation – her arm was extensively swollen and there was blistering. She also had some neurological effects – she was objectively hallucinating. Fortunately however she did not develop any significant weakness / paralysis.

She received 4 vials of polyvalent antivenom but developed an allergic reaction. Luckily she had no anaphylaxis, but she did develop urticaria (hives) and some difficulty breathing. No further antivenom was given & she received a low dose of adrenalin, antihistamines and steroids.

The surgical team did not rush her to theatre for a fasciotomy (a miracle!) but instead observed her in the ward. She received intravenous fluids, antibiotics, analgesics & anti-inflammatories. She developed a marked SIRS response (essentially the immune system in overdrive) but remained stable.

Unfortunately, despite their best efforts she developed a horrible infection. We brought her to theatre today. The following pictures were taken: (apologies for the quality – I had to use my cellphone camera)

This is her hand – it just shows the degree of swelling
Image

This pic is of her arm – note the pus pouring out from her hand and her cubital fossa (opposite of elbow) These wound tracts opened spontaneously
Image

A close up of her cubital fossa – see the extensive pus
Image

Her arm once they had finished cleaning. Note this is not a fasciotomy. The muscle & its membranes are deeper. The pus had tracked under the skin from her hand all the way up to her deltoid area. Most of the overlying skin was intact but there was extensive pus. The muscle all looks very healthy – the sepsis is superficial. There was also thrombophlebitis (inflammation & clotting of her superficial veins) The skin was not closed (due to the risk of the pus re-accumulating) but was just opposed.
Image

She will most likely return to theatre in a few days time for another washout. Once the sepsis has settled, her skin can be closed.

Take home message – DO NOT UNDERESTIMATE A MOZAMBIQUE SPITTER BITE!
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby BOOGY » Tue May 03, 2011 10:08 pm

Yes they are fiesty snakes with a terrible bite. I stongly believe these types of pictures keeps me on my toes and reminds me not to get "windgat". Thanks for shareing this.
I hope sincerely hope the little girl has a full recovery. Keep us updated if possible.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Fooble » Tue May 03, 2011 10:18 pm

So glad to hear of success stories rather then the disaster stories.

But sheesh that last picture is quite well...intense.

Thanks for posting Jen!
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Boadicea » Tue May 03, 2011 10:38 pm

I know of a guy that freee handles one :shock: .It's only a matter of time I guess.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Westley Price » Wed May 04, 2011 7:23 am

Wow, that last pic is definitely an eye opener!

I hope she makes a full recovery.

It is hard to imagine that amount of damage occurring in just a few hours. The wounds look days old.

Please see if you can keep us updated with her recovery.

Thanx for posting.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Rob Macmillan » Wed May 04, 2011 7:31 am

That is a serious bite!! People don't realise the severity of a cytotoxic bite. I'd like to say a speedy recovery, but sadly its a long haul. Hope she recovers with few complications. Thanks for sharing Jen ;) and keep us posted.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Spider » Wed May 04, 2011 8:03 am

Damn! You have to feel sorry for someone so young going through so much pain. I hope she recovers very soon.
I wonder how the bite happened.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Eyelash » Wed May 04, 2011 8:43 am

Thanks for sharing Jen !

Do you guy's know witch Bacteria sp. was/is responsible for the infection ?

Please wish her and her family a speedy recovery !

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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Smeegle » Wed May 04, 2011 9:24 am

Shees, awesome post, Jen! It breaks my heart that a little girl has to go through all that trauma, but luckily she is in good hands!
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Rodis » Wed May 04, 2011 9:44 am

Eish- I reminder of what can happen on our lodge at anytime, but thankfully has never occurred in 25 years.

I can’t help but think of my 2 year olds arm, it’s so small and skinny!

Jen is it safe to say that besides amputation, is this the worse case scenario? I am assuming and need to be corrected if I am wrong,
but if she did not develop the allergic reaction, that the polyvalent antivenom seeing as it was administered within a few hours of the bite, would have neutralised some of these effects?

As I have stated before, this in my worse nightmare, not only for myself but for my family as we only encounter and remove this species.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Bushviper » Wed May 04, 2011 11:28 am

Her biggest problem was the secondary infection. Snake venom does not have bacteria in it so this was introduced at the hospital in some form or another. Sometimes there is not much you can do. Getting an infection like this whilst on antibiotics just shows her immune system was compromised. I hope the skin re-attaches itself without any more problems.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby ryan654 » Wed May 04, 2011 11:45 am

wow definately abit of a shock to the system and definately something to think about before catching one thanks for the post hope the little girl is ok
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby fuscusV2 » Wed May 04, 2011 3:20 pm

Indeed a success story considering the complications, glad no anaphylaxis, that in itself is a big scare. How was the snake Id'd? Alot of work with a snake bite, kudos to you and your team Jen.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Jen » Wed May 04, 2011 4:08 pm

@Westley - sorry I didn't make it clear. She was bitten on the 25th of April, but the pus started coming out the day before yesterday (the 2nd) - so yes, you're right - those wounds are a few days old.

@Spider - it happened when she was alseep in the middle of the night, which is the typical story in Northern KZN. They enter homes looking for warmth.

@Eyelash - we're waiting to see which bug grows from the specimen which we've sent to the lab. She's being treated with Augmentin which is a broad spectrum antibiotic.

@Rodis - actually, a compartment syndrome would have been worse. Although it looks very gruesome, the muscles are all very healthy. The infection is just localised to the area below the skin but above the muscle. As long as the fascia (the membrane covering the muscle) doesn't become involved, she will probably just land up with a nasty scar. As BV says, her biggest problem was actually the infection. Perhaps if she could have received the full dose of antivenom, there would have been less superficial tissue necrosis & perhaps less extensive sepsis.

@FuscusV2 - the snake was ID's by the little girl's uncle. He identified as a "mfezi.' Before I chatted to the family, I thought that was the most likely culprit because of the cytotoxic effects & the mild neurological effects, coupled with the geographical location. Unfortunatley, they killed the snake and then removed its gallbladder for use in traditional medicine. I've never heard of that before.

Thanks for all the comments - I'll definitely keep you posted.
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Re: Mozambique Spitter Bite – Caution GRAPHIC

Postby Snake Charmer » Sat May 07, 2011 12:51 pm

:shock: I'm feeling very faint whilst looking at the third picture.

Thanks so much for sharing, Jen. I hope the little girl makes a full recovery.

Well done to all involved in treating this girl!
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