Dendroaspis viridis bite - West African Green Mamba

[Chip Cochran]

I echo the well wishes on the speedy recovery and thank you for such a well written account of the ordeal.

Thanks again,

Chip

[Pelamis]

Hi Sico

From all the members of the West Rand Herpetological Association (WRHA), we would like to wish you a speedy recovery and to get well soon.

Thanks for sharing your experience with us.

Vice Chairperson - WRHA

[froot]

Sico you can pat yourself on the back, you did not panic, you were proactive in the sense that you gained a wealth of knowledge about bite treatment and brought literature with you and with this you assisted the medical staff tremendously. You played a pivotal role in surviving a very serious bite practically unscathed. Then to top it off you gave us a comprehensive account of your experience.

We have learned invaluable information from this, I am truly impressed. Thank you.

[Sico]

Again thanks for the wishes. I arrived back in SA at 10h00 this morning and have been through a battery of blood tests etc, which hopefully I should have the results tomorrow.
Yesterday morning 24hours after the bite, I did a urinalysis and there was a significant amount of urobilinogen and billirubin showing in my urine, which is indicative of haemolysis (the breaking down of blood cells). This appears to have cleared up today so hopefully that’s the last of that. So far my kidney function seems to be normal and other than a little tenderness around the bite wound and a nagging headache (which is pretty normal for me anyway so not sure of the significance of that) I feel fine, although strenuous activity does tire me out faster than normal and my pulse rate has not been less than 95/min since I was bitten. Normally my resting pulse is around 60-64/min and even waking up from sleep it is still sitting at around 98/min.
Below are some pics, the first two of the snake that bit me, apologies for them being not the best quality but I had other things on my mind when I was taking them and quite a tremor going at the time … as you can see, it is still relatively tiny, I’d estimate the head size to be not bigger than the end of my pinky finger, although it had a huge gape.


The bite site +1 hour. The single fang mark is quite clear roughly in the centre of the reddened area, which is the area that I got the goose bumps initially. This reddened area was quite a bit more sensitive than the rest of my skin, and would become extremely tender over the next day. It never raised higher than the surrounding skin though.

The bite site +24 hours. Not really much change visually although as I said it was a lot more sensitive to pressure feeling badly bruised.

At the moment the reddened area has all but vanished other than the faintest ring demarcating where the edge was. The area immediately around the fang mark has turned slightly brown-grey like, a bruise for about 6mm in diameter. It is still a bit tender to pressure but seems better. My sublingual glands are still slightly inflamed and tender, but other than what I mentioned above about being easily fatigued I feel fine.
I will put up the blood results if there is anything worth putting up as well as a timeline of the onset and resolution of symptoms for your info. This incident has created quite a sh!t storm up on the site, with the powers that be now investigating the whole matter. Obviously there is some upset about the fact that I am handling snakes without a “professional certification”, as well as why I was not using all the protective equipment and the appropriate snake catching instruments. I am the first to agree that not having hand protection on was negligent on my part – my 1st mistake – regardless I was not bitten anywhere near my hand, so wearing those would have not likely resulted in a different outcome in this instance. I have explained to them that the 1.2m grab stick and 1.5m hook stick would have been rather difficult to use on such a small snake, underneath a 6m container sitting 20cm off the ground on concrete blocks with the snake stuck up between the top of the concrete block and the base of the container, but somewhere this argument falls on deaf ears. I’ll worry about that when I get back to work though. I guess it’s another case of people being quite happy for you to deal with the problem (like the 15-odd venomous snakes I have already removed without incident off the site) until something occurs then it’s all your fault and you need to be taken to task. Ah well… such is the attitude of the ignorant.

[hotherps]

Wishing you a speedy recovery. I know of several people who received bites from Dendroapis angusticeps during 2009.... never a good situation to be in.

[Sico]

Most of the blood tests have returned, with the only significant results being that my Haemoglobin was 3 points lower than my baseline reading earlier this year, and my platelet count quite a bit higher than the earlier baseline. Tying in with the billirubin/urobilinogen in my earlier urinalysis, this is evidence that somewhere there was quite a bit of heamolysis going on. Whether this is due to some component of the venom, or if it is as a result of the antivenom reaction we aren’t sure, but it did happen, although it seems to be resolving itself without further problems. The small bruise around the bite hasn’t changed much, but it is still tender. Yesterday I went for a 12-lead ECG, as my pulse rate was still fairly high and somewhat irregular, the ECG showed no abnormalities, but my diastolic blood pressure is quite high (142/104mmHg). For those of you that don’t know, blood pressure is measured with a systolic pressure (x) and a diastolic pressure (y) to give you a reading of x/y mmHg. Very basically, the systolic pressure is the pressure measured when your left ventricle contracts and ejects blood from the heart, and the diastolic pressure is the pressure measured when the heart is relaxed and refilling, in other words the “residual” pressure in your vascular system. The systolic has a wide acceptable range and changes continuously from person to person, minute to minute, activity to activity, but generally we like to see it in healthy adults sitting between 110-130mmHg. It can peak quite highly in times of stress, whether this be physical (exertion), or emotional, and high, short-term peaks are easily tolerated by the body. The diastolic should preferably be around 70-80mmHg (+-10), but readings above 90-95mmHg are not generally healthy, especially for protracted periods, as this indicates that the resting pressure of your vascular walls is high and this can lead to numerous long term complications. Readings above 100mmHg are serious cause for concern… The various doctors involved in my case think that I have developed a vasculitis (in laymans terms – inflammation of the vascular system), most likely due to the antivenom reaction as opposed to the actual venom itself. This may explain why I am so easily fatigued, as well as why my BP is high. I am quite surprised at the cardiogenic effects of this whole episode, from the time I received the bite, as knowing that the Mamba complex do have a cardiotoxic component to their venom, I would have assumed it would have had more of a depressant effect, thus causing blood pressure to drop, and pulse rate to decrease, but in my case in particular I have not seen any evidence of this, in fact only the opposite. I do know that dendrotoxin in particular is used in cell research for its specific effect on the sodium potassium pump (I’m not going to go into a full physiology lecture here ) but I am assuming that untreated this effect would have become more apparent. There is some evidence from in vivo testing that the mamba venoms do affect the vagus nerve, which is responsible for slowing everything down, and that may explain why things are higher and faster as opposed to being lower and slower. I’m going for round two of the blood tests today, I’ll post results once they come in.

[Wolf777]

Woah glad you are still with us, and all that from a such a small snake. I don't want to get bitten by anything venomous, imagine what a really angry 3m+ D. polylepis can do...

[Bushbaby]

Thanks for posting and I am VERY glad that you recovered so well / quickly after the bite.

Be careful out there!!

[Sico]

So far all the test results have come back normal. My blood pressure is still a little on the high side though, and my heart rate is coming down, although it’s a bit of a roller coaster, going up and down all the time. 7 days after the bite there is a tiny slightly raised bump at the site of the fang mark but the bruising and tenderness has gone completely.
The Docs are now waiting to see if any serum sickness develops, as it has been known to take up to three weeks from the time of administration of the antivenom. Dr Blaylock was also consulted at some point during this last week, and he is of the impression that the antivenom would have been infective as they do not use D viridis venom in making the antivenom, only the other three mambas (D. polylepis, D. angusticeps and D. jamesonii), and that the symptoms resolved coincidentally. I do however doubt this was the case, as with my experience in medicine, patients do not develop such significant symptoms within a short space of time, and just “spontaneously” recover over the course of half an hour or so, and none of the other medications I was given would have had that effect. Surely the mamba venoms are similar enough that 3/4 components covers 4/4 types? Looks like this one might stir up some debate and maybe some further investigation. Hopefully something good comes of it! I’ll keep you posted as to further happenings.

[Bushviper]

It is fairly common knowledge that antivenoms can be used on species that are not in the donor pool of snakes.

A typical example is CroFab antivenom in the US. The US food and drug administration tested the serum. It is made from the follwoing species :Crotalus atrox (Western Diamondback rattlesnake), Crotalus adamanteus (Eastern Diamondback rattlesnake), Crotalus scutulatus (Mojave rattlesnake), and Agkistrodon piscivorus (Cottonmouth or Water Moccasin). It was tested on :C. atrox, C. adamanteus, C. scutulatus, A. piscivorus and also C. h. atricaudatus, C. v. helleri, C. m. molossus, A. c. contortrix, S. m. barbouri and C. h. horridus and was effective on all of them.

[Sico]

Right... a little over a month since I have been bitten, my BP is still sitting abnormally high, around 160/110mmHg. I have now been put onto anti-hypertensive medication for the next 12 months to see if that will bring it back down to a more reasonable level. I am not sure whether this is a direct result of the components of the venom or antivenom, and nobody else seems to be too sure either, but I had several serious medicals for work earlier this year, prior to the bite and I passed all of them without any problems whatsoever, so it seems a little bit more than coincidence that I should have hypertension now, and at my age (33). Did some more blood tests at the doc when he put me on the meds, and I should get the results tomorrow, it will be interesting to see if anything has changed over the last month.

[MrG]

Your experience was something we all can learn from. Luckly the proffesionalism and knowledge was there to pull you through. It will be interesting to see how your body react to any venom exposure( touch, breath etc). Please keep us up to date.