Težak slučaj trovanja usled ujeda poskoka, Vipera ammodytes, u zimu
Ključne reči:
Srbija, poskok, šok, ekologija zmija, povišene zimske temperature, interdisciplinarnost
Sažetak
Uvod. Ujedi otrovnih zmija u Srbiji nisu ni preterano česti niti naročito opasni. Ipak, neki mogu dovesti do komplikacija.
Prikaz slučaja. Dvadeset četvrtog decembra 2023. u bolnicu je primljen mladić koga je ujela zmija, najverovatnije poskok, Vipera ammodytes. Mladić je bio u stanju šoka, bez svesti, i krvni pritisak mu se nije mogao izmeriti.
Zaključak. Ovde opisani slučaj predstavlja najozbiljniju kliničku manifestaciju nakon ujeda zmije koja je tretirana u Opštoj bolnici Užice i jednu od najozbiljnijih među retkim objavljenim slučajevima ujeda otrovnica u Srbiji. Kako u našoj zemlji jedva da postoje ikakvi podaci vezani za ujede otrovnih zmija, svaki neuobičajen slučaj treba objaviti. Objavljivanje slučaja koji ovde opisujemo još je značajnije jer se desio početkom zime, u periodu kada bi zmije trebalo da budu neaktivne.
Reference
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Bhaumik S, Beri D, Jagnoor J. The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare. J Family Med Prim Care 2022;11:6147–6158. https://doi.org/10.4103/jfmpc.jfmpc_677_22
Boviatsis EJ, Kouyialis AT, Papatheodorou G, Gavra M, Korfias S, Sakas DE. Multiple hemorrhagic brain infarcts after viper envenomation. Am J Trop Med Hyg. 2003;68(2):253–257.
Chippaux J-P. Epidemiology of snakebites in Europe: A systematic review of the literature. Toxicon. 2012;59(1):86–99. https://doi.org/10.1016/j.toxicon.2011.10.008
Chowdhury A, Zdenek CN, Lewin MR, Carter R, Jagar T, Ostanek E, et al. Venom-induced blood disturbances by Palearctic viperid snakes, and their relative neutralization by antivenoms and enzyme-inhibitors. Front Immunol. 2021;12:688802. https://doi.org/10.3389/fimmu.2021.688802
Copernicus Climate Change Service. Accessed January 14, 2024. https://climate.copernicus.eu/copernicus-2023-hottest-year-record.
Curić I, Curić S, Bradarić I, Bubalo P, Bebek-Ivanković H, Nikolić J, et al. Snakebites in Mostar region, Bosnia and Herzegovina. Coll Anthropol. 2009;33(Suppl. 2):93–98.
Cvitanović V, Pocs G. Toksični šok posle ujeda poskoka [Toxic shock after a nose-horned viper bite]. Medicinski Pregled 1980;XXXIII(9-10):407–410. In Bosnian with French abstract
D’Hoore L, Anseeuw K. Preparing for venomous snake bites in Europe. Eur J Emerg Med. 2020;27:247–248. https://doi.org/10.1097/MEJ.0000000000000694
Di Nicola MR, Pontara A, Kass GEN, Kramer NI, Avella I, Pampena R, et al. Vipers of major clinical relevance in Europe: Taxonomy, venom composition, toxicology and clinical management of human bites. Toxicology 2021;453:152724. https://doi.org/10.1016/j.tox.2021.152724
Dobaja Borak М, Babić Ž, Caganova B, Grenc D, Karabuva S, Kolpach Z, et al. Viper envenomation in Central and Southeastern Europe: a multicentre study. Clin Toxicol. 2023;61(9):656–664. https://doi.org/10.1080/15563650.2023.2273761
Đorđević S. The nose-horned viper awakened from under the snow. Ecol Mont. 2015;3:62–63.
Ferraz C, Arrahman A, Xie C, Casewell NR, Lewis RJ, Kool J, et al. Multifunctional toxins snake venoms & therapeutic implications: From pain to hemorrhage and necrosis. Front Ecol Evol. 2019;7:218. https://doi.org/10.3389/fevo.2019.00218
Filipović J, Ostojić-Bakotin V. Ujedi zmija u splitskom gravitacijskom području [Snake bites in the Split area]. Liječnički Vjesnik 1981;103:538–544. In Croatian with English summary
Gopčević K, Karadžić I, Izrael-Živković L, Medić A, Isaković A, Popović M, et al. Study of the venom proteome of Vipera ammodytes ammodytes (Linnaeus, 1758): A qualitative overview, biochemical and biological profiling. Comp Biochem Physiol - D: Genom Proteom. 2021;37:100776. https://doi.org/10.1016/j.cbd.2020.100776
Greene S, Gilbert M, Wolk B, Campleman S, Ruha A-M, et al. Geographic variation in the clinical features of Mohave rattlesnake (Crotalus scutulatus) envenomations reported to the North American Snakebite Registry. Toxicon:X 2024;21:100171. https://doi.org/10.1016/j.toxcx.2023.100171
Gregory-Dwyer VM, Egen NB, Bianchi Bosisio A, Righetti PG, Russell FE. An isoelectric focusing study of seasonal variation in rattlesnake venom proteins. Toxicon 1986;24(10):995–1000. https://doi.org/10.1016/0041-0101(86)90005-x
Gubenšek F, Sket D, Turk V, Lebez D. Fractionation of Vipera ammodytes venom and seasonal variation of its composition. Toxicon 1974;12:167–171. https://doi.org/10.1016/0041-0101(74)90241-4
Gutiérrez JM, Bolon I, Borri J, Ruiz de Castañeda R. Broadening the research landscape in the field of snakebite envenoming: Towards a holistic perspective. Toxicon. 2023;233:107279. https://doi.org/10.1016/j.toxicon.2023.107279
Gutiérrez JM, Calvete J, Habib AG, Harrison RA, Williams D, Warrell DA. Snakebite envenoming. Nat Rev Dis Primers 2017;3:17063. https://doi.org/10.1038/nrdp.2017.63
Kang S, Moon J, Chun B. Does the traditional snakebite severity score correctly classify envenomated patients? Clin Exp Emerg Med. 2016;3(1):34–40. https://doi.org/10.15441/ceem.16.123
Karabuva S, Vrkić I, Brizić I, Ivić I, Lukšić B. Venomous snakebites in children in southern Croatia. Toxicon 2016;112:8–15. https://doi.org/10.1016/j.toxicon.2016.01.057
Kobolkuti L, Cadar D, Czirjak G, Niculae M, Kiss T, Sandru C, et al. The effects of environment and physiological cyclicity on the immune system of Viperinae. Sci World J. 2012:574867. https://doi.org/10.1100/2012/574867
Kurtović T, Karabuva S, Grenc D, Dobaja Borak M, Križaj I, Lukšić B, et al. Intravenous Vipera berus venom-specific fab fragments and intramuscular Vipera ammodytes venom-specific F(ab')2 fragments in Vipera ammodytes-envenomed patients. Toxins 2021;13(4):279. https://doi.org/10.3390/toxins13040279
Lakušić M, Bjelica V, Tomović L. Record size for the Nose-horned viper, Vipera ammodytes (Linnaeus, 1785), from Serbia. Herpetol Notes 2021;14:605–607.
Latifi M. Variation in yield and lethality of venoms from Iranian snakes. Toxicon 1984;22(3):373–380. https://doi.org/10.1016/0041-0101(84)90081-3
Latinović Z, Leonardi A, Šribar J, Sajevic T, Žužek MC, Frangež R, et al. Venomics of Vipera berus berus to explain differences in pathology elicited by Vipera ammodytes ammodytes envenomation: Therapeutic implications. J Proteomics 2016;146:34–47. https://doi.org/10.1016/j.jprot.2016.06.020
Liapis K, Charitaki E. Psaroulaki A. Case report: Spherocytic hemolytic anemia after envenomation by long-nosed viper (Vipera ammodytes). Am J Trop Med Hyg. 2019;101(6): 1442–1445. https://doi.org/10.4269/ajtmh.19-0611
Lukšić B, Bradarić N, Prgomet S. Venomous snakebites in Southern Croatia. Coll Antropol 2006;30(1):191–197.
Malhotra A, Wüster W, Owens JB, Hodges CW, Jesudasan A, Ch G, et al. Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base. Toxicon:X 2021;12:100081. https://doi.org/10.1016/j.toxcx.2021.100081
Marinov I, Atanasov VN, Stankova E, Duhalov D, Petrova S, Hubenova A. Severe coagulopathy after Vipera ammodytes ammodytes snakebite in Bulgaria: A case report. Toxicon 2010;56:1066–1069. https://doi.org/10.1016/j.toxicon.2010.06.010
Martín G, Yáñez-Arenas C, Rangel-Camacho R, Murray KA, Goldstein E, Iwamura T, et al. Implications of global environmental change for the burden of snakebite. Toxicon:X. 2021;9-10:100069. https://doi.org/10.1016/j.toxcx.2021.100069
Milišić D, Aleksić N, Milišić N, Lugonja V. Kritički osvrt na terapijske postupke ujeda zmije [A critical review of snakebite therapeutic procedures]. Vojnosanit Pregl. 1983;40(5):352–354. In Bosnian
Nikolić S. Venomous snakebites in Serbia through 125 years: what we do (not) know in comparison with neighboring countries. A literature review. Acta Med Medianae 2020;59(4):95–103. https://doi.org/10.5633/amm.2020.0413
Nikolić S, Antić M, Pavić A, Ajtić R, Pavić S. Analysis of the venomous snakebite patients treated in the Užice General Hospital (Western Serbia) between 2006 and 2018. Srp Arh Celok Lek. 2021;149(3-4):189–195. https://doi.org/10.2298/SARH200114014N
Nikolić S, Radonjić I, Miloradović Z. What do mountaineers and their guides in Serbia know about venomous snakes? A pilot questionnaire analysis. Turizam 2023;27(1):12–32. https://doi.org/10.5937/turizam27-37069
Nori J, Carrasco PA, Leynaud GC. Venomous snakes and climate change: ophidism as a dynamic problem. Clim Change 2014;122:67–80. https://doi.org/10.1007/s10584-013-1019-6
Paolino G, Di Nicola MR, Pontara A, Didona D, Moliterni E, Mercuri SR, et al. Vipera snakebite in Europe: a systematic review of a neglected disease. J Eur Acad Dermatol Venereol. 2020;34:2247–2260. https://doi.org/10.1111/jdv.16722
Popović N, Baljošević S, Katanić R, Bojović K. Klinička slika bolesti nastale ujedom zmije otrovnice – naša iskustva [Clinical picture of the disease caused by the bite of a venomous snake – our experiences]. Acta Infectologica Yugoslavica 1998;3:109–116. In Serbian
Radonić V, Budimir D, Bradarić N. Envenomation by the horned viper (Vipera ammodytes L.). Mil Med. 1997;162(3):179.
Rhua A, Pizon A. Native (US) venomous snakes and lizards. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR, eds. Goldfrank’s toxicologic emergencies. 10th ed. McGraw-Hill Education; 2015:1537–1546.
RINA, Regional Information News Agency. A phenomenon on Zlatibor, viper invasion in winter: Experienced mountaineers have never seen so many snakes at this time of year [Čudo na Zlatiboru, invazija poskoka used zime: Iskusni planinari nikada nisu videli ovoliki broj zmija u ovo doba godine]. In Serbian. Available at https://www.rina.rs/item/17614-/. Accessed January 10, 2024.
Ruiz de Castañeda R, Bolon I, Gutiérrez JM. A transdisciplinary approach to snakebite envenoming. Toxicon:X 2022;13:100088. https://doi.org/10.1016/j.toxcx.2021.100088
Rugiero L, Milana G, Petrozzi F, Capula M, Luiselli L. Climate-change-related shifts in annual phenology of a temperate snake during the last 20 years. Acta Oecol. 2013;51:42e48. https://doi.org/10.1016/j.actao.2013.05.005
Sadeghi M, Barazandeh M, Zakariaei Z, Davoodi L, Tabaripour R, Fakhar M, et al. Massive cutaneous complications due to snakebite: A case report and literature review. Clin Case Rep. 2021;9:e04129. https://doi.org/10.1002/ccr3.4129
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Bhaumik S, Beri D, Jagnoor J. The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare. J Family Med Prim Care 2022;11:6147–6158. https://doi.org/10.4103/jfmpc.jfmpc_677_22
Boviatsis EJ, Kouyialis AT, Papatheodorou G, Gavra M, Korfias S, Sakas DE. Multiple hemorrhagic brain infarcts after viper envenomation. Am J Trop Med Hyg. 2003;68(2):253–257.
Chippaux J-P. Epidemiology of snakebites in Europe: A systematic review of the literature. Toxicon. 2012;59(1):86–99. https://doi.org/10.1016/j.toxicon.2011.10.008
Chowdhury A, Zdenek CN, Lewin MR, Carter R, Jagar T, Ostanek E, et al. Venom-induced blood disturbances by Palearctic viperid snakes, and their relative neutralization by antivenoms and enzyme-inhibitors. Front Immunol. 2021;12:688802. https://doi.org/10.3389/fimmu.2021.688802
Copernicus Climate Change Service. Accessed January 14, 2024. https://climate.copernicus.eu/copernicus-2023-hottest-year-record.
Curić I, Curić S, Bradarić I, Bubalo P, Bebek-Ivanković H, Nikolić J, et al. Snakebites in Mostar region, Bosnia and Herzegovina. Coll Anthropol. 2009;33(Suppl. 2):93–98.
Cvitanović V, Pocs G. Toksični šok posle ujeda poskoka [Toxic shock after a nose-horned viper bite]. Medicinski Pregled 1980;XXXIII(9-10):407–410. In Bosnian with French abstract
D’Hoore L, Anseeuw K. Preparing for venomous snake bites in Europe. Eur J Emerg Med. 2020;27:247–248. https://doi.org/10.1097/MEJ.0000000000000694
Di Nicola MR, Pontara A, Kass GEN, Kramer NI, Avella I, Pampena R, et al. Vipers of major clinical relevance in Europe: Taxonomy, venom composition, toxicology and clinical management of human bites. Toxicology 2021;453:152724. https://doi.org/10.1016/j.tox.2021.152724
Dobaja Borak М, Babić Ž, Caganova B, Grenc D, Karabuva S, Kolpach Z, et al. Viper envenomation in Central and Southeastern Europe: a multicentre study. Clin Toxicol. 2023;61(9):656–664. https://doi.org/10.1080/15563650.2023.2273761
Đorđević S. The nose-horned viper awakened from under the snow. Ecol Mont. 2015;3:62–63.
Ferraz C, Arrahman A, Xie C, Casewell NR, Lewis RJ, Kool J, et al. Multifunctional toxins snake venoms & therapeutic implications: From pain to hemorrhage and necrosis. Front Ecol Evol. 2019;7:218. https://doi.org/10.3389/fevo.2019.00218
Filipović J, Ostojić-Bakotin V. Ujedi zmija u splitskom gravitacijskom području [Snake bites in the Split area]. Liječnički Vjesnik 1981;103:538–544. In Croatian with English summary
Gopčević K, Karadžić I, Izrael-Živković L, Medić A, Isaković A, Popović M, et al. Study of the venom proteome of Vipera ammodytes ammodytes (Linnaeus, 1758): A qualitative overview, biochemical and biological profiling. Comp Biochem Physiol - D: Genom Proteom. 2021;37:100776. https://doi.org/10.1016/j.cbd.2020.100776
Greene S, Gilbert M, Wolk B, Campleman S, Ruha A-M, et al. Geographic variation in the clinical features of Mohave rattlesnake (Crotalus scutulatus) envenomations reported to the North American Snakebite Registry. Toxicon:X 2024;21:100171. https://doi.org/10.1016/j.toxcx.2023.100171
Gregory-Dwyer VM, Egen NB, Bianchi Bosisio A, Righetti PG, Russell FE. An isoelectric focusing study of seasonal variation in rattlesnake venom proteins. Toxicon 1986;24(10):995–1000. https://doi.org/10.1016/0041-0101(86)90005-x
Gubenšek F, Sket D, Turk V, Lebez D. Fractionation of Vipera ammodytes venom and seasonal variation of its composition. Toxicon 1974;12:167–171. https://doi.org/10.1016/0041-0101(74)90241-4
Gutiérrez JM, Bolon I, Borri J, Ruiz de Castañeda R. Broadening the research landscape in the field of snakebite envenoming: Towards a holistic perspective. Toxicon. 2023;233:107279. https://doi.org/10.1016/j.toxicon.2023.107279
Gutiérrez JM, Calvete J, Habib AG, Harrison RA, Williams D, Warrell DA. Snakebite envenoming. Nat Rev Dis Primers 2017;3:17063. https://doi.org/10.1038/nrdp.2017.63
Kang S, Moon J, Chun B. Does the traditional snakebite severity score correctly classify envenomated patients? Clin Exp Emerg Med. 2016;3(1):34–40. https://doi.org/10.15441/ceem.16.123
Karabuva S, Vrkić I, Brizić I, Ivić I, Lukšić B. Venomous snakebites in children in southern Croatia. Toxicon 2016;112:8–15. https://doi.org/10.1016/j.toxicon.2016.01.057
Kobolkuti L, Cadar D, Czirjak G, Niculae M, Kiss T, Sandru C, et al. The effects of environment and physiological cyclicity on the immune system of Viperinae. Sci World J. 2012:574867. https://doi.org/10.1100/2012/574867
Kurtović T, Karabuva S, Grenc D, Dobaja Borak M, Križaj I, Lukšić B, et al. Intravenous Vipera berus venom-specific fab fragments and intramuscular Vipera ammodytes venom-specific F(ab')2 fragments in Vipera ammodytes-envenomed patients. Toxins 2021;13(4):279. https://doi.org/10.3390/toxins13040279
Lakušić M, Bjelica V, Tomović L. Record size for the Nose-horned viper, Vipera ammodytes (Linnaeus, 1785), from Serbia. Herpetol Notes 2021;14:605–607.
Latifi M. Variation in yield and lethality of venoms from Iranian snakes. Toxicon 1984;22(3):373–380. https://doi.org/10.1016/0041-0101(84)90081-3
Latinović Z, Leonardi A, Šribar J, Sajevic T, Žužek MC, Frangež R, et al. Venomics of Vipera berus berus to explain differences in pathology elicited by Vipera ammodytes ammodytes envenomation: Therapeutic implications. J Proteomics 2016;146:34–47. https://doi.org/10.1016/j.jprot.2016.06.020
Liapis K, Charitaki E. Psaroulaki A. Case report: Spherocytic hemolytic anemia after envenomation by long-nosed viper (Vipera ammodytes). Am J Trop Med Hyg. 2019;101(6): 1442–1445. https://doi.org/10.4269/ajtmh.19-0611
Lukšić B, Bradarić N, Prgomet S. Venomous snakebites in Southern Croatia. Coll Antropol 2006;30(1):191–197.
Malhotra A, Wüster W, Owens JB, Hodges CW, Jesudasan A, Ch G, et al. Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base. Toxicon:X 2021;12:100081. https://doi.org/10.1016/j.toxcx.2021.100081
Marinov I, Atanasov VN, Stankova E, Duhalov D, Petrova S, Hubenova A. Severe coagulopathy after Vipera ammodytes ammodytes snakebite in Bulgaria: A case report. Toxicon 2010;56:1066–1069. https://doi.org/10.1016/j.toxicon.2010.06.010
Martín G, Yáñez-Arenas C, Rangel-Camacho R, Murray KA, Goldstein E, Iwamura T, et al. Implications of global environmental change for the burden of snakebite. Toxicon:X. 2021;9-10:100069. https://doi.org/10.1016/j.toxcx.2021.100069
Milišić D, Aleksić N, Milišić N, Lugonja V. Kritički osvrt na terapijske postupke ujeda zmije [A critical review of snakebite therapeutic procedures]. Vojnosanit Pregl. 1983;40(5):352–354. In Bosnian
Nikolić S. Venomous snakebites in Serbia through 125 years: what we do (not) know in comparison with neighboring countries. A literature review. Acta Med Medianae 2020;59(4):95–103. https://doi.org/10.5633/amm.2020.0413
Nikolić S, Antić M, Pavić A, Ajtić R, Pavić S. Analysis of the venomous snakebite patients treated in the Užice General Hospital (Western Serbia) between 2006 and 2018. Srp Arh Celok Lek. 2021;149(3-4):189–195. https://doi.org/10.2298/SARH200114014N
Nikolić S, Radonjić I, Miloradović Z. What do mountaineers and their guides in Serbia know about venomous snakes? A pilot questionnaire analysis. Turizam 2023;27(1):12–32. https://doi.org/10.5937/turizam27-37069
Nori J, Carrasco PA, Leynaud GC. Venomous snakes and climate change: ophidism as a dynamic problem. Clim Change 2014;122:67–80. https://doi.org/10.1007/s10584-013-1019-6
Paolino G, Di Nicola MR, Pontara A, Didona D, Moliterni E, Mercuri SR, et al. Vipera snakebite in Europe: a systematic review of a neglected disease. J Eur Acad Dermatol Venereol. 2020;34:2247–2260. https://doi.org/10.1111/jdv.16722
Popović N, Baljošević S, Katanić R, Bojović K. Klinička slika bolesti nastale ujedom zmije otrovnice – naša iskustva [Clinical picture of the disease caused by the bite of a venomous snake – our experiences]. Acta Infectologica Yugoslavica 1998;3:109–116. In Serbian
Radonić V, Budimir D, Bradarić N. Envenomation by the horned viper (Vipera ammodytes L.). Mil Med. 1997;162(3):179.
Rhua A, Pizon A. Native (US) venomous snakes and lizards. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR, eds. Goldfrank’s toxicologic emergencies. 10th ed. McGraw-Hill Education; 2015:1537–1546.
RINA, Regional Information News Agency. A phenomenon on Zlatibor, viper invasion in winter: Experienced mountaineers have never seen so many snakes at this time of year [Čudo na Zlatiboru, invazija poskoka used zime: Iskusni planinari nikada nisu videli ovoliki broj zmija u ovo doba godine]. In Serbian. Available at https://www.rina.rs/item/17614-/. Accessed January 10, 2024.
Ruiz de Castañeda R, Bolon I, Gutiérrez JM. A transdisciplinary approach to snakebite envenoming. Toxicon:X 2022;13:100088. https://doi.org/10.1016/j.toxcx.2021.100088
Rugiero L, Milana G, Petrozzi F, Capula M, Luiselli L. Climate-change-related shifts in annual phenology of a temperate snake during the last 20 years. Acta Oecol. 2013;51:42e48. https://doi.org/10.1016/j.actao.2013.05.005
Sadeghi M, Barazandeh M, Zakariaei Z, Davoodi L, Tabaripour R, Fakhar M, et al. Massive cutaneous complications due to snakebite: A case report and literature review. Clin Case Rep. 2021;9:e04129. https://doi.org/10.1002/ccr3.4129
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Objavljeno
2025/11/19
Broj časopisa
Rubrika
Prikaz slučaja / Case report