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A review of bites by non-front-fanged snakes (NFFS) of Europe.

Toxicon

November 2024

Institute for Insect Biotechnology, Justus Liebig University of Giessen, Heinrich-Buff Ring 26-32, 35392, Giessen, Germany; Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology, Ohlebergsweg 12, 35392, Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics, Senckenberganlage 25, 60325, Frankfurt, Germany.

Article Synopsis
  • Non-front-fanged snakes (NFFS) have been largely neglected in snake venom research, leading to unclear assessments of their medical significance for human bites.
  • The review focuses on European NFFS, highlighting that while most bites cause mild symptoms, the genus Malpolon can result in more severe local and systemic effects.
  • It emphasizes the importance of professional medical evaluation for any bite from these snakes to ensure safety and aid in understanding their potential risks.
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Snakebite is a neglected tropical disease and a globally important driver of death and morbidity. Vipers of the genus (Viperidae: Viperinae) are among the snakes of higher medical importance in the Old World. Despite the medical relevance of venoms, the knowledge regarding them is heterogeneously distributed with virtually all works conducted so far focusing on subspecies of , while other species within the genus are largely overlooked.

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Snake envenomation leads to significant morbidity and mortality with local, hematological, renal, and neurological complications. Hemotoxic envenomation activates a hemorrhagic cascade, leading to many manifestations ranging from skin bleeds to major organ bleeds and fatal intracranial hemorrhage. Although rare, ischemic manifestations are possible following a hemotoxic envenomation, and they may present as cortical blindness, an unusual ocular symptom.

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Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment.

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Respiratory and airway-protective muscle weakness caused by the blockade of neuromuscular transmission is a major cause of early mortality from snakebite envenoming (SBE). Once weakness is manifest, antivenom appears to be of limited effectiveness in improving neuromuscular function. Herein, we review the topic of venom-induced neuromuscular blockade and consider the utility of adopting clinical management methods originally developed for the safe use of neuromuscular blocking agents by anesthesiologists in operating rooms and critical care units.

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