Systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (Hypnale hypnale) envenoming: A case report from Sri Lanka
Out of seven venomous land snake species of Sri Lanka, hump-nosed pit viper (Hypnale spp.) causes the commonest venomous snakebites. It is widely distributed all over the country except in the peninsula of Jaffna. The genus has three species naming H. hypnale, H. zara and H. nepa. They frequently ca...
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Veröffentlicht in: | Toxicon (Oxford) 2019-12, Vol.170, p.21-28 |
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creator | Rathnayaka, R.M.M.K. Namal Ranathunga, P.E.A.Nishanthi Kularatne, S.A.M. |
description | Out of seven venomous land snake species of Sri Lanka, hump-nosed pit viper (Hypnale spp.) causes the commonest venomous snakebites. It is widely distributed all over the country except in the peninsula of Jaffna. The genus has three species naming H. hypnale, H. zara and H. nepa. They frequently cause local envenoming and rarely cause coagulopathy and acute kidney injury. Systemic bleeding is the most trivial complication associated with coagulopathy caused by these snakes and pulmonary haemorrhages are one of them which are rarely reported. Antivenoms are currently not available for genus Hypnale bites in Sri Lanka. We describe a fatal case of pulmonary haemorrhage caused by a proven hump-nosed viper (Hypnale hypnale) bite associated with other systemic bleeding manifestations and thrombotic microangiopathy. This is the first known case of pulmonary and intracranial haemorrhages caused by hump-nosed viper bite.
•Systemic bleeding following hump-nosed viper (H.hypnale) bite is described.•Pulmonary haemorrhage is the most trivial manifestation.•Unavailability of antivenoms for these bites in Sri Lanka is highlighted.•Complex nature of Hypnale venom is clinically explained. |
doi_str_mv | 10.1016/j.toxicon.2019.09.009 |
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•Systemic bleeding following hump-nosed viper (H.hypnale) bite is described.•Pulmonary haemorrhage is the most trivial manifestation.•Unavailability of antivenoms for these bites in Sri Lanka is highlighted.•Complex nature of Hypnale venom is clinically explained.</description><identifier>ISSN: 0041-0101</identifier><identifier>EISSN: 1879-3150</identifier><identifier>DOI: 10.1016/j.toxicon.2019.09.009</identifier><identifier>PMID: 31513811</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Animals ; Crotalid Venoms - poisoning ; Crotalinae ; Fatal Outcome ; Hemorrhage - etiology ; Humans ; Hump-nosed viper ; Hypnale hypnale ; Lung Diseases - etiology ; Male ; Pulmonary haemorrhage ; Snake Bites - complications ; Snakebites ; Sri Lanka ; Systemic bleeding ; Thrombotic microangiopathy</subject><ispartof>Toxicon (Oxford), 2019-12, Vol.170, p.21-28</ispartof><rights>2019 Elsevier Ltd</rights><rights>Copyright © 2019 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-f7ebf24f942c1a802bed03c78f537d4dffc5e21de568f5bc10edf5352b04520f3</citedby><cites>FETCH-LOGICAL-c365t-f7ebf24f942c1a802bed03c78f537d4dffc5e21de568f5bc10edf5352b04520f3</cites><orcidid>0000-0002-2628-7383</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.toxicon.2019.09.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31513811$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rathnayaka, R.M.M.K. Namal</creatorcontrib><creatorcontrib>Ranathunga, P.E.A.Nishanthi</creatorcontrib><creatorcontrib>Kularatne, S.A.M.</creatorcontrib><title>Systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (Hypnale hypnale) envenoming: A case report from Sri Lanka</title><title>Toxicon (Oxford)</title><addtitle>Toxicon</addtitle><description>Out of seven venomous land snake species of Sri Lanka, hump-nosed pit viper (Hypnale spp.) causes the commonest venomous snakebites. It is widely distributed all over the country except in the peninsula of Jaffna. The genus has three species naming H. hypnale, H. zara and H. nepa. They frequently cause local envenoming and rarely cause coagulopathy and acute kidney injury. Systemic bleeding is the most trivial complication associated with coagulopathy caused by these snakes and pulmonary haemorrhages are one of them which are rarely reported. Antivenoms are currently not available for genus Hypnale bites in Sri Lanka. We describe a fatal case of pulmonary haemorrhage caused by a proven hump-nosed viper (Hypnale hypnale) bite associated with other systemic bleeding manifestations and thrombotic microangiopathy. This is the first known case of pulmonary and intracranial haemorrhages caused by hump-nosed viper bite.
•Systemic bleeding following hump-nosed viper (H.hypnale) bite is described.•Pulmonary haemorrhage is the most trivial manifestation.•Unavailability of antivenoms for these bites in Sri Lanka is highlighted.•Complex nature of Hypnale venom is clinically explained.</description><subject>Aged</subject><subject>Animals</subject><subject>Crotalid Venoms - poisoning</subject><subject>Crotalinae</subject><subject>Fatal Outcome</subject><subject>Hemorrhage - etiology</subject><subject>Humans</subject><subject>Hump-nosed viper</subject><subject>Hypnale hypnale</subject><subject>Lung Diseases - etiology</subject><subject>Male</subject><subject>Pulmonary haemorrhage</subject><subject>Snake Bites - complications</subject><subject>Snakebites</subject><subject>Sri Lanka</subject><subject>Systemic bleeding</subject><subject>Thrombotic microangiopathy</subject><issn>0041-0101</issn><issn>1879-3150</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9uEzEQxi0EoqHwCCAfy2HD2Lub7HJBVUUpUiQOhbPltceNg_8s9m4gz8BL1yGBK9JIY_n7fR55PkJeM1gyYKt3u-UUf1kVw5ID65dQCvonZMG6dV_VrIWnZAHQsAoKfkFe5LwDgLrrV8_JRdFZ3TG2IL_vD3lCbxUdHKK24YHaoNz85zTOzscg04FuJfqY0lY-IDXRufjzqG9nP1YhZtR0tBPd2xETvbo7jEE6pNtTf0sx7DFEXxzv6TVVMiNNOMY0UZOip_fJ0o0M3-VL8sxIl_HVuV-Sb7cfv97cVZsvnz7fXG8qVa_aqTJrHAxvTN9wxWQHfEANtVp3pq3XutHGqBY509iuytWgGKAuUssHaFoOpr4kV6d3xxR_zJgn4W1W6JwMGOcsOO-hh65uuoK2J1SlmHNCI8ZkfdmIYCCOOYidOOcgjjkIKAV98b05j5gHj_qf6-_iC_DhBGD56N5iEllZDKpEkFBNQkf7nxGPniCfmg</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Rathnayaka, R.M.M.K. Namal</creator><creator>Ranathunga, P.E.A.Nishanthi</creator><creator>Kularatne, S.A.M.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2628-7383</orcidid></search><sort><creationdate>201912</creationdate><title>Systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (Hypnale hypnale) envenoming: A case report from Sri Lanka</title><author>Rathnayaka, R.M.M.K. Namal ; Ranathunga, P.E.A.Nishanthi ; Kularatne, S.A.M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-f7ebf24f942c1a802bed03c78f537d4dffc5e21de568f5bc10edf5352b04520f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Animals</topic><topic>Crotalid Venoms - poisoning</topic><topic>Crotalinae</topic><topic>Fatal Outcome</topic><topic>Hemorrhage - etiology</topic><topic>Humans</topic><topic>Hump-nosed viper</topic><topic>Hypnale hypnale</topic><topic>Lung Diseases - etiology</topic><topic>Male</topic><topic>Pulmonary haemorrhage</topic><topic>Snake Bites - complications</topic><topic>Snakebites</topic><topic>Sri Lanka</topic><topic>Systemic bleeding</topic><topic>Thrombotic microangiopathy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rathnayaka, R.M.M.K. Namal</creatorcontrib><creatorcontrib>Ranathunga, P.E.A.Nishanthi</creatorcontrib><creatorcontrib>Kularatne, S.A.M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Toxicon (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rathnayaka, R.M.M.K. Namal</au><au>Ranathunga, P.E.A.Nishanthi</au><au>Kularatne, S.A.M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (Hypnale hypnale) envenoming: A case report from Sri Lanka</atitle><jtitle>Toxicon (Oxford)</jtitle><addtitle>Toxicon</addtitle><date>2019-12</date><risdate>2019</risdate><volume>170</volume><spage>21</spage><epage>28</epage><pages>21-28</pages><issn>0041-0101</issn><eissn>1879-3150</eissn><abstract>Out of seven venomous land snake species of Sri Lanka, hump-nosed pit viper (Hypnale spp.) causes the commonest venomous snakebites. It is widely distributed all over the country except in the peninsula of Jaffna. The genus has three species naming H. hypnale, H. zara and H. nepa. They frequently cause local envenoming and rarely cause coagulopathy and acute kidney injury. Systemic bleeding is the most trivial complication associated with coagulopathy caused by these snakes and pulmonary haemorrhages are one of them which are rarely reported. Antivenoms are currently not available for genus Hypnale bites in Sri Lanka. We describe a fatal case of pulmonary haemorrhage caused by a proven hump-nosed viper (Hypnale hypnale) bite associated with other systemic bleeding manifestations and thrombotic microangiopathy. This is the first known case of pulmonary and intracranial haemorrhages caused by hump-nosed viper bite.
•Systemic bleeding following hump-nosed viper (H.hypnale) bite is described.•Pulmonary haemorrhage is the most trivial manifestation.•Unavailability of antivenoms for these bites in Sri Lanka is highlighted.•Complex nature of Hypnale venom is clinically explained.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>31513811</pmid><doi>10.1016/j.toxicon.2019.09.009</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2628-7383</orcidid></addata></record> |
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subjects | Aged Animals Crotalid Venoms - poisoning Crotalinae Fatal Outcome Hemorrhage - etiology Humans Hump-nosed viper Hypnale hypnale Lung Diseases - etiology Male Pulmonary haemorrhage Snake Bites - complications Snakebites Sri Lanka Systemic bleeding Thrombotic microangiopathy |
title | Systemic bleeding including pulmonary haemorrhage following hump-nosed pit viper (Hypnale hypnale) envenoming: A case report from Sri Lanka |
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