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Envenoming by Protobothrops mucrosquamatus and Viridovipera stejnegeri accounts for the majority of venomous snakebites in Taiwan. We conducted a retrospective study to systematically examine the clinical manifestations and responses to antivenom therapy after P. mucrosquamatus and V. stejnegeri envenoming. Information on demographic characteristics, treatments, and systemic/local complications were abstracted from medical charts between 1991 and 2006. One hundred forty-nine patients with P. mucrosquamatus envenoming and 51 with V. stejnegeri envenoming were eligible for the final analysis, and they differed in terms of patient age, bite site, local bruising, proportion of patients needing >/= 3 vials of antivenom, and mean hospital stay. Univariate analysis revealed that P. mucrosquamatus envenoming had a higher risk of developing rhabdomyolysis, cellulitis, necrosis, and skin graft. Our findings suggested that P. mucrosquamatus envenoming was associated with a greater risk of severe clinical events, and monitoring for major clinical complications would be recommended.

Ten species of venomous snakes belonging to three families occur in Israel and in Jordan, some of which may pose a serious threat to humans. Specific, local antivenins are available against only two of the species, while against others regional or European preparations are used. It is suggested that in addition to the monospecific anti-Vipera palaestinae, a polyspecific antivenin be prepared against the clinically most important venomous snakes of the region, namely, Echis coloratus, Pseudocerastes fieldi, Cerastes cerastes, Walterinnesia aegyptia, and Atractaspis engaddensis.