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Rattlesnake envenomation may lead to a multitude of clinical effects, including a late onset hemorrhage. Laboratory values such as platelets and fibrinogen are commonly used to assess the risk of developing a life-threatening bleed. To date, no specific threshold has been identified that links a lab value to the risk of bleeding. This has led to widespread practice variability among clinicians managing snake bites. In assessing risk for patients, we apply the concept that the more abnormal the lab values are, the higher the risk probably is. Late onset coagulopathies pose a unique clinical challenge because they indicate the potential risk for a life-threatening hemorrhage, yet they have been identified after hospital discharge. There are currently two antivenom (AV) products on the US market to treat rattlesnake envenomations, a Fab product, CroFab® (BTG, UK) and a F (ab')This study intended to characterize the incidence and severity of late coagulopathies reported to a Regional Poison Center (RPC) and hypothesized that late coagulopathies occur at rates higher than previously reported in the literature. Additionally, we sought to compare rates of late coagulopathy between Fab and F (ab')The investigators performed an in-depth review of all suspected snakebite envenomations from 2018 to 2020 that presented to an Arizona healthcare facility in the RPC's catchment area between January 2018 through December of 2020. Patients were excluded from analysis if they did not receive any antivenom, had an incomplete medical record with the APDIC, were diagnosed as something other than a rattlesnake bite or had a known medical history that clouded the diagnosis or assessment of a rattlesnake envenomation.In total, 522 records were reviewed of which 283 patients met the inclusion criteria. There were 149 patients who received Fab AV and 134 who received F (ab')The results from this study suggest the total rate of late onset coagulopathies may be underestimated. Additionally, our results suggest the potential that F (ab')

Snakebite severity corresponds to size of snake because the amount of venom a snake injects is positively associated with snake size. Because fang marks are often present on snakebite patients, we tested whether the relationship between snake length and distance between fang puncture wounds can be generalized for rattlesnakes of genus Crotalus.We measured 2 interfang distances from 79 rattlesnakes of both sexes, 5 species, and varying body length: 1) distance between fang bases in anesthetized snakes, and 2) distance between fang punctures in a membrane-covered beaker bitten defensively.Statistical analyses supported our 2 hypotheses, that 1) body size-related fang divergence during fang protraction (ie, anterolateral movement during fang erection), and 2) the relationship between snake length and interfang distance are similar between the sexes and among different rattlesnake species. We therefore derived a general equation to estimate snake length based on distance between fang marks, and recommended 5 snake size categories: very small (10 mm), small (10-15 mm), medium (15-20 mm), large (20-25 mm), and very large (25 mm).The distance between fang marks on a snakebite patient may be used to estimate the size or size category of the offending snake, which in some cases may have predictive value for overall clinical severity of a given envenomation. Assessing interfang distance from puncture wounds can improve snakebite research and anticipation of snakebite severity.

Artículo 10 páginas, 3 figuras 1 tabla, Understanding the origin and maintenance of phenotypic variation, particularly across a continuous spatial distribution, represents a key challenge in evolutionary biology. For this, animal venoms represent ideal study systems: they are complex, variable, yet easily quantifiable molecular phenotypes with a clear function. Rattlesnakes display tremendous variation in their venom composition, mostly through strongly dichotomous venom strategies, which may even coexist within a single species. Here, through dense, widespread population-level sampling of the Mojave rattlesnake, Crotalus scutulatus, we show that genomic structural variation at multiple loci underlies extreme geographical variation in venom composition, which is maintained despite extensive gene flow. Unexpectedly, neither diet composition nor neutral population structure explain venom variation. Instead, venom divergence is strongly correlated with environmental conditions. Individual toxin genes correlate with distinct environmental factors, suggesting that different selective pressures can act on individual loci independently of their co-expression patterns or genomic proximity. Our results challenge common assumptions about diet composition as the key selective driver of snake venom evolution and emphasize how the interplay between genomic architecture and local-scale spatial heterogeneity in selective pressures may facilitate the retention of adaptive functional polymorphisms across a continuous space., Funding: Leverhulme Trust Grant RPG 2013-315 to WW, Santander Early Career Research Scholarship to GZ, Ministerio de Economía y Competitividad Grant BFU2013-42833-P to JJC.

The original description of Crotalus scutulatus (Chordata: Reptilia: Squamata: Viperidae) was published in 1861 by Robert Kennicott, who did not identify a type specimen or a type locality. We review the history of specimens purported to be the type(s) and various designations of type locality. We provide evidence that ANSP 7069 (formerly one of two specimens of USNM 5027) is the holotype and that the appropriate type locality is Fort Buchanan, near present-day Sonoita, in Santa Cruz County, Arizona.

The rapid and accurate recognition of dangerously venomous snakes following bites is crucial to making appropriate decisions regarding first aid, evacuation, and treatment. Past recommendations for identification of dangerous North American pit vipers have often required subjective determinations of head shape or relied on traits shared with some nondangerous species (elliptical pupils and undivided subcaudal scales). Heat-sensitive facial pits are diagnostic but require close examination of the dangerous head, and cephalic traits are useless when working with a decapitated carcass. Exclusive of cephalic traits, pit vipers north of Mexico can be recognized by the combination of keeled middorsal scales and undivided subcaudal scales. The order of colored rings is usually suggested to identify coral snakes in the United States, yet extension of the colored rings across the ventral scales must be added as an essential identifying factor to ensure elimination of all harmless look-alikes. A novel 3-step flow chart is presented that allows dangerous snakes in the United States and Canada to be recognized quickly and dependably without relying on cephalic traits. This process cannot be used in other countries, however, due to greater variability of these characteristics in snakes from other parts of the world. Finally, close examination of potentially venomous snakes is extraordinarily dangerous and steps to safeguard those making such observations are discussed.

Southern Pacific rattlesnake (Crotalus helleri ) venom is not 1 of the 4 venoms used to produce Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV). There is currently no published clinical experience regarding the efficacy of this new antivenom for confirmed C helleri envenomation, and animal data suggest greatly diminished efficacy. We assessed the efficacy of FabAV for patients with confirmed C helleri envenomation.We conducted a prospective observational study of 23 consecutive rattlesnake envenomations that were treated with FabAV at our center. Patients were excluded if the species of snake could not be confirmed, if FabAV antivenom was not given, or if Antivenin (Crotalidae) polyvalent (equine) was given. We collected serial physical examination and laboratory data over a 24-hour period to serially evaluate the severity score and performed follow-up to evaluate delayed reactions.There were 15 patients who received FabAV and had the species of rattlesnake confirmed (9 C helleri, 4 C scutulatus scutulatus, 1 C mitchellii pyrrhus, 1 C ruber ruber ). C helleri envenomations demonstrated similar improvement in serial snakebite severity scores to those of other species. Three patients treated with scheduled dosing had recurrence of progressive swelling (2 C helleri and 1 C mitchellii pyrrhus ) during the 24-hour study period.We observed similar improvement in FabAV-treated patients with C helleri envenomation compared with those of other species and conclude that this treatment in standard doses appears efficacious for bites by this species. Progressive swelling may recur despite scheduled dosing.

From the Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs Caravati, Fuller, Kanaan, Ray, and Stewart); Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT (Dr Russell); Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Norris); Department of Biological Sciences, California State University, Sacramento, CA (Mr Cardwell); Department of Toxinology, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia (Dr Weinstein); and the East Carolina University Brody School of Medicine, Greenville, NC (Dr Bush).

Mojave rattlesnake (Crotalus scutulatus scutulatus) identification has important diagnostic and therapeutic implications. Envenomation by certain populations of Mojave rattlesnakes may cause a different clinical presentation than that caused by other rattlesnakes. Specifically, Mojave rattlesnake envenomation may cause fewer local effects and more neurologic effects (including respiratory difficulty) than are typically seen after bites from other types of rattlesnake. Thus, it is useful for clinicians to distinguish the Mojave rattlesnake from other rattlesnakes in order to prevent underestimation of severe envenomation because of the lack of local tissue injury. Patients suspected to have been bitten by Mojave rattlesnakes may need more aggressive treatment with antivenin as well as more intensive supportive care. In addition, patients suspected to have been bitten by Mojave rattlesnakes should be closely monitored for an extended observation period, as venom effects may be delayed or prolonged. Mojave rattlesnakes may be particularly difficult to distinguish from Western Diamondback rattlesnakes (Crotalus atrox) because of their similarity in appearance and overlapping ranges. The purpose of this report is to provide clinicians with key characteristics which may assist in distinguishing Mojave rattlesnakes from Western Diamondback and other rattlesnakes.

Mojave toxin (MT) was detected in five of 25 Crotalus helleri (Southern Pacific rattlesnake) sampled using anti-MT antibodies and nucleotide sequence analysis. All of the venoms that were positive for MT were collected from Mt San Jacinto in Riverside Co., California. Since this population is geographically isolated from C. scutulatus scutulatus (Mojave rattlesnake), it is unlikely that this finding is due to recent hybridization. MT concentration differences between C. helleri and C. s. scutulatus reflected the presence of ‘isoforms’ of the toxin in the venom. Whereas C. s. scutulatus generally has several isoforms of the toxin (detected by Western blotting), only one ‘isoform’ that focused at pI 5.1 was detected in C. helleri. Both acidic and basic subunits of MT sequences were obtained from C. helleri DNA with primers specific for MT, but only from snakes that had MT in their venom. The sequence identity of the C. helleri acidic subunit to the C. s. scutulatus subunit was 84.9%, whereas the sequence identity of the C. helleri basic subunit was 97% to the C. s. scutulatus basic subunit. Using casein, fibrin, and hide powder azure as substrates, assays for proteolytic activity suggested that C. helleri possesses several different types of metalloproteinases in their venom. However, proteolytic activity was not detected, or present in reduced amounts, in specimens having MT. Clinical neurotoxicity following envenomation by certain populations of C. helleri may be due to MT.