Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013–2017

K. Domanski, Kurt C Kleinschmidt, S. Greene, A. M. Ruha, V. Berbata, Nancy S Onisko, S. Campleman, J. Brent, Paul M Wax

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium’s (ToxIC) North American Snakebite Registry (NASBR) Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management. Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7–12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours. Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations. Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.

Original languageEnglish (US)
JournalClinical Toxicology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Agkistrodon
Antivenins
Snake Bites
Toxicology
Registries
Research Personnel
Toxicity
Epidemiology
Bites and Stings
Swelling
Snakes
Crotalus
Water
Colubridae

Keywords

  • antivenins
  • complications of poisoning
  • organ/tissue specific
  • skin
  • snakes
  • Toxinology
  • toxinology

ASJC Scopus subject areas

  • Toxicology

Cite this

Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013–2017. / Domanski, K.; Kleinschmidt, Kurt C; Greene, S.; Ruha, A. M.; Berbata, V.; Onisko, Nancy S; Campleman, S.; Brent, J.; Wax, Paul M.

In: Clinical Toxicology, 01.01.2019.

Research output: Contribution to journalArticle

@article{c6d38cbfc45c4eab8790ca9f0cb91b57,
title = "Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013–2017",
abstract = "Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium’s (ToxIC) North American Snakebite Registry (NASBR) Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management. Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7–12 (39{\%}). Most bites involved the lower extremity (72{\%}). Intentional interaction with the snake occurred in three cases (10{\%}). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19{\%} of patients, and 19{\%} developed coagulopathy. Antivenom treatment was used in 84{\%} of patients. Nineteen patients (61{\%}) required hospital stays of >24 hours. Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations. Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.",
keywords = "antivenins, complications of poisoning, organ/tissue specific, skin, snakes, Toxinology, toxinology",
author = "K. Domanski and Kleinschmidt, {Kurt C} and S. Greene and Ruha, {A. M.} and V. Berbata and Onisko, {Nancy S} and S. Campleman and J. Brent and Wax, {Paul M}",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/15563650.2019.1627367",
language = "English (US)",
journal = "Clinical Toxicology",
issn = "1556-3650",
publisher = "Dekker",

}

TY - JOUR

T1 - Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013–2017

AU - Domanski, K.

AU - Kleinschmidt, Kurt C

AU - Greene, S.

AU - Ruha, A. M.

AU - Berbata, V.

AU - Onisko, Nancy S

AU - Campleman, S.

AU - Brent, J.

AU - Wax, Paul M

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium’s (ToxIC) North American Snakebite Registry (NASBR) Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management. Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7–12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours. Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations. Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.

AB - Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium’s (ToxIC) North American Snakebite Registry (NASBR) Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management. Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7–12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours. Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations. Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.

KW - antivenins

KW - complications of poisoning

KW - organ/tissue specific

KW - skin

KW - snakes

KW - Toxinology

KW - toxinology

UR - http://www.scopus.com/inward/record.url?scp=85067695356&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067695356&partnerID=8YFLogxK

U2 - 10.1080/15563650.2019.1627367

DO - 10.1080/15563650.2019.1627367

M3 - Article

C2 - 31190571

AN - SCOPUS:85067695356

JO - Clinical Toxicology

JF - Clinical Toxicology

SN - 1556-3650

ER -