A 49 y.o. male is bitten on the thumb by a Japanese pit viper

What needs to be done?


Globally there are millions of snake bites annually with 2,000 deaths. The poisonous snakes of North America include cottonmouths, rattlesnakes, coral snakes and copperheads. The tiger rattlesnake near the Arizona-Mexico border has the most potent bite, and the copperhead has the least. Rattlesnakes are known for their hemotoxic properties.  The sea snake, Mohave rattler, coral snake (including Mambas) and cobra family of snakes have venom with predominantly neurotoxic characteristics.

While rattlesnakes have been thought of as containing mainly hemotoxic venom components, there has been a shift to a more neurotoxic venom requiring more antivenom to treat. Only rattlesnakes with more potent neurotoxin will be able to feed on hemotoxic resistant squirrels, mice, and small animals, which gives them an evolutionary advantage.

  Protobothrops elegans,  a Japanese pit viper.

Protobothrops elegans, a Japanese pit viper.

The snake which bit our patient was a Protobothrops elegans, which is from the Ryukyu Islands in Japan, and was the patient’s own snake. The patient was a snake breeder and was accidentally bitten. At the outside hospital, the patient was given Crofab antivenin, which has no effect on Protobothrops elegans. The effects of its venom were mainly local and he was managed with multiple fasciotomies of the hand.  He continues to recover.


  Echis carinatus,  also in the viper familym causes 50% of the snakebite deaths in India.

Echis carinatus, also in the viper familym causes 50% of the snakebite deaths in India.

Trivia fact

The most toxic venom of any snake is the Fierce Snake or inland Taipan.  Its bite contains enough venom to kill 100 people. World wide the saw-scaled viper (carpet viper), cobra, common krait, and Russel’s viper in India are responsible for most of the world’s snakebite fatalities.


Laustsen A, Lomnte B, Lohse B, Fernandez J, et al. Unveiling the nature of black mamba venom through venomics and antivenom immunoprofiling Identification of key toxin targets for antivenom development. Journal of Proteomic 2015. 119:126-142.

Spawls S, Branch B. The dangerous snakes of Africa; natural history, species directory, venoms, an dsnakebite. 1995 Dubai:Oriental Press: Ralph Curtis-Books.  Pp 49-51. ISBN 978-0-88359-029.

So S, Murakami T, Ikeda N, Chijwa T. Identification and evolution of venom phospholipase A2 ingibitors from Protobothrops elegans serum. 2011. Biochemistry and Molecular Biology Regular papers. 2011.  https://doi.org/10,1271.bbb.100676