Lauren Anderson

Final Article Summary

Tuesday 4pm Biology Lab

Prognostic Factors of Green Pit Viper Bites

Symptoms of the green pit viper bites of the Bangkok, Thailand area
vary between having no symptoms to having fatal bleeding. Antivenin is a
medicine that counteracts the snake venom in these bites. Antivenin does its
job well but there are some difficult side effects, like an allergic reaction.
Different things were studied for predictions of tissue death, infection, and
bleeding from a body system. 271 patients were evaluated in this study. Of
these patients, 46 bled from either their urinary tract, gastrointestinal tract,
or gums, 17 had tissue death, 14 became secondarily infected, and 56 had
an allergic reaction to the antivenom medicine. The signs that predicted
bleeding were a lower count of clotting platelets in the blood aand a
unusually longer clotting time. Bites on toes and/or fingers had a higher
chance of tissue death, whereas other bite sites had higher risk for bleeding
from any of the body systems. Ruptured blisters predicted tissue death and
also secondary infection because the open sore is a portal of entry for
bacteria. The green pit viper venom was tested and doesnt always cause
blood clots so in some cases, the antivenom medicine should not be used,
because it helps with clotting.
As said earlier, 271 patients with green pit viper bites were involved in
this study. Originally, there were 278 but as said by The American Society of
Tropical Medicine and Hygiene in 1998, seven cases were excluded because

they did not show some of the variables stated above. These patients were
bitten and came to the Chulalongkorn Hospital between the years of 1987
and 1995. Some patients were able to bring the suspected snake to the
doctor for identification/verification and others were able to describe the
green pit vipers distinct colored look: a green snake with a red tail. Patients
were determined to be severe if they were bleeding from their internal
systems and moderate if they were taking a long time to clot or had not a
lot of clotting platelets. Severe and moderate patients stayed in the hospital.
If patients did not show these signs, they were considered to be mild and
were taken care of at a clinic, rather than the hospital. Signs and symptoms
usually occurred within 72 hours. If there was no signs or symptoms after 24
hours, patients did not need to receive the antivenom medicine. All these
patients received a skin test where the antivenom medicine was diluted with
saline and injected into the patients skin. If a raised, red bump was still
present after 15 minutes, the patients were considered to be positive to the
risk of an allergic reaction from the antivenom medicine. According to The
American Society of Tropical Medicine and Hygiene in 1998, most cases
with a positive skin test result did not receive antivenin. Swelling was also
an evaluated sign. The seriousness of the swelling was rated on a scale from
0 to 6, meaning no swelling to swelling reaching up to 3 joints or the entire
body. The predicting variables for the bleeding included age, gender, location
of the bite, medicine needed withing 24 hours or not, swelling, black (dead)
skin tissue, tissue death, the number of clotting platelets in the blood, and an

unusually long clotting time. The predicting variables for the allergic reaction
to the antivenin included age, gender, skin test results, and if the medicine
was either pure or diluted.
The average age of the patients was between 15 and 32 years old,
with 159 of the patients being males. According to The American Society of
Tropical Medicine and Hygiene in 1998, all bite sites were on the
extremities, except for one case of a bite on the forehead. 113 patients
were bitten on the fingers and 32 were bitten on the toes. The usual number
on the swelling scale was a 4, meaning the swelling reached up to 2 joints.
140 patients came to the hospital within the first 24 hours of the incident.
Signs and symptoms usually showed up between 27 and 29 hours. There was
serious bleeding of the urinary tract, gastrointestinal tract, or gums in 46 of
the patients. 26 patients had a positive skin test result for the risk of an
allergic reaction and 192 patients were injected with the antivemon
medicine. 56 patients had some type of allergic reaction to the medicine,
usually a rash, and 10 patients actually went into anaphylactic shock or had
bronchospasms. No one died in this study.