SNAKEBITE BY THE BUSHMASTER (LACHESIS-MUTA) IN BRAZIL - CASE-REPORT AND REVIEW OF THE LITERATURE

The bushmaster (Lachesis muta) of Central and South America, the world 's longest pit viper, is capable of injecting a large dose of potent v enom when it bites. A 28-year-old man, bitten by a 1.82 m long L. m. m uta in Brazil, developed pain and oedema at the bite site, nausea, vom iting, diarrhoea and sweating. There was peripheral neutrophil leucocy tosis and evidence of fibrinogen consumption with secondary activation of the fibrinolytic system. Two hours after the bite, eight ampoules of Institute Butantan Lachesis antivenom was administered, and haemost asis was normal 24 hr later. A review of reports of 20 cases of bites in humans reliably attributed to this snake in Costa Rica, French Guia na, Brazil, Colombia and Venezuela confirms a syndrome of nausea, vomi ting, abdominal colic, diarrhoea, sweating, hypotension, bradycardia a nd shock, possibly autopharmacological or autonomic in origin, not see n in victims of other American crotaline snakes. These, and other symp toms of bushmaster envenoming, art explained by haemorrhagic, coagulan t and neurotoxic venom activities. The therapeutic efficacy of non-spe cific Bothrops/Crotalus polyvalent antivenoms in these cases has been unimpressive. For the treatment of bites by a snake which potentially injects a large dose (> 300 mg dry weight) of venom with a range of li fe-threatening activities, there is an urgent need to develop more pot ent specific antivenoms and to treat the dramatic and life-threatening cardiovascular symptoms. (C) 1997 Elsevier Science Ltd.