Man Dies From Rare Blood-Vessels Leak After Russell's Viper Bite

A man in India has died after snake venom caused his blood vessels to leak, even following treatment with 30 bottles of antivenom.

The 40-year-old male patient was rushed to Midnapore Medical College and Hospital in West Bengal after being bitten by a Russell's viper on his foot, a BMJ case study reported. He was quickly treated with 10 vials of antivenom, but the swelling continued and doctors administered 20 more.

The next day, the patient developed capillary leak syndrome, an illness characterized by painful parotid swelling on both sides of his face. CLS is a rare disorder where blood vessels leak plasma into other muscles and cavities in the body.

The Russell's viper is one of the most dangerous snakes in Asia and one of the most common snakes to inflict bites in India. The venom from a Russell's viper usually causes cardiovascular complications, hemostatic abnormalities, renal failure and other effects, according to the case study. Those bitten by the viper usually need between 10 and 25 bottles of antivenom.

CLS is a common side effect of a Russell's viper bite, but it does not usually occur after anti-venom treatment. "It's a very well-known problem that's associated with envenomation," Kartik Sunagar, a venom expert at Bangalore's Evolutionary Venomics Lab, told Newsweek.

"[The doctors] are not insinuating that it's antivenom that's caused it. Of course, it's the venom itself that has caused [the CSL]. But a lot of the underlying effects of a lot of these toxicities [in snake venom] are not very clear," Sunagar said.

For two more days, the patient continued to deteriorate, displaying signs of renal failure and haematuria. He died on the fourth day after the snakebite. Doctors determined in the study that CSL is an under-recognized complication following Russell's viper envenomation.

Timely administration of antivenom usually saves the lives of those bitten by highly venomous snakes. But doctors concluded from this incident that under-recorded side effects of snake venom, such as CSL, can still be fatal.

The doctors said that "CLS may develop even after adequate doses of [anti-snake venom] administration" and that this comes with a very high mortality rate of over 50 percent.

"We seek to highlight bilateral parotid swelling as a rare and poor prognostic sign in viper snake bite," the case study said. "However, more research is needed to delineate the pathophysiology and to establish this as a prognostic indicator of viper bite."

About 5 million snakebites occur in India each year, according to the World Health Organization, and are responsible for between 81,000 and 138,000 deaths. Snakes are a particular problem in rural areas, as people do not have fast access to antivenom.

But a lack of access to antivenom is not the only reason so many deaths occur each year. In India, many people still practice herbal or traditional remedies for snakebites. And these can be extremely dangerous.

"Snakebite education is really important. There is no doubt about it," said Sunagar. "[But] if you actually go to India and see how some of these farmers work...no matter how much of education you provide them, they're not going to follow some of the practices. They're not going to change some of the traditional practices, because it's just an inconvenience."