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HISTORY AND EPIDEMIOLOGY

The incidence of snakebites worldwide is difficult to ascertain, as there is no systematic reporting mechanism. This fact, when combined with the variable degree of confirmation of snakebites, makes the estimation of an accurate number extremely difficult. Attempts have been made utilizing available data from case reports in the literature, hospital records, surveys, and existing reporting systems. Current estimates place the worldwide annual incidence of snakebites as high as 5.5 million,13,44 of which roughly 50% are thought to be from venomous snakes.8 Estimated annual complications include 400,000 amputations44 and approximately 100,000 deaths.13,44

Snakes, although feared by many, are popular around the world as pets. The desire to keep venomous snakes as pets, which is typically illegal in the United States, and the financial, clinical and ethical implications throughout the world make the trade of exotic creatures third only in sales to drugs and weapons on the international black market. In fact, the estimated annual worth of this trade in the United States alone is at least $15 million.18

This Special Consideration will discuss the evaluation and management of patients evenomated in the United States by nonnative snakes (also known as exotic snakes). A review from 2005 through 2011 of the National Poison Data System (NPDS), maintained by the American Association of Poison Control Centers (AAPCC), confirmed 258 exotic snakebites reports, of which 218 were identified by genus and species, from a total of 71 different varieties.42 The most common envenomations involved male owners bitten in a private residence during feeding or handling the snakes, cleaning the cages, or while milking the snakes for venom.24,41,42 Of all bites, 82.9% were the result of an Elapidae or Viperidae snakes.42

The previous AAPCC study from 1995 to 2004 documented 399 nonnative exposures, of which 350 snakes (87%) were identified by genus and species, comprising at least 77 different varieties. One US expert reported 54 consultations regarding bites from nonnative venomous snakes.24

In the most recent AAPCC data, the most common family responsible for envenomations was the Viperidae, making up 43% of these bites. Of the Viperidae, 42 different species were identified, with the top 4 species involved being: gaboon viper (Bitis gabonica), bush master (Lachesis mutus), the sharpnosed viper (Deinagkistrodon acutus), and the hognosed viper (Bothrops ophroyomegas). The second most common family responsible for envenomations was the Elapidaes, resulting in 39% of US exotic snakebites. Forty-two percent were from 3 different species: monocellate cobra (Naja naja kaouthia), black necked spitting cobra (Naja nigricollis), and the Black mamba (Dendroaspis polylepis). The monocellate cobra was the most common snake identified during this study (17 envenomations). Of note, 79% of patients were male, the average age was 33 years (7% were 12 years ...

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