anti-venomous sero-therapy
poison control

How to Cite

BOUTROIS, A. ., Bellier , S., Aletti , M., Michel , X., & Lefort , H. (2021). ENVENIMATION. PRISE EN CHARGE D’UNE MORSURE DE VIPÈRE AU RETOUR DU MALI. Mediterranean Journal of Emergency Medicine, (26), 39-43. Retrieved from http://ojs.mjemonline.com/index.php/mjem/article/view/74


We report the case of a 69-year-old man who consulted the emergency department of a French peripheral hospital after seven days of a viper bite in Mali. He had received an anti-venomdose as well as oral metronidazole as antibiotic therapy during initial on-site treatment. He had a large swelling on the left arm with blisters and a wet necrosis appearance around the bite. Hemodynamic parameters were stable, the patient complained of paresthesias and intense pain. No significant biological inflammatory syndrome was found. Doppler ultrasound eliminated deep-vein thrombosis. The poison control center did not recommend a new sero-therapy. Treatment included intravenous antibiotic therapy and local healing in hospitalization with surgical debridement and hyperbaric sessions at the end.

Envenomation is a rare reason for admission to an emergency department in France. Four degrees of severity allow for initial non-prognostic classification. Our clinical case of grade 2 envenomation would provide an update on the emergency care at pre hospital and hospital levels. The viper venom contains components affecting hemostasis. The systemic action must be rapidly limited by anti-venomous serotherapy, preferably in a medical structure, rapidly distancing the prognosis and significantly reducing a pejorative evolution of scarring and function. Antibiotherapy is not routinely recommended, especially if the initial intrafocal wash and debridement measures are well performed. Simple preventive measures should be reminded to people who may be exposed in an occupational or leisure context.



Chippaux JP. Venomous and poisonous animals. II. Viper bites. Med Trop 2006; 66:423-8

Choumet V, Goyffon M. Les morsures de vipères. Le concours 2003; 125:1383-8. Dernier accès en ligne le 10 mars 2017, http://ekladata.com/naturazoom. eklablog.com/perso/Les-morsures-de-viperes.pdf

Aziz H, Rhee P, Pandit V, Tang A, Gries L, Joseph B. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg 2015; 78:641-8.

Lefort H, Zanker C, Fromantin I, Claret PG, Douay B, Ganansia O, et al. Prise en charge des plaies en structure d’urgence. Recommandations de la Société française de médecine d’urgence (SFMU) en partenariat avec la Société française et francophone des plaies et cicatrisations (SFFPC) et la Société française de chirurgie plastique, reconstructrice et esthétique (SOFCPRE) et le soutien de la Société française de pathologie infectieuse de langue française (SPILF) et du Groupe francophone de réanimation et urgences pédiatrisques (GFRUP). Ann Fr Med Urgence 2017; 7:332-50.

Chen E, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian bites. Acad Emerg Med 2000; 7:157-61.

Kerrigan KR, Mertz BL, Nelson SJ, Dye JD. Antibiotic prophylaxis for pit viper envenomation: prospective, controlled trial. World J Surg. 1997; 4:369-73.

Boels D, Hamel JF, Bretaudeau Deguigne M, Harry P. European viper envenomings: Assessment of ViperfavTM and other symptomatic treatments. Clin Toxicol (Phila) 2012; 50:189-96.

Michael GC, Thacher TD, Shehu MIL. The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans R Soc Trop Med Hyg 2011; 105:95-101.

Karaye KM, Mijinyawa MS, Yakasai AM, Kwaghe V, Joseph GA, Iliyasu G, et al.Cardiac and hemodynamic features following snake bite in Nigeria. Int J Cardiol 2012; 156:326-8.

Larréché S, Mion G, Mayet A, Verret C, Puidupin M, Benois A, et al. Antivenin remains effective against African Viperidae bites despite a delayed treatment. Am J Emerg Med 2011; 29:155-61.

Ferquel E, de Haro L, Jan V, Guillemin I, Jourdain S, Teynié A, et al. Reappraisal of Viperaaspis venom neurotoxicity. PLoS One 2007; 21:194.

Chani M, Abouzahir A, Haimeur C, Kamili ND, Mion G. Ischaemic stroke secondary to viper envenomation in Morocco in the absence of adequate antivenom. Ann Fr Anesth Reanim 2012; 31:82-5.

Jollivet V, Hamel JF, de Haro L, Labadie M, Sapori JM, Cordier L, et al. European viper envenomation recorded by French poison control centers: A clinical assessment and management study. Toxicon 2015; 108:97-103.

Anonymous, 2012. Viperfav™, Solution à diluer pour perfusion. Vidal, Paris.

Boels D. Surveillance et prise en charge des morsures de vipères en France métropolitaine. Infobox, bulletin de la société de toxicologie clinique n°44 2014.

Mion G, Larréché S. Quel antivenin pour les envenimations par les vipères du genre Cerastes ? Med Trop 2014; 24:105-6.

Chippaux JP, Massougbodji A, Diouf A, Baldé CM, Boyer LV. Snake bites and antivenom shortage in Africa. Lancet 2015; 386:2252-3.

Hamza M, Idris MA, Maiyaki MB, Lamorde M, Chippaux JP, Warrell DA, et al. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa. PLoS Negl Trop Dis 2016; 30:10.