Vipera berus bites in Eastern Poland – a retrospective analysis of 15 case studies
More details
Hide details
Student Scientific Group at the Department of the Infectious Diseases and Neuroinfections, Medical University, Bialystok, Poland
Department of the Infectious Diseases and Neuroinfections, Medical University, Bialystok, Poland
Corresponding author
Adam Garkowski   

Student Scientific Group at the Department of the Infectious Diseases and Neuroinfections, Medical University, Bialystok, Poland
Ann Agric Environ Med. 2012;19(4):793-797
Introduction and objective:
The common European adder (Vipera berus) is the only venomous snake that is found naturally in Poland. This study presents the epidemiological and clinical characteristics of V.berus bites in Eastern Poland and describes the methods of poisoning treatment.

Material and Methods:
Medical documentation of 15 patients hospitalized at the Department of Infectious Diseases and Neuroinfections of the Medical University of Bialystok between 1998-2010 because of V.berus bite was analyzed retrospectively.

Most of the snakebites were accidental (86.7% of the cases). The bites usually took place in forests (66.7% of the cases). The majority of patients were bitten in the lower extremity (8 cases, 53.3%), most often in the area of ankle joint. The severity of poisoning was usually minor to moderate. The most common local symptom was oedema (93.3% of the cases) and associated extravasations (73.3% of the cases). One patient experienced shock. Transient hypertension was observed in 3 cases. Mild coagulation disorders were present in 4 cases. In 4 cases, leukocytosis was observed. 86.7% of patients received the specific antivenom. No fatal outcome and no adverse reactions after antivenom administration were reported.

In the majority cases of poisoning with V.berus venom, the poisoning takes a mild course, limited to local oedema, but sometimes it may lead to severe complications. The only specific method of the treatment is antivenom administration.

Williams D, Gutiérrez JM, Harrison R, Warrell DA, White J, Winkel KD, et al. The Global Snake Bite Initiative: an antidote for snake bite. Lancet 2010; 375(9708): 89-91.
Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ 1998; 76(5): 515-24.
Reading CJ. Incidence, pathology, and treatment of adder (Vipera berus L.) bites in man. J Accid Emerg Med. 1996; 13(5): 346-351.
Warrell DA. Snake bite. Lancet 2010; 375(9708): 77-88.
Calderón L, Lomonte B, Gutiérrez JM, Tarkowski A, Hanson LA. Biological and biochemical activities of Vipera berus (European viper) venom. Toxicon. 1993; 31(6): 743-753.
Karlson-Stiber C, Salmonson H, Persson H. A nationwide study of Vipera berus bites during one year-epidemiology and morbidity of 231 cases. Clin Toxicol. 2006; 44(1): 25-30.
Reid HA. Adder bites in Britain. Br Med J. 1976; 17(2): 153-156.
Magdalan J, Trocha M, Merwid-Lad A, Sozański T, Zawadzki M. Vipera berus bites in the Region of Southwest Poland – a clinical analysis of 26 cases. Wilderness Environ Med. 2010; 21(2): 114-119.
Kępa L, Oczko-Grzesik B, Stolarz W. Przypadki ukąszeń ludzi przez żmije – obserwacje z terenu Śląska w latach 1999-2003. Prz Epidemiol. 2004; 58(1): 219-226.
Malina T, Krecsák L, Jelić D, Maretić T, Tóth T, Siśko M, et al. First clinical experiences about the neurotoxic envenomings inflicted by lowland populations of the Balkan adder, Vipera berus bosniensis. Neurotoxicology 2011; 32(1): 68-74.
Grönlund J, Vuori A, Nieminen S. Adder bites. A report of 68 cases. Scand J Surg. 2003; 92(2): 171-174.
Warrell DA. Treatment of bites by adders and exotic venomous snakes. BMJ 2005; 331(7527): 1244-1247.
DJ Harborne. Emergency treatment of adder bites: case reports and literature review. Arch Emerg Med. 1993; 10(3): 239-243.
Trybus M, Chmiel A, Wierzbicka-Chmiel J. The general anaphylactic and local reaction after the Vipera berus’s bite – case report. Pol Merkur Lek. 2007; 22(129): 218-220.
Luksić B, Bradarić N, Prgomet S. Venomous snakebites in southern Croatia. Coll Antropol. 2006; 30(1): 191-197.
Westerström A, Petrov B, Tzankov N. Envenoming following bites by the Balkan adder Vipera berus bosniensis – first documented case series from Bulgaria. Toxicon. 2010; 56(8): 1510-1515.
Malina T, Krecsak L, Warrell DA. Neurotoxicity and hypertension following European adder (Vipera berus berus) bites in Hungary: case report and review. QJM 2008; 101(10): 801-806.
Moore RS. Second-degree heart block associated with envenomation by Vipera berus. Arch Emerg Med. 1988; 5(2): 116-118.
Petite J. Viper bites: treat or ignore? Review of a series of 99 patients bitten by Vipera aspis in an alpine Swiss area. Swiss Med Wkly. 2005; 135(41-42): 618-625.
Karlson-Stiber C, Persson H. Antivenom treatment in Vipera berus envenoming – report of 30 cases. J Intern Med. 1994; 235(1): 57-61.
Antytoksyna jadu żmij. Wytwórnia Surowic I Szczepionek Biomed w Warszawie.
Persson H. Envenoming by European vipers antivenom treatment – influence on morbidity. Prz Lek. 2001; 58(4): 223-225.
Karlson-Stiber C, Persson H, Heath A, Smith D, al-Abdulla IH, Sjöström L. First clinical experiences with specific sheep Fab fragments in snake bite. Report of a multicentre study of Vipera berus envenoming. J Intern Med. 1997; 241(1): 53-58.
British National Formulary. Emergency treatment of poisoning. British Medical Association and the Royal Pharmaceutical Society, 2009; 57: 27-36.
Kerrigan KR, Mertz BL, Nelson SJ, Dye JD. Antibiotic prophylaxis for pit viper envenomation: prospective, controlled trial. World J Surg. 1997; 21(4): 369-372.
Persson H, Irestedt B. A study of 136 cases of adder bite treated in Swedish hospitals during one year. Acta Med Scand. 1981; 210(6): 433-439.
Czarnecka-Operacz M, Jenerowicz D, Polańska A, Sadowska A. Mineralocorticoid effect of hydrocortisone – an important clinical problem. Post Dermatol Alergol. 2011; 4: 328-329.
Journals System - logo
Scroll to top