The Diagnosis and Management of Snakebite in Dogs – a Southern African Perspective
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Review article — Oorsigartikel The diagnosis and management of snakebite in dogs – a southern African perspective A L Leisewitza*, R S Blaylockb, F Kettnera, A Goodheada, A Goddarda and J P Schoemana dogs attack snakes with their mouths. ABSTRACT Standing humans are most commonly Cases of snakebite envenomation are frequently presented to veterinary practitioners in bitten below the knee5,9,18. The different southern Africa. Despite this, no published guidelines exist on how this medical emergency anatomical location of this bite distribu- should be managed. Southern African snake venoms can be classified into 3 main types tion has important consequences for the based on the main mechanism of venom action and clinical presentation. A polyvalent outcome of bites, specifically cytotoxic antivenom is manufactured in South Africa and contains antibodies against the most ones. important southern African snake venoms. The cytotoxic venoms are represented mainly by the puff-adder (Bitis arietans), Mozambique spitting cobra (Naja mossabica), black-necked Snakebite is confined almost completely spitting cobra (Naja nigricollis) (in the Western Cape and Namibia) and the stiletto snake to rural environments and is rarely a 11 (Atractaspis bibronii). These venoms may cause dramatic local swelling, high morbidity and problem in built-up urban areas . low mortality and infrequently require the use of antivenom for survival (the only cytotoxic Hunting dogs and dogs that are inquisi- venoms used to prepare the antivenom are the puff-adder and Mozambique spitting co- tive by nature are especially prone to bra). The neurotoxic venoms (represented chiefly by the non-spitting cobras and mambas) bites. There is no study to evaluate cause high mortality due to rapid onset of paresis and require antivenom and mechanical snakebite predilection for breed or sex of ventilatory support which is life-saving. The boomslang (Dispholidus typus) and the vine dog. snake (coagulopathic venom) rarely bite humans but dogs may be bitten more frequently. In humans, cytotoxic bites outnumber These venoms cause a consumption coagulopathy and successful treatment of boomslang neurotoxic bites by about 10:15,9,18,21. This is bites requires the use of snake species-specific monovalent antivenom. There is no likely to be similar for dogs. Morbidity is antivenom available for treating vine snake (Thelotornis capensis), berg adder (Bitis atropos), high in the case of bites from cytotoxic night adder (Causus spp.), stiletto snake and other lesser adder bites. There are some impor- snake species but mortality is low. The tant differences between the way snakebites are managed in humans and dogs. opposite is true of bites due to the neuro- Key words: dog, snakebite, southern Africa. toxic snake species where mortality is Leisewitz A L, Blaylock R S, Kettner F,Goodhead A, Goddard A, Schoeman J P The manage- high and morbidity is low. It is probable ment of snakebite in dogs – a southern African perspective. Journal of the South African that many snake-envenomated dogs die Veterinary Association (2004) 75(1): 7–13 (En.). Department of Companion Animal Clinical prior to veterinary care. Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110 South Africa. SNAKE IDENTIFICATION This can be a daunting task for the novice but some simple, general rules INTRODUCTION species most commonly causing bites in may be helpful in deciding if a southern Snakebite is a common medical their area of practice and be able to iden- African snake is venomous or not. The emergency16 with significant morbidity tify them. Of 175 species of snakes in the following usually indicate a dangerous and mortality in small animal practice in subregion, only a handful are regarded as snake: southern Africa. In Australia, a country poisonous enough to cause death7. There • The snake raises its head from the with similar climatic conditions to south- are some important differences between ground and makes a hood when threat- ern Africa, snakebite is also reported as a humans and dogs in the way snakebite is ened (cobras, Naja spp.; rinkhals, common presentation20. There is almost managed. Haemachatus haemachatus; black mamba, no veterinary literature addressing this Dendroaspis polylepis). The boomslang problem in dogs in southern Africa. EPIDEMIOLOGY (Dispholidus typus) and vine snake Because the interaction between the pet Being ectotherms (cold blooded), the (Thelotornis capensis) will inflate the and the snake is often not witnessed, the level of activity of a snake is determined front portion of the body. diagnosis of snakebite is most often pre- by the temperature of its environment. • The snake is banded as opposed to sumptive, based on clinical presentation. For this reason the highest incidence of striped along the length of the body. A The snake itself, or a good description snakebite in humans and dogs is during chevron-like pattern dorsally (adders) is of the snake, is usually not presented the warmer summer months5,9,18,21. There an indication of danger. with the patient, necessitating syndrom- is a consistent annual peak in late summer • Heavy bodied snakes with a distinct ic management. Veterinarians should and early autumn in the area served by neck and triangular head (adders). have knowledge of the poisonous snake the Onderstepoort Veterinary Academic It is important to remember that some Hospital (OVAH)16. This is thought to snakes will sham death when threatened aDepartment of Companion Animal Clinical Studies, be due to increased pre-hibernation (particularly the rinkhals) and no snake Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110 South Africa. activity. should be assumed dead and handled. If bGold Fields Health Services at Leslie Williams Private The most common bite site in dogs is the snake is presented along with the dog, Hospital, PO Box 968, Carletonville, 2500 South Africa. *Author for correspondence. E-mail: [email protected] cranial to the shoulders, especially the advice on identification should be sought Received: July 2003. Accepted: December 2003. face and the loose skin around the neck as as this would be helpful in predicting the 0038-2809 Jl S.Afr.vet.Ass. (2004) 75(1): 7–13 7 clinical course and outcome of the patient. of fur and looseness of a dog’s skin physiological response to blood loss In this regard owners are poor sources of around the neck may make deep and a fall in blood pressure result in reliable information. In most cases, snake- muscle deposition of the venom more fluid retention, haemodilution and a bite is strongly suspected but never con- difficult in dogs as opposed to humans. later fall in haematocrit. In serious cases, firmed, therefore the clinical presentation Human furless skin requires more pain haematocrit should be monitored twice and progression of clinical signs often receptors for protection which are espe- daily. confirms the diagnosis. cially prevalent on the hands. Some In-saline-agglutination-positive, sec- venom components are hyperalgesic. ondary immune mediated haemolytic VENOM TYPES In the few bites involving muscle bellies anaemia (IMHA) has occasionally been There are essentially 3 important groups in dogs (shoulder and gluteal region), observed following bites. It is necessary to of venoms in terrestrial snakes of southern pain has been severe although tissue monitor cases with a falling haematocrit Africa. Each leads to a particular clinical loss was not remarkable. A further with regular in-saline agglutination tests envenomation syndrome. exception is bites by spitting cobras27 (ISA) and look for signs of free haemoglo- 1. Cytotoxic venoms result in progres- which are extremely painful and cause bin in serum or urine. It may be necessary sive swelling. The 3 important snakes significant skin loss (Fig. 4). to treat this complication with glucocorti- in this group are the puff-adder (Bitis • Infection. It is somewhat surprising coids. arietans) and spitting cobras (Naja that secondary bacterial infections are A non-DIC thrombocytopenia is very mossambica, N. nigricollis), with the uncommon in dogs. This is counter- common in puff-adder bites. In the baboon stiletto snake (Atractaspis bibronii) and intuitive as free blood, anaerobic tissue the venom has been shown to contain a night adder (Causus spp.) causing and bacteria from a snake’s mouth potent irreversible platelet aggregation- lesser swelling. would provide grounds for sepsis. inducing component8 that may be associ- 2. Neurotoxic venoms of the family Snake venom is, however, antibacterial ated with active haemorrhage seen in Elapidae produce progressive paresis. in action2 and there are few bacteria in humans30 which has also been observed This group is represented by the cobras snake mouths4. In 1 study of infected in a dog at the OVAH. Immune-mediated (snouted, Cape and forest cobras, Naja snakebite wounds only aerobic bacteria platelet destruction may occur as a few annulifera, Naja nivea and Naja melano- which were either Gram positive cocci cases develop intravascular haemolysis as leuca, respectively) and the mambas or Gram negative bacilli were isolated3. a result of secondary IMHA. (Dendroaspis spp.). • Systemic signs associated with massive Typically the leukogram observed in 3. Coagulopathic venoms of the family blood loss and hypotension. Progressive the OVAH following puff-adder bites is Colubridae, which includes the swelling from a puff-adder bite is rapid inflammatory