32

Reptile Bites
A. NELSON AVERY

Key words: reptile bites, snakebite, rattlesnakes, copperhead snakes, coral

snakes, exotic snakes, antivenin, agriculture

Reptiles are poikilothermic (cold blooded), and to warm themselves they lie
in direct sunlight or absorb radiant heat from warm surfaces. For that reason,
most reptile species are found between latitudes of 40˚N and 40˚S (1).
While reptiles can transmit various pathogens and toxins via bite wounds
and cause trauma and pain by biting, the most common diseases in humans
related to reptiles and amphibians are due to transmission of various species
of Salmonella. As an example, an outbreak of Salmonella enterica occurred
among visitors to a Colorado zoo reptile exhibit in 1996 that was associated
with touching a wooden barrier around a Komodo dragon exhibit (1–3).
Reptiles are in the class Reptilia, which includes four orders: Squamata
(snakes and lizards), Crocodylia (crocodiles, alligators, caimans, and gavials),
Testudinata (tortoises and turtles), and Rhynchocephalia (tuatara). Depend-
ing on the classification scheme, there are 4 to 5 families of venomous snakes
in the world: Viperidae, Elapidae, Colubridae, Atractaspididae (sometimes
included with Columbridae), and Hydrophiidae (Table 32.1) (1,4–6).
Of the estimated 3,000 species of snakes in the world, there are only about
375 known species of venomous snakes, and even fewer that are capable of
causing significant envenomation. There may be as many as 3 million snake
bites annually worldwide, with estimates of death ranging from 30,000 to
150,000 (4,6–12).

Foreign Agricultural Data about Snakebites

Snakebite is mainly a rural and occupational hazard. The highest incidence
of snakebite is in South America, West Africa, the Indian subcontinent, and
Southeast Asia. In Mexico, they report 27,000 rattlesnake bites annually and
100 fatalities; the majority of patients are adults who work in agriculture or
with cattle. In India with a large agricultural population there have been over

440
 32. Reptile Bites 441

TABLE 32.1. Classification of venomous snakes in the world.

Classification Examples
Crotalus rattlesnakes

(pit vipers)
Crotalidae
order Squamata (snakes and lizards)

Viperidae
Agkistrodon copperheads
suborder Serpentes (snakes)

water moccasins (cottonmouths)

Sistrurus pigmy rattlesnakes massasaugas
Class Reptilia

Viperinae true vipers, adders

Elapidae coral snakes
cobras, kraits, mambas, terrestrial
Australian venomous snakes
Colubridae mangrove snake
whip snake
Atractaspididae burrowing asps
stiletto snakes
Hydrophiidae sea snakes

Source: Data from Davison, Schafer and Jones (4), Warrell (5), and White (6).

20,000 reported snakebite deaths annually for the last 100 years. Among
Philippino rice farmers, cobra bites mostly afflict young males, with a death
rate of 107 per 100,000 residents in one study. In parts of the Benue Valley in
northeastern Nigeria, the incidence rate of bites is almost 500/100,000 annu-
ally with a mortality rate of more than 10%. In contrast, as Costa Rica trans-
formed its rainforest into agricultural fields over four decades, its rate of
snakebite deaths fell from 4.83 to 0.2/100,000 (5,13–15).
In tropical developing countries, snakebite is usually an occupational
injury inflicted on the feet and ankles of agricultural workers, herders, and
hunters who inadvertently step on a snake. It occurs most commonly during
the summer in open fields, threshing yards, barns, irrigation channels and
storage sheds. With night work, there is also risk from walking by thick grass
or undergrowth. Special footwear that can deflect snakebites should be worn
in high risk locations. In contrast to other agricultural areas, farmers in the
Sucua canton of Ecuador had 72% of bites on upper extremities, due to their
primitive farming technique of kneeling to plant or harvest (5,16–18).

United States Snakebite Data

American farmers are at high risk from animal-associated injuries. Surveys
by the National Safety Council found animals accounting for 17% of all non-
fatal farm injuries, second only to agricultural machinery. In an epidemiology
study from 1979 to 1990, animals were responsible for 3.6% of all farm
deaths, and there were 66 deaths from snakebites, accounting for 3.5% of all
animal-related deaths (19,20).
About 45,000 snakebites are reported in the United States annually, with
approximately 8,000 venomous bites, but only about 6 to 15 persons die
each year. There were only two snakebite fatalities reported to poison con-
trol centers in 2002 (Table 32.2), and both were related to rattlesnake bites.