Cerastes vipera
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Family: Viperidae
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Subfamily: Viperinae
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Genus: Cerastes
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Species: vipera
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Common Names
Sahara Desert Viper , Cleopatra's Asp , Avicenna's Viper , Sahara Hornless Viper , Lesser Cerastes Viper , Sahara Sand Viper
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Local Names
Lefaa , Lefaa Seghir , Qerna , Haya Qaraa , Tachelt
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Region
Middle East + North Africa
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Countries
Algeria, Chad, Egypt, Israel, Jordan, Lebanon, Libya, Mali, Morocco, Niger, Saudi Arabia, Tunisia, Mauritania, West Sahara
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Taxonomy and Biology
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Adult Length: 0.30 m
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General Shape
Small, depressed, tapered, relatively thick bodied snake with a short tail. Can grow to a maximum of about 0.53 metres. Head is broad, flattened, roughly triangular shaped when viewed from above and very distinct from narrow neck. Snout is very short and broad. Canthus is indistinct. Eyes are moderately small in size, prominent, set well forward at the junction of the top and side of the head, with vertically elliptical pupils. Nostrils directed sideways. Dorsal scales have apical pits, are rough and heavily keeled, large vertebrally and smaller laterally, oblique with serrated keels. Ventrals have lateral keels and subcaudals are keeled posteriorly.
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Habitat
Sandy areas including dunes in desert, in areas not occupied by other snakes of this genus. Prefers dune terrain with sparse grass tussocks
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Habits
Mainly nocturnal or crepuscular, terrestrial and slow moving snake. Uses sidewinding locomotion and generally active after dusk. Tends to bury itself in soft sand, often under a bush or some other form of shade, during the day, leaving only the eyes and snout exposed ready to ambush unsuspecting prey. The black tail tip can be used as a lure for prey. If disturbed it assumes an S-shaped coil position and rubs the sides of the body together making a rasping sound and hisses loudly. If provoked it is quick to strike.
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Prey
Feeds mainly on small lizards and small or young rodents.
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Venom
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General: Venom Neurotoxins
Probably not present
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General: Venom Myotoxins
Probably not present
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General: Venom Procoagulants
Mixture of procoagulants
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General: Venom Anticoagulants
Probably not present
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General: Venom Haemorrhagins
Possibly present
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General: Venom Nephrotoxins
Probably not present
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General: Venom Cardiotoxins
Probably not present
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General: Venom Necrotoxins
Probably not present
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General: Venom Other
Unknown
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Clinical Effects
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General: Dangerousness
Unknown, but potentially lethal envenoming, though unlikely, cannot be excluded.
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General: Rate of Envenoming: Unknown but likely to be high
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General: Untreated Lethality Rate: <1%
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General: Local Effects
Local pain, swelling & bruising, less commonly necrosis.
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General: Local Necrosis
Uncommon but can be moderate to severe
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General: General Systemic Effects
Variable non-specific effects which may include headache, nausea, vomiting, abdominal pain, diarrhoea, dizziness, collapse or convulsions
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General: Neurotoxic Paralysis
Does not occur, based on current clinical evidence
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General: Myotoxicity
Does not occur, based on current clinical evidence
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General: Coagulopathy & Haemorrhages
Common, may be mild to moderate coagulopathy; severe coagulopathy not reported but cannot be excluded.
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General: Renal Damage
Does not occur, based on current clinical evidence
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General: Cardiotoxicity
Does not occur, based on current clinical evidence
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General: Other
Shock secondary to fluid shifts due to local tissue injury is possible in severe cases
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First Aid
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Description: First aid for bites by Viperid snakes likely to cause significant local injury at the bite site (see listing in Comments section).
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Details
1. After ensuring the patient and onlookers have moved out of range of further strikes by the snake, the bitten person should be reassured and persuaded to lie down and remain still. Many will be terrified, fearing sudden death and, in this mood, they may behave irrationally or even hysterically. The basis for reassurance is the fact that many venomous bites do not result in envenoming, the relatively slow progression to severe envenoming (hours following elapid bites, days following viper bites) and the effectiveness of modern medical treatment. 2. The bite wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is unlikely to do much harm (or good) but the wound must not be massaged. 3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if oedema develops. 4. The bitten limb should be immobilised as effectively as possible using an extemporised splint or sling; if available, crepe bandaging of the splinted limb is an effective form of immobilisation. 5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to mouth) technique of expired air transfer. Seek urgent medical attention. 6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock. 7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration. 8. If the offending snake has been killed it should be brought with the patient for identification (only relevant in areas where there are more than one naturally occurring venomous snake species), but be careful to avoid touching the head, as even a dead snake can envenom. No attempt should be made to pursue the snake into the undergrowth as this will risk further bites. 9. The snakebite victim should be transported as quickly and as passively as possible to the nearest place where they can be seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back. 10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous. These include local cauterization, incision, excision, amputation, suction by mouth, vacuum pump or syringe, combined incision and suction ("venom-ex" apparatus), injection or instillation of compounds such as potassium permanganate, phenol (carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on.
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Treatment
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Treatment Summary
Both significant local effects and systemic effects, including coagulopathy can occur, so all cases should be managed as potentially severe. Systemic envenoming with coagulopathy requires antivenom therapy.
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Key Diagnostic Features
Local pain, swelling, blistering, necrosis + coagulopathy, bleeding
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General Approach to Management
All cases should be treated as urgent & potentially lethal. Rapid assessment & commencement of treatment including appropriate antivenom (if indicated & available) is mandatory. Admit all cases.
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Antivenom Therapy
Antivenom is the key treatment for systemic envenoming. Multiple doses may be required.
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1. Antivenom Code: SAfAVC02
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Antivenom Name: Polyvalent Snake Antivenom
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Manufacturer: National Antivenom and Vaccine Production Centre
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Phone: ++966-1-252-0088 ext 45626, 45637.
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Address: P.O. Box 22490 Riyadh 11426
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Country: Saudi Arabia
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2. Antivenom Code: SAfIPM02
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Antivenom Name: Antiviperin Sera
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Manufacturer: Institut Pasteur du Maroc
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Phone: Tél standard +212 22 43 44 50 Tél Expertise +212 22 43 44 75 Tél Médical +212 22 43 44 68
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Address: Place Louis Pasteur 20100 Casablanca Maroc
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Country: Morocco
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3. Antivenom Code: SAfIPT02
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Antivenom Name: Antiviperin Sera
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Manufacturer: Institut Pasteur du Tunis
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Phone: ++21-61-283022
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Address: 13 Place Pasteur, B.P. 74 1002 Tunis-Belvedere,
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Country: Tunisia
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4. Antivenom Code: SAfVAC02
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Antivenom Name: Polyvalent Snake Venom Antiserum
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Manufacturer: VACSERA
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Phone: (+20 2) 3761-1111
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Address: 51 Wezaret El Zeraa St., Agouza, Giza, 22311
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Country: Egypt
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Images
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Cerastes vipera ( Sahara Desert Viper ) [ Original photo copyright © Dr Julian White ]
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