"Venomous" Bites from "Non-Venomous" Snakes, second edition thoroughly examines the potential hazards associated with bites by non-front-fanged snakes. This diverse group contains approximately 80% of living snake species (approximately 2,900 species). A large proportion of these snakes were previously assigned to the family Colubridae but, as a consequence of expanding systematics investigations, have been split into multiple families and subfamilies. Many of these snakes produce venoms or oral secretions that contain toxins and other biologically active substances. A large variety of non–front-fanged snakes figure in the pet industry, yet little documented information or formal study of their potential medical importance has been published. Therefore, although the possible medical importance of many of these species has been subjected to speculation since the mid-19th century, there is a limited amount of useful descriptive information regarding the real hazard (or lack thereof) of this wide variety of snakes. The first edition of this book provided "one-stop shopping" by offering information regarding their possible toxicity and clinical relevance as well as recommendations for medical management of their bites. The second edition expands and updates the content with detailed information about the effects and medical management of bites by a broad representation of non–front-fanged species. The hypothetical venomous nature of some lizards considered as non-venomous such as the Komodo monitor or dragon and their allies, as well as the medical effects of their bites, is also examined. The dynamic taxonomy of advanced snakes is updated, and the bases for some of these fluid changes are discussed. Likewise, terminology is also updated in order to reflect the ongoing debates regarding the definition of "venom" and the balanced reinforcement of nonmedical criteria used to define the biological basis of the term "venomous."
1. An overview of the artificial assemblage, the Colubridae
1.1 An overview of shifting classification: higher phylogeny and reassignment of non-front-fanged snakes
2. Differences between oral gland secretion and associated delivery systems of front-fanged and non-front-fanged snakes
2.1. Basic considerations regarding gland structure and function
2.2. Overview of hypotheses for the evolution of venom-delivery systems
2.3. Theories considering the evolution of canaliculated fangs and enlarged grooved teeth
2.4. ‘Duvernoy’s glands’ and venom glands: troublesome terminology; a question of semantics?
3. A summary of the toxinology of non-front-fanged snake venoms and other oral secretions
4. Medically significant bites by non-front-fanged snakes
4.1. Typical features of documented cases and evidence-based risk
4.2. Some representative genera: typical features of bites and an overview of their natural history and toxinology
4.3. Life-threatening and fatal cases and assessment of evidence-based risk
4.4. Aberrant cases and representative cases without clear etiology: a critical assessment of risk
4.5. Pitfalls noted in documented cases: differentiating perceived versus evidence-based risk
4.6. Recommendations for management of medically significant bites by non-front-fanged snakes
5. Summary and conclusions
Appendix A. Representative unverified cases of medically significant non-front-fanged snake bites posted on the internet
Appendix B. Representative lethal potency ranges and yields of duvernoy’s secretions and venoms from selected non-front-fanged snakes
Appendix C. Strategies of management of gram-negative septicemia: are there lessons to be learned for managing venom-induced coagulopathies?
Appendix D. Kegal considerations regarding private ownership of venomous snakes (including hazard level 1 non-front-fanged snakes): an opinionated essay
Appendix E. List of examined specimens
Additional recommended reading
A call for cases
Dr Scott A. Weinstein is a clinical toxinologist, venom researcher, and family physician. His academic training includes general and field herpetology, medical microbiology/immunology, biomedical sciences and comparative religion. His experience includes: treating snakebites and marine envenoming, as well as poisonous ingestions; characterization of aberrant toxins present in snake venoms; isolation of antimicrobial components of venoms; pharmacological studies of venom toxins in the rat blood-brain-barrier model and iontophoretic investigations, and antigenic relationships among venoms and secretions/blood of non-front-fanged snakes. He is a faculty member of the recurring Marine Animals and Snakebite Management symposia (Kuala Lumpur, Malaysia, Bangkok, Thailand and Yogyakarta, Indonesia) and is also a practising family physician. He has contributed more than 100 peer-reviewed journal papers, and 4 books in toxinology, herpetology and clinical medicine. He is currently a clinical toxinologist at the Women’s and Children’s Hospital, Adelaide, Assoc. Professor with the University of Adelaide School of Medicine, and Fellow of the American Academy of Family Physicians.
Professor David Alan Warrell is Emeritus Professor of Tropical Medicine and Honorary Fellow of St Cross College, University of Oxford, UK. After training at Oxford, St Thomas’ Hospital and the Royal Postgraduate Medical School in London, he lived, worked, researched and travelled in Ethiopia, Nigeria, Kenya, South Africa, Thailand, Burma, Sri Lanka, Bangladesh, Papua New Guinea, Brazil, Ecuador, Peru and other tropical countries, founding the Oxford University-based Tropical Medicine Research Program whose units study malaria and other major tropical diseases. He became Director of the Oxford Topical Network in 1986, and later Head of The Nuffield Department of Clinical Medicine, University of Oxford. He has published more than 400 research papers, articles, reviews and textbook chapters. He is a consultant to the World Health Organization on snake bites, rabies and malaria; the British Army, UK Medical Research Council, Foreign and Commonwealth Office, Earth Watch International (conservation), Zoological Society of London, Royal Geographical Society and ToxBase UK. He also served as the past President of the Royal Society of Tropical Medicine and Hygiene, and the International Federation for Tropical Medicine. His principal research interest remains the pathophysiology and treatment of envenoming. In November 2010, David Warrell was awarded the William Osler Memorial Medal by the University of Oxford and was recently (September 2019) awarded the Sir Patrick Manson Medal, the highest honour awarded by the Royal Society of Tropical Medicine and Hygiene.
Dr Daniel E. Keyler is Co-Director of Toxicology Research with the Minneapolis Medical Research Foundation. He is an Emeritus Professor (Department of Experimental & Clinical Pharmacology with the University of Minnesota, College of Pharmacy) and has authored numerous publications in peer-reviewed journals. He has also authored multiple book chapters involving immunotherapeutics, animal toxins, venomous snakebite, and the medical management of snakebite victims. He has been actively involved with venomous snakes for over 40 years. The medical treatment of venomous snakebites has been a significant component of his professional career, and he has been involved in the medical treatment of over 250 venomous snakebites, including exotic species. He served as Chair of the Envenomations SIG with the American Academy of Clinical Toxicology 2002-07 and is a founding member of the Medical Advisory Committee to the Online Antivenom Index. He is also an author and reviewer of medical management recommendations for snakebites in the Antivenom Index.