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1 September 2008 Snakes of Medical Significance in India: The First Reported Case of Envenoming by the Levantine Viper (Macrovipera lebetina)
Lekh R. Sharma, Vivek Lal, Ian D. Simpson
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This article reports for the first time the medical significance of the Levantine viper (Macrovipera lebetina) in India. This snake is found in India in the mountainous regions of Jammu and Kashmir and is capable of causing necrosis and hemostatic manifestations, as seen in the case reported here. It is thus a class II snake of medical significance, as defined by the World Health Organization grading scale. This finding reinforces the recent decision by the Indian Government to abandon the term “Big Four” to describe important venomous species in India. Levantine viper venom is not included in the manufacture of Indian polyvalent anti–snake venom; thus, there is no current antidote for this species. Recommendations are to manage confirmed bites from this species without Indian anti-snake venom. In areas where this snake is found to be a significant contributor to envenomations, alternative anti-snake venoms can be sourced from outside India for use in high-risk groups. Continuing attention to preserving dead snakes brought with the victim for reliable identification remains a high priority.

Lekh R. Sharma, Vivek Lal, and Ian D. Simpson "Snakes of Medical Significance in India: The First Reported Case of Envenoming by the Levantine Viper (Macrovipera lebetina)," Wilderness & Environmental Medicine 19(3), 195-198, (1 September 2008).
Published: 1 September 2008

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anti-snake venom
developing world
Levantine viper
Macrovipera lebetina
snake envenomation
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