Definitive sequelae observed in 2 patients.

BackgroundSpecies of the genus Echis, particularly those of the ‘ocellatus’ group, are responsible for the majority of snakebite envenomations and deaths in the savannas of sub-Saharan Africa. In a clinical study conducted in Cameroon, we treated a series of patients bitten by formally identified E. romani. The clinical outcomes are described and discussed.Methodology/Principal findingsSpecimens brought in by the victim were identified by a herpetologist. Clinical description and therapeutic management followed a standardized protocol applied by trained physicians.We included 92 patients, 95% of whom (n = 87) were envenomated. More than one third of the bites occurred during agricultural work, and one quarter in the victim’s home. The bite site was the foot in 48 victims (52%) and the hand in 40 others (43%), mostly children and teenagers. Cytotoxic syndrome was observed in 84 of the 87 envenomated patients (97%). Hemostasis disorders were observed in 78 patients (90%), 38 of whom (44%) experienced bleeding during hospitalization. In 5 of the latter (13%), the bleeding recurred, whereas it had stopped after antivenom administration. A further 7 patients, who were not bleeding on arrival, experienced late bleeding despite antivenom administration. Four patients (4.3%), including one pregnant woman, died. All were bleeding on arrival. Finally, 2 patients (2.2%) had permanent sequelae of moderate severity.Conclusion/SignificanceThis study confirms the frequency and severity of hemorrhagic complications in E. romani envenomation. Lethality remains high despite antivenom treatment. Cytotoxic syndromes, present in 95% of victims, rarely progress to extensive necrosis.