What are the other Names for this Condition? (Also known as/Synonyms)

• Common Green Bush Racer Snake Bite
• Philodryas Olfersii Snake Bite
• South American Green Racer Snake Bite

What is Lichtenstein's Green Racer Snake Bite? (Definition/Background Information)

• The Lichtenstein's green racer, or Philodryas olfersii, is a leaf green snake (sometimes with yellow underside) about 3-5 feet long having a slender body. It is a moderately venomous snake that belongs to the largest snake family called Colubridae
• The snake is endemic to many parts of South America, and hence, also known as the South American Green Racer. This tropical snake is typically found on the outskirts of forests, in scrubby thickets and open grasslands
• Lichtenstein's green racer is generally non-aggressive and can dwell on trees, though it is by and large a terrestrial reptile. It preys on small lizards, frogs, rodents, and other snakes, mostly during the day (diurnal in nature)
• Three sub-species of Lichtenstein's green racers are described in the scientific literature:
  • Philodryas olfersii herbeus, commonly known as lora, found in parts of Brazil, Columbia, and Venezuela
  • Philodryas olfersii latirostris that is found in parts of Argentina, Bolivia, and Paraguay
  • Philodryas olfersii olfersii, called Olfer's green snake, mostly reported from Brazil
• The snake is difficult to spot, because it blends well among the foliage (plants, trees, and tall grass). Even though human interactions are uncommon, moving dense shrubs, plants, or tree branches with one’s bare hands or inadvertently picking up the snake can result in bites
• Lichtenstein's Green Racer Snake Bite can be potentially lethal, if early and adequate treatment is not provided. However, severe envenomation (venom injection through a bite) is not observed in a majority of cases
• The signs and symptoms of Lichtenstein's Green Racer Bite may include severe pain and swelling of the affected limb, skin rashes along with discoloration, and bleeding. In severe cases, it may result in muscle damage and neurological symptoms
• Antivenom therapy is not considered; but, supportive therapy is provided as per the signs and symptoms noted. The prognosis of Lichtenstein's Green Racer Snake Bite with prompt and effective treatment is usually excellent

Who gets Lichtenstein's Green Racer Snake Bite? (Age and Sex Distribution)

• Lichtenstein's Green Racer Snake Bite may occur to any individual exposed to the snake, particularly in its natural habitat
• Individuals of any age and gender are prone to snake bites
• Lichtenstein's green racer is found in the South American continent, from the northern nations of Venezuela and Colombia to the southern nations of Paraguay and (north of) Argentina
• It is also reported from French Guinea, Guinea, and Surinam

What are the Risk Factors for Lichtenstein's Green Racer Snake Bite? (Predisposing Factors)

The risk factors for Lichtenstein's Green Racer Snake Bite include the following factors:

• Living or residing in areas where the Lichtenstein's green racer is found; there is a higher risk for people in the endemic zones (many nations in South America including few areas of the Amazon basin)
• The snake is active during the day, specifically during the hottest time of the day, which increases the chances of human contact
• Traveling on foot by the edge of forests, clearing bushes and thickets using one’s hands, climbing trees to pluck fruits, and trekking; in many cases, hand bites are reported
• Walking barefoot or unprotected through open grasslands and savannahs
• The snake may even visit one’s backyard, verandahs, and porticos; and occasionally, inside homes that are located next to densely vegetated areas
• Wildlife enthusiasts and scientific study groups, who explore the region
• Keeping them as pets
• Handling dead or live snakes; intentionally or accidentally picking up the snake

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lichtenstein's Green Racer Snake Bite? (Etiology)

• Lichtenstein's Green Racer Snake Bite takes place when one comes into contact with the venomous snake, usually unintentionally or inadvertently. The snake typically remains well-camouflaged, whether it is on plants, trees, or grassy terrain; thus, making it hard to spot
• The snake bite, which is usually a threat response, can cause the injection of a neurotoxic and myotoxic venom into the body, resulting in local and systemic signs and symptoms. The severity of the condition depends on the amount of venom injected and general health of the individual

What are the Signs and Symptoms of Lichtenstein's Green Racer Snake Bite?

The signs and symptoms of Lichtenstein's Green Racer Snake Bite can vary from one individual to another; however, the snake is described as being only moderately venomous. The signs and symptoms depend on the age (whether child or adult), weight, and overall health status of the individual (whether having an underlying condition or illness). Also, the signs and symptoms vary according to the potency and amount of venom injected.

The signs and symptoms of Lichtenstein's Green Racer Bite that may develop within a period of 1-4 hours may include:

• Pain at the bite site that increases in severity; presence of fang marks
• Numbness and tingling sensation in the bitten arm or leg
• Presence of skin reddening or rashes; skin discoloration
• Swelling that slowly involves a wider limb region, and sometimes moving to the chest, neck, or abdomen
• Swollen limb and/or digits may cause difficult joint movements or stiffness, which may develop after 48 hours usually in the absence of treatment
• Bleeding from the wound; although, the venom is not known to affect blood coagulation
• Pus formation
• Swollen lymph nodes (regional lymphadenopathy)
• Damage of the muscles due to myotoxic effect of the venom
• Increased pain sensitivity
• Breathing difficulties
• Fainting, dizziness
• Weakness and malaise
• Hemorrhaging may be noted
• Systemic signs and symptoms are not frequently noted; fever is typically absent
• Bleeding episodes are usually not observed; furthermore, the blood pressure is usually stable in individuals who have been bitten by the snake

Note:

• In some cases, the fang marks may not be pronounced or even visible. Sometimes, only small scratch marks or lacerations may be observed. Nevertheless, any contact with a Lichtenstein's green racer merits medical attention
• Severe anxiety may also result in some misleading symptoms of snakebites, such as sweating, fatigue, and shock, even when no bite has taken place (the individual may be imagining), or when it is a dry bite. Nevertheless, even in suspect cases, the presence of any such symptoms requires the attention of a qualified medical professional
• Also, if the individual has been treated using alternative/native medicines, it may present additional confusing symptoms. Thus, it is important to always consult a qualified healthcare provider promptly

How is Lichtenstein's Green Racer Snake Bite Diagnosed?

Lichtenstein's Green Racer Snake Bite may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history; a physical examination of the affected site by the physician may be normally sufficient to diagnose a snake bite
• The individual may be asked to provide an account (history) of the events that occurred (what took place and how), if possible
• Assessment of the signs and symptoms exhibited by the individual may be carefully observed
• Blood tests that may include: (some of these tests may be repeated over the course of treatment)
  • Complete blood count (CBC) with differential and platelet count
  • White blood cell count
  • Prothrombin time (PT) and partial thromboplastin time (PTT) tests
  • Fibrinogen blood test
  • Lactate dehydrogenase (LDH) test
  • Serum electrolytes including blood urea nitrogen (BUN) and creatinine levels blood tests
• Urine test or urinalysis
• Electrocardiogram (ECG), if needed
• Nerve conduction studies and neurological evaluation

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lichtenstein's Green Racer Snake Bite?

Complications from Lichtenstein's Green Racer Snake Bites are usually rare. In some cases, though the complications may include:

• Severe tissue and muscle damage of the affected leg or hand, which can result in superimposed infections and gangrene formation
• Increased pressure causing compartment syndrome, which is an urgent medical condition
• Temporary loss of limb function; the swelling of the affected arm or leg may persist from 10 days to even 2 weeks
• The snake toxin can damage the muscle resulting in muscle breakdown known as rhabdomyolysis
• Necrosis of the muscle tissue may be rarely observed
• Respiratory complications
• Severe shock
• Antivenom reaction, if antibotropic serum is mistakenly administered in some cases

How is Lichtenstein's Green Racer Snake Bite Treated?

All snake bites should be considered as medical emergencies and evaluated by trained medical professionals, as soon as possible; the first 6-8 hours are particularly vital for preventing life-threatening symptoms. Failure to obtain early assessment and management from the highest level of care (available within the community) may potentially result in severe complications and death.

The following measures may be considered in the treatment of Lichtenstein's Green Racer Snake Bite, based on the medical evaluation of a trained healthcare professional. Antivenom therapy is typically not necessary and the administration of antibotropic serum (effective for other snake species, but not for Philodryas species) is discouraged.

• Pain relief using medications
• Tetanus vaccination is required, if it is not up to date
• Address any signs of an allergic reaction; administration of antihistamines
• Periodic blood and urine tests may be undertaken
• The patient is generally hospitalized and monitored for at least a day following the abatement of symptoms; the patient has to be rested and kept warm
• Pressure management (using appropriate pressure devices) of affected limb for compartment syndrome; in rare cases, it may merit a fasciotomy
• Rehabilitation of the affected limb through physical therapy

Note:

• Consultation with a medical toxicologist is recommended for all cases requiring the administration of anti-snake venom
• Gynecological evaluation may be necessary for pregnant women bitten by snakes to evaluate the health of the fetus
• In many instances, the type of venomous snake involved in the bite is unknown; hence, all vital organs and systems should be closely monitored and treated appropriately, as necessary

How can Lichtenstein's Green Racer Snake Bite be Prevented?

Lichtenstein's Green Racer Snake Bite may be avoided by:

• If you spot a Lichtenstein's green racer, step back slowly from the snake and ensure a safe distance between yourself and the snake
• Being alert, if you are in snake-infested regions, particularly containing dangerous species of snakes
• Avoid walking unprotected through dense foliage and thick grasslands
• Do not reach out to move or hold bushes or tree branches without properly examining them for any camouflaged creatures such as snakes
• Carry a snake bite kit, if possible, when traveling through areas containing highly venomous snake species
• Avoiding being outdoors at night in forested areas; be careful while camping outdoors
• Avoid tall grassy areas or thick bushes; if you plan to explore the area, use heavy boots and wear thick pants
• Be on the lookout for snakes and other animals while trekking or hiking; also, if you are with a pet, do not allow the pet to wander away
• Always allow snakes crossing your path the right of way
• Always check before sitting on dead tree logs, stumps, or a pile of rocks; use a stick to stir or probe around the area
• While walking through areas with thick undergrowth, pay attention to the sound of birds or monkeys that may warn of potential dangers such as snakes
• Keep homes and surrounding areas clean and clear of rubbish or leafy piles, termite mounds, even building materials (like bricks and large stones)
• Cut tall and unkempt grass or low-lying shrubs and bushes around dwelling areas that provides hiding places for snakes and other rodents
• Avoid playing with or teasing snakes such as by touching their tails
• Do not pick up dead snakes - they may be poisonous and still bite through a reflex action
• Do not reach into dark nooks/corners/recesses with your bare hands/foot
• Educate local communities on how to identify such venomous snakes, their activities, habitats, whether they are ‘day-snakes’ or ‘night-snakes’, their weather preferences, recognize bite symptoms, and how to avoid encounter with snakes
• Teach and educate children about the dangers and importance of snakes
• Completely avoid any form of native or traditional treatment for snake bites

Both large and small snakes have the potential for severe envenomation; hence, all snake bites should be treated promptly and appropriately.

What is the Prognosis of Lichtenstein's Green Racer Snake Bite? (Outcomes/Resolutions)

• The prognosis of Lichtenstein's Green Racer Snake Bite is dependent on the site of bite, age and overall health of the individual, promptness of medical response, and continued observance and treatment of complications following admission of the patient. In a majority of cases, the prognosis is excellent with appropriate symptomatic treatment
• In the absence of treatment or access to proper healthcare, systemic symptoms may develop in some cases. However, mortality from Lichtenstein's Green Racer Bite is extremely uncommon

Additional and Relevant Useful Information for Lichtenstein's Green Racer Snake Bite:

• In some cases, the snake bite may be a ‘dry bite’, meaning that even though there is a bite mark, no venom injection occurs. However, even for dry bites, the patient must be placed under observation and monitored closely for a period ranging anywhere from 12-24 hours, prior to discharge
• The snake venom is a highly complex mix of several proteins, enzymes, amino acids, peptide chains, fats, and even certain metals. The bite causing venom injection into the body may be categorized as:
  • Intramuscular injection: Long-fanged snakes have a potential for injecting venom directly into the muscles (this is highly infrequent though)
  • Intraperitoneal injection: When the snake bite involves the stomach or abdomen region
  • Intravenous injection: In very rare cases, the snake fangs may inject venom directly into a blood vessel, releasing venom directly into blood (posing an even greater danger than normal snake bites)
  • Subcutaneous injection: A majority of snake bites involve the subcutaneous skin layers (venom is injected just below the skin surface)