What is it about?

This study provides verified and reliable information regarding the frequency, geographical distribution, clinical characteristics and outcome of Tropidolaemus species bite cases consulted to the Remote Envenomation Consultancy Services (RECS) in Malaysia. This is a retrospective cohort study from 2015 to 2021. This study have shown that all T. subannulatus cases occurred in East Malaysia while all cases of T. wagleri occurred in Peninsular Malaysia. The majority of patients were male (74.8%) and adults between 18-59 years old (61.2%). The upper limb (56.6%) was the most frequent part of the body that got bitten. Most cases were not related to occupation (75.4%). Bites from both pit viper species caused local pain (77.1%) and swelling (27.2%). Most patients complained of mild pain (48.0%) that only required Paracetamol (40.0%) as pain control medication. There was no indication for antivenom in all cases observed. Most patients (54.7%) only needed a short hospital stay of less than 24 hours for observation. No deaths were documented.

Featured Image

Why is it important?

Pit vipers from the genus Tropidolaemus frequently causes bite injuries in human. However, there were limited information regarding the frequency, clinical features, clinical management and outcome in Malaysia. This study emphasizes the importance of proper snake species identification and appropriate diagnosis to achieve optimal management for patients. Most Tropidolaemus pit viper species bites only caused mild local symptoms. This study shows that human envenomation from Tropidolaemus pit viper species does not indicate for antivenom administration. Symptomatic management with analgesia and short period of close serial monitoring are sufficient to manage these patients.


I firmly believe that proper identification and optimal management for bite envenomation from the Tropidolaemus pit viper species can reduce unnecessary worries among patients, shortened hospital stay and reduce medical cost. The list of snakes of medical significance form Malaysia and other countries in the ASEAN region that justifies antivenom production need to be revised and the WHO categories for such snake species need to be updated.

Ahmad Khaldun Ismail
Department of Emergency Medicine, Faculty of Medicine, University Kebangsaan Malaysia

Read the Original

This page is a summary of: Frequency, clinical characteristics and outcomes of Tropidolaemus species bite envenomations in Malaysia, PLoS Neglected Tropical Diseases, January 2023, PLOS,
DOI: 10.1371/journal.pntd.0010983.
You can read the full text:

Open access logo



The following have contributed to this page