Snakebites in Hungary--epidemiological and clinical aspects over the past 36 years.

Epidemiological and clinical aspects of snakebites in Hungary between 1970 and 2006 were surveyed. A total of 97 cases were recorded from 21 species, including the two native vipers, Vipera berus and Vipera ursinii, and various exotic species represented by Viperidae, Elapidae, and Colubridae. Bites by native species on laymen are uncommon (17 cases) and present trivial clinical manifestations. Compared with the consequences of native Vipera cases, bites by exotic species often resulted in severe or life-threatening envenomations. These cases were treated with antivenom administration, plasmapheresis, fasciotomy, and amputation. There were two fatalities caused by V. berus and Agkistrodon contortrix. Both of these cases were inflicted in snake-handlers with a previous history of Viperidae bites and the cause of deaths are attributed to anaphylactic reactions as a consequence of hypersensitivity to the venom. Snake-handlers and their physicians face a major challenge due to the diversity and severity of signs and symptoms following exotic venomous snakebites, and the risk of anaphylaxis or anaphylactoid reactions in patients with repeated exposure to snake venom and antivenom. Highly dangerous venomous snake species continue to appear in collections of Hungarian snake-handlers.