ASI Newsletter - March 2019 

Berg Adders and Bites

The Berg Adder (Bitis atropos) is a smallish adder, averaging 30 – 40 cm but reaching a maximum length of 60cm. As the common name indicates, it favours mountainous areas and occurs from sea level at Betties Bay to altitudes exceeding 3,000 m in the Drakensberg.

There are four major populations of Berg Adders – those in the Cape Fold Mountains, The KwaZulu-Natal Drakensberg, the Mpumalanga Drakensberg and another population in eastern Zimbabwe.

The four main populations: Zimbabwe Eastern Highlands (top left), Mpumalanga highlands (top right), Drakenberg (bottom right) and Western Cape (bottom left). 

This little snake is commonly found basking on footpaths or amongst grass tufts or rocky ridges and shelters under rocks. It is particularly bad-tempered and will hiss loudly and strike repeatedly.

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Berg Adder venom differs from that of most other adders in that it is potently neurotoxic and cytotoxic. Some bites are particularly bad with patients being hospitalised and ventilated but whether there has been fatalities is not quite clear. In earlier versions of the book Dragon Wrath by James Byron a fatal Berg Adder bite is described but in a subsequent revision there was doubt as to whether it was a Berg Adder bite.

Berg Adder mid-strike. Photo Andre Coetzer

In a recent scientific publication by A.J v.d. Walt and G.J. Muller, fourteen Berg Adder bites that were recorded over a sixteen year period were analysed in great detail, giving us a much clearer understanding of the effects of Berg Adder envenomation and how patients need to be treated – there is no antivenom for Berg Adder bites.

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Results of study

Eleven patients were bitten between the warm summer months of September to April, ten on the foot or ankle, three on the hand or wrist and one on the buttock.

In all of these cases studied, patients developed local cytotoxic effects with blistering. All of the patients vomited.

This was followed by disturbance of the cranial nerve function. Loss of smell, drooping eyelids, dilated pupils, difficulty with swallowing, blurring and poor near vision, and respiratory failure occurred in 10 out of 13 patients.

Reduced ability to smell and loss of taste manifested within 1 – 2 hours and took anything from a few days to a few years to resolve. In two patients the diminished sense of smell lasted more than 10 years while the loss of taste was resolved after 6 days to one year.

Drooping eyelids, diluted pupils, blurring and poor near vision developed within 30 to 120 minutes in all patients and weaned slowly over days to several months.

Ptosis or dropping eyelids is a common symptom from Berg Adder bites and other neurotoxic envenomations. 

Difficulty in swallowing was a common complaint in nearly all of the patients within 2 – 12 hours while motor power was diminished in all patients and took several days to resolve.

Ten of the thirteen patients developed respiratory failure, the earliest within eight hours and the latest thirty six hours. These patients were placed on a ventilator for anything from three days to eighteen days.

Hyponatremia (when the level of sodium is too low in the body) was recorded in eight out of nine patients tested and was documented eighteen to forty eight hours after the bite. This resulted in two children and two adults having convulsions. 

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Conclusion

Bites from the Berg Adder can be extremely dangerous and patients need to be hospitalised sooner than later. As for first aid, there is little that can be done. Patients should be immobilised and safely transported to a hospital. Respiratory failure occurred after eight hours (or more) and any form of bandaging, including pressure immobilisation, is not recommended.

As there is no antivenom for Berg Adder bites, doctors will treat the symptoms. Pilocarpine (a medication to treat increased pressure inside the eye and dry mouth) may be required to manage dilated pupils and respiratory support is necessary in most cases. Adequate hydration using normal saline is important and will speed up recovery from hyponatremia. 

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