Rattlesnake bites in Europe--experiences from southeastern France and northern Germany.

INTRODUCTION: Rattlesnakes are indigenous to the New World and hence their envenomations are a significant percentage of all poisonings in North and South America. Some years ago rattlesnake bites were virtually unknown in Europe. But the biodiversity of European household fauna has changed: cats and dogs are increasingly replaced by stingrays, tarantulas, fire fish, and rattlesnakes. This phenomenon is the background of a French-German cooperation to evaluate the relevance of rattlesnake bites for European doctors. MATERIAL AND METHODS: In a retrospective study all consultations of the GIZ-Nord poison centre in Göttingen and the Centre Antipoison in Marseille concerning bites of poisonous snakes in a 20-yr time period were analyzed. RESULTS: Altogether 671 cases of poisonous snake bites were registered. Rattlesnake bites came up to 21 (3.1% of all consultations due to poisonous snake bites). Over the years the number increased constantly. All patients were adult men with a mean age of 37.2 (20-64) years. There were no females and no pediatric patients involved. According to the Poisoning Severity Score there were 8 minor, 5 moderate, and 8 severe envenomations; no fatalities. The leading clinical symptoms consisted of rhabdomyolysis, neurological, and coagulational disorders. In 5 cases antivenom therapy was applied, and in 4 patients surgical therapy was performed. CONCLUSION: Rattlesnake bites are rare in Europe, but the incidence is rising. The patients' profile is different from large American case series. European doctors should be aware of the increase in these infrequent envenomations.