Mojave rattlesnake envenomation in southern California: A review of suspected cases

To clarify whether Mojave rattlesnake (Crotalus scutulatus scutulatus) envenomations occurring in California cause typical crotalid tissue effects, pain, edema, and ecchymosis, we reviewed charts of snakebite victims at a tertiary care teaching hospital and a moderate-size community hospital. Forty-two patients were bitten within the range of Mojave rattlesnakes. Eight snakes were identified as Mojave rattlesnakes (group 1); of these, four were confirmed by experts in snake identification (group 1a). Fifteen patients were reported bitten by other rattlesnake species (group 2), and in 19 envenomations the species was unknown (group 3). Seventy-five percent of patients in group 1 were reported to have local edema at the envenomation site compared with all of the patients in group 2. Ecchymosis was found in 25% of group 1 patients and 73% of group 2 patients. Pain was documented in only 12% of group 1 and 67% of group 2 victims. Neurotropic events, many severe, were found in 75% of group 1 patients compared with 7% of those in group 2. Although this study does not have the power to justify statistical evaluation, C. scutulatus envenomations do appear inclined to less tissue reaction. A disturbing trend toward severe neurotropic manifestations was also suggested in presumed Mojave rattlesnake envenomations.