{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:43:22Z","timestamp":1788479002447,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Viper bites are medical emergencies that can develop into serious clinical complications and can endanger the life of the paediatric patient. This observational retrospective study analyses 24 cases of viper bites involving paediatric patients (&lt;18 years) encountered over 10 years (2016\u20132025) in the emergency department of Saint Mary Emergency Hospital of Iasi, Romania, with a focus on those requiring specialised surgical monitoring. Sociodemographic factors, toxicity, and surgical management of snakebites were analysed. In 83.33% cases, viper bites were found on the lower limb. The retrospective study was completed through an in-depth analysis of two representative cases, with a particular focus on the evolution up to compartment syndrome. Of the 24 cases presented in the Emergency Department, one was a rare and severe case, which evolved into compartment syndrome and required fasciotomy to save the limb in the Plastic Surgical Department. Another one, with the bite localised at the upper limb, had perilesional oedema, without skin colour changes or secretions, preservation of joint contours, and normal nail colouration. Both were analysed and described in detail with all available data (images, investigations, etc.) to highlight pathophysiological and therapeutic aspects. Appropriate, multidisciplinary treatment considerably improves the functional prognosis of patients with viper bites; administration of antivenom and selective fasciotomy contribute to successful outcomes. The study emphasises that viper bites in children remain a public health problem in Romania and require prompt and multidisciplinary treatment.<\/jats:p>","DOI":"10.3390\/toxins18030128","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T09:45:12Z","timestamp":1772531112000},"page":"128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Paediatric Snakebite Toxicity up to Compartment Syndrome: A Ten-Year Retrospective Study in Iasi, Romania"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8514-3204","authenticated-orcid":false,"given":"Bogdan","family":"Caba","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Faculty of Medical Bioengineering, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidonia Petronela","family":"Susanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1615-4824","authenticated-orcid":false,"given":"Ioana Cezara","family":"Caba","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Ro\u0219u-Solange","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Huzum","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"\u201cSf. Spiridon\u201d Emergency Clinical Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasile Eduard","family":"Ro\u0219u","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana Katerina","family":"Ioniuc","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Adriana","family":"Mocanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3937-7425","authenticated-orcid":false,"given":"Iuliana Magdalena","family":"Starcea","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Saint Mary Emergency Hospital for Children, 700309 Iasi, Romania"},{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.21037\/jeccm-24-81","article-title":"European viper bites: Clinical management from pre-hospitalisation to follow-up a narrative review","volume":"9","author":"Esposito","year":"2025","journal-title":"J. Emerg. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1080\/15563650.2023.2273761","article-title":"Viper envenomation in Central and Southeastern Europe: A multicentre study","volume":"61","author":"Caganova","year":"2023","journal-title":"Clin. Toxicol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ni\u021bescu, G.V., Ulmeanu, C.E., Cr\u0103ciun, M.-D., Ciuc\u0103, A.M., Ulici, A., Ghira, I., and Lonati, D. (2022). Neurotoxicity and Other Clinical Manifestations of a Common European Adder (Vipera berus) Bite in Romania. Toxins, 14.","DOI":"10.3390\/toxins14070500"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.toxicon.2010.06.010","article-title":"Severe coagulopathy after Vipera ammodytes ammodytes snakebite in Bulgaria: A case report","volume":"56","author":"Marinov","year":"2010","journal-title":"Toxicon"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Orlandi, G., Rossi, N., Chiarelli, F., and Di Filippo, P. (2025). Vipera Snakebite in Children: A Focus on Europe. Children, 12.","DOI":"10.3390\/children12030393"},{"key":"ref_6","first-page":"50","article-title":"Acute compartment syndrome and fasciotomy after a viper bite in Italy: A case report","volume":"1","author":"Cavalcante","year":"2024","journal-title":"Ital. J. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1371\/journal.pmed.0050218","article-title":"The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths","volume":"5","author":"Kasturiratne","year":"2008","journal-title":"PLoS Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zdenek, C.N., Rodrigues, C.F.B., Bourke, L.A., Tanaka-Azevedo, A.M., Monagle, P., and Fry, B.G. (2023). Children and Snakebite: Snake Venom Effects on Adult and Paediatric Plasma. Toxins, 1.","DOI":"10.3390\/toxins15020158"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"de Farias, A.S., Cristino, J.S., da Costa Ar\u00e9valo, M., Carneiro Junior, A., Gomes Filho, M.R., Ambrosio, S.A., Vissoci, J.N., Wen, F.H., Machado, V.A., and Sachett, J. (2023). Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives. Toxins, 1.","DOI":"10.3390\/toxins15060352"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.hansur.2020.07.003","article-title":"Upper limb compartment syndrome after a viper bite in a child: A case report","volume":"40","author":"Barani","year":"2021","journal-title":"Hand Surg. Rehabil."},{"key":"ref_11","first-page":"250","article-title":"Venom-induced myocarditis: An unusual case attributable to Vipera aspis bite","volume":"6","author":"Paffoni","year":"2024","journal-title":"Toxicon"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Verma, A., Baid, H., Sharma, N., Vaya, S., and Patel, S.M. (2022). Anti-snake Venom-Induced Kounis Syndrome: A Unique Case in the Emergency Department. Cureus, 14.","DOI":"10.7759\/cureus.31510"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"435","DOI":"10.15386\/cjmed-581","article-title":"Lethal case of vipera bersus bite","volume":"89","author":"Tranca","year":"2016","journal-title":"Med. Pharm. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.toxicon.2019.05.012","article-title":"Severe disseminated intravascular coagulation in a child envenomated by Echis coloratus and successful treatment with monovalent equine immunoglobulin G antivenom","volume":"167","author":"Glatstein","year":"2019","journal-title":"Toxicon"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"695","DOI":"10.2147\/TCRM.S261303","article-title":"Hematotoxic manifestations and management of green pit viper bites in Thailand","volume":"16","author":"Thumtecho","year":"2020","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Koh, Y.H. (2017). A rare case of Ludwig\u2019s angina after viper bite. BMJ Case Rep., 2017.","DOI":"10.1136\/bcr-2016-218427"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Marano, M., Pisani, M., Zampini, G., Pontrelli, G., and Roversi, M. (2021). Acute exposure to European viper bite in children: Advocating for a pediatric approach. Toxins, 1.","DOI":"10.3390\/toxins13050330"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3109\/15563650903356201","article-title":"Compartment syndrome after Bothrops jararaca snakebite: Monitoring, treatment, and outcome","volume":"48","author":"Bucaretchi","year":"2010","journal-title":"Clin. Toxicol."},{"key":"ref_19","first-page":"105","article-title":"Compartment syndrome following snakebite in a boy: A case report and literature review","volume":"4","author":"Navaeifar","year":"2023","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1111\/jdv.16722","article-title":"Vipera snakebite in Europe: A systematic review of a neglected disease","volume":"34","author":"Paolino","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.jpedsurg.2007.11.011","article-title":"Pediatric snakebites: Lessons learned from 114 cases","volume":"43","author":"Campbell","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_22","first-page":"367","article-title":"The compartment syndrome associated with deep vein thrombosis due to rattlesnake bite: A case report","volume":"34","author":"Tincu","year":"2017","journal-title":"Balkan Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1590\/S1678-91992009000400006","article-title":"Venomous snakebites and antivenom treatment according to a protocol for pediatric patients in Taiwan","volume":"15","author":"Wang","year":"2009","journal-title":"J. Venom. Anim. Toxins Incl. Trop. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1007\/s00134-003-1782-3","article-title":"Life-threatening snakebites by Vipera berus","volume":"29","author":"Schroth","year":"2003","journal-title":"Intensive Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"107299","DOI":"10.1016\/j.toxicon.2023.107299","article-title":"Case fatality rate and burden of snakebite envenoming in children\u2014A systematic review and meta-analysis","volume":"234","author":"Iliyasu","year":"2023","journal-title":"Toxicon"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5999\/aps.2018.00577","article-title":"Fasciotomy in compartment syndrome from snakebite","volume":"46","author":"Kim","year":"2019","journal-title":"Arch. Plast Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1080\/15563650.2021.1891245","article-title":"Moderate-to-severe Vipera berus envenoming requiring ViperaTAb antivenom therapy in the UK","volume":"59","author":"Lamb","year":"2021","journal-title":"Clin. Toxicol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/j.1442-200x.2005.02134.x","article-title":"Clinical characteristics of children with snakebite poisoning and management of complications in the pediatric intensive care unit","volume":"47","author":"Ozay","year":"2005","journal-title":"Pediatr. Int."},{"key":"ref_29","first-page":"2305","article-title":"Effects of vacuum sealing drainage to improve the therapeutic effect in patients with orthopedic trauma and to reduce post-operative infection and lower-limb deep venous thrombosis","volume":"20","author":"Zhang","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4495","DOI":"10.12659\/MSM.913579","article-title":"Small incisions combined with negative-pressure wound therapy for treatment of protobothrops mucrosquamatus bite envenomation: A new treatment strategy","volume":"25","author":"Zeng","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1136\/bmj.331.7527.1244","article-title":"Clinical review: Treatment of bites by adders and exotic venomous snakes","volume":"331","author":"Warrell","year":"2005","journal-title":"BMJ"},{"key":"ref_32","first-page":"e082","article-title":"Compartment syndrome following snake bite","volume":"32","author":"Dhar","year":"2015","journal-title":"Oman Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Boda, F., Banfai, K., Garai, K., Curticapean, A., Berta, L., Sipos, E., and Kvell, K. (2018). Effect of vipera ammodytes ammodytes snake venom on the human cytokine network. Toxins, 10.","DOI":"10.3390\/toxins10070259"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1056\/NEJMra013477","article-title":"Bites of venomous snakes","volume":"347","author":"Arry","year":"2002","journal-title":"N. Engl. J. Med."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/18\/3\/128\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T10:01:50Z","timestamp":1773136910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/18\/3\/128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["toxins18030128"],"URL":"https:\/\/doi.org\/10.3390\/toxins18030128","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]}}}