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Travellers to tropical countries are often extremely concerned about the risk of bites and stings by venomous animals. This fear prompts many enquiries, usually at the last moment before departure, about the possibility of carrying first aid kits and antivenoms. In fact, these accidents are extremely rare because most travellers wear shoes and are far less exposed to venomous animals than indigenous peoples for whom bites and stings may be important causes of death or morbidity.
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Bite wounds of the lower extremities present a challenge in diagnosis and management. Primary care of the initial injury remains controversial. Innocuous as these wounds may appear, severe infections are frequent. The microbial flora of the animal mouth harbor a multitude of unusual bacteria, aerobic and anaerobic, that make antibiotic selection difficult. A protocol for initial management and antibiotic selection is presented.
Although venomous animals are less frequent in Europe than in tropical countries, some dangerous species can be responsible of envenomations in France. Bites by two species of adders (Vipera aspis and Vipera berus) can lead to extensive swelling with multiorgan failure. Treatment is based on intravenous infusions of specific antivenom. Bites and stings by other animal species encountered in France are characterised by important pain with local signs like necrosis, bleeding or oedema: weevers, scorpion fish, centipedes, bees, wasps.... Contrary to scorpions of North Africa or India, the 5 scorpion species which live in France are completely harmless. Such is not the case with spiders: latrodectism (neurotoxicity) and loxoscelism (extensive necrosis) observed in Provence and in Corsica.
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Human mortality due to envenomation by animals in Monagas state, Venezuela was evaluated. In this state 47 deaths due to envenomations produced by vertebrates and invertebrates (scorpions = 21, snakes = 20, bees = 6) during the period 1980-2000 were registered. The mountainous area, at the north of the state (Turimiquire sub-region) and its piedmonts reported most of the mortality by scorpionism (57.2%) and ophidism (70.0%). The age group of the patients was related with the sort of envenomation causing the death. During the period of dry season the highest percentage of deaths by scorpions and bees occurred; and the deaths produced by snakes were more frequent in the median raining season. The most frequent causes of death (61.9%) by scorpionism were the acute lung edema and congestive heart failure. In 40% of the deaths caused by snakes, alterations of the blood coagulability were observed. Bee envenomation was responsible of 50% of the deaths produced by anaphylactic shock. In none of the deaths, the species responsible of the accident was identified. The annual mean mortality rate/100,000 inhabitants, in the 21 years registered was 0.20 for the scorpion envenomation, 0.19 for ophidism and 0.06 for bee envenomation. The data suggest the importance of the mortality produced by scorpions and snakes, particularly at the north of the state.
Commercially available adventure and survival trips usually do not involve any serious health risks. Serious adventurous journeys lead into the great deserts, jungles and to extreme altitude and involve a whole spectrum of risks, depending on climate, latitude and inhabitants of the area. Survival is determined by the experience and the determination of the explorer of the unknown.
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