Table 5. Snake species with cytotoxic and broad-range toxicity in humans [23, 24].

Species	Habitat/habit	Species-specific toxin	Clinical manifestation	Antivenom availability
West African Carpet Viper (Echis ocellatus)**	Terrestrial, nocturnal & crepuscular	Mixture of procoagulants, Anticoagulants, Haemorrhagin (Zinc metalloproteinase), Nephrotoxins, Necrotoxins	Renal complication, coagulopathy, Marked local effects (pain, severe swelling, bruising, blistering), Moderate to severe necrosis	SAIMR Echis Antivenom, FAV-Afrique, Pan-African antivenom (EchiTAb-Plus-ICP), EchiTAbG, Antivipmyn Africa, SAIMR Echis antivenom
West African Green Tree Viper (Atheris chloroechis)*	Forest, semi-arid regions, Diurnal & arboreal	Haemorrhagins	Severe envenoming possible, potentially lethal Local pain, swelling, bruising & blistering Coagulopathy & hemorrhages are uncommon to rare, but may be moderate to severe coagulopathy	No Antivenoms
Variable Burrowing Asp (Atractaspis irregularis)*	Moist forest, Savanna, Fossorial & nocturnal	Cardiotoxins (Indirect cardiotoxin (endothelin-like activity of sarafotoxins), Necrotoxins	Local pain, swelling, bruising & blistering Local Necrosis is common but usually not severe Ischaemia or infarction	No Antivenoms
Puff adder (Bitis arietans)*	Savanna & scrubs	Procoagulants, Anticoagulants, Haemorrhagins+, Nephrotoxins, Necrotoxins+	60–80% rate of envenoming Marked local effects; pain, severe swelling, bruising, blistering Moderate to severe local Necrosis Common, moderate to severe coagulopathy + haemorrhagins causing extensive bleeding Cardiotoxicity is common and is major clinical effect Shock secondary to fluid shifts due to local tissue injury is likely in severe cases	SAIMR Snakebite Kit, Antivipmyn Africa, Pan-African antivenom (EchiTAb-Plus-ICP), Polyvalent, FAV-Afrique, Favirept, SAIMR, Polyvalent Antivenom
Rhinoceros viper (Bitis nasicornis)**	Forest, woodland, nocturnal good swimmer	Cytotoxin	Rapid and conspicuous swelling, intense pain, severe shock, and local blistering. Other symptoms include uncoordinated movements, defecation, urination, swelling of the tongue and eyelids, convulsions, and unconsciousness. Blistering, bruising, and necrosis may be extensive. Sudden hypotension, heart damage, and dyspnoea may occur The blood may become incoagulable, with internal bleeding that may lead to haematuria and haematemesis	SAIMR Snakebite Kit, Antivipmyn Africa, Pan-African antivenom (EchiTAb-Plus-ICP), Polyvalent Snake Venom Antiserum, SAIMR Polyvalent Antivenom
West African Gaboon Viper (Bitis rhinoceros)**	Forest and forest fringes	Procoagulants (Fibrinogenases), Anticoagulants, Haemorrhagins (Zinc metalloproteinase), Cardiotoxins+, Necrotoxins+	Marked local effects; pain, severe swelling, bruising, blistering, Minor neurotoxic paralysis, Coagulopathy & Haemorrhages, very common, coagulopathy + haemorrhagins causing bleeding is major clinical effect, Cardiotoxicity, Common, cardiotoxicity is major clinical effect	FAV-Afrique, Antivipmyn Africa Polyvalent Snake Venom Antiserum SAIMR Polyvalent Antivenom SII Polyvalent
Boomslang (Dispholidus typus)**	Open bush, savanna and sparsely wooded grassland, Diurnal and arboreal	Procoagulants, Anticoagulants, Haemorrhagins	Local pain, swelling & bruising, Coagulopathy & Haemorrhages, Common, moderate to severe coagulopathy + haemorrhagins causing extensive bleeding	SAIMR Boomslang Antivenom