Regional Differences in Systemic Toxicity Following Texas Coral Snake (Micrurus tener) Envenomations

Background: The Texas coral snake, Micrurus tener, is one of three elapid species native to the continental United States. The purpose of the study was to describe the clinical features of their envenomation. Methods: We reviewed all human coral snake bites reported to the Texas Poison Center Network between January 2000 and December 2023. We excluded informational calls and cases in which the snake responsible for the bite was not confirmed as M. tener. Finally, we excluded bite victims who did not seek medical attention and those for whom no clinical information was available. The data collected included patient demographics, the county in which the patient was treated, clinical features, and treatment. Results: There were 501 human bites. In 472 (94.2%) cases, symptoms were limited to pain and paresthesias. Systemic toxicity, for example, weakness, dysphagia, and ptosis, was observed in 18 (3.6%) patients. Eleven (2.2%) patients had no clinical findings. Antivenom was administered in 126 (25.1%) cases. Antivenom use decreased over time; in the 5-year period from 2000–2007, antivenom was administered to 74 (55.6%) patients. Conversely, only 8 (4.1%) of patients from 2016–2023 received antivenom. Systemic findings were observed in 13 (6.5%) cases in Northeast and Central Texas compared to 5 (1.6%) in Southeast and South Texas. Conclusion: Micrurus tener envenomations were characterized primarily by pain and paresthesias. Additional systemic findings may be observed, particularly in Northeast and Central Texas. Antivenom was administered to a minority of Texas coral snake envenomation victims.