A Retrospective Cohort Study of Cobra Envenomation: Clinical Characteristics, Treatments, and Outcomes (original) (raw)
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A study of Thai cobra (Naja kaouthia) bites in Thailand
Military medicine, 2005
This study evaluated factors affecting the severity of bite site necrosis and systemic symptoms resulting from envenomation among patients bitten by Thai cobras (Naja kaouthia) in Thailand. We studied 45 victims prospectively. An additional 40 medical records were obtained for a retrospective study. Collected data included gender of the victims, anatomic locations of bites, where attacks took place, and predisposing factors and how they might have affected the clinical course. Most patients were asymptomatic or mildly symptomatic. Neurotoxic symptoms and respiratory failure developed in 31.11% and 12.50% in the prospective and retrospective groups, respectively. Only one patient died, from the effects of prolonged respiratory failure. There was some degree of tissue necrosis at the bite site for almost all victims. One victim required amputation of a digit in the retrospective study, and 33.60% of the prospective group and 20% of the retrospective group required minor surgical debri...
A Study of Thai Cobra (Naja kaouthia) Bites in Thailand
Military Medicine, 2005
This study evaluated factors affecting the severity of bite site necrosis and systemic symptoms resulting from envenomation among patients bitten by Thai cobras (Naja kaouthia) in Thailand. We studied 45 victims prospectively. An additional 40 medical records were obtained for a retrospective study. Collected data included gender of the victims, anatomic locations of bites, where attacks took place, and predisposing factors and how they might have affected the clinical course. Most patients were asymptomatic or mildly symptomatic. Neurotoxic symptoms and respiratory failure developed in 31.11% and 12.50% in the prospective and retrospective groups, respectively. Only one patient died, from the effects of prolonged respiratory failure. There was some degree of tissue necrosis at the bite site for almost all victims. One victim required amputation of a digit in the retrospective study, and 33.60% of the prospective group and 20% of the retrospective group required minor surgical debridement. Snakebites in Thailand are still a public health problem, although rapid urbanization has decreased the number of victims because of degradation of the snake's habitat.
The American journal of tropical medicine and hygiene, 2017
We describe 70 cases of monocled cobra (Naja kaouthia) bite admitted to Chittagong Medical College Hospital, Bangladesh. The biting snakes were identified by examining the dead snake and/or detecting N. kaouthia venom antigens in patients' serum. Bites were most common in the early morning and evening during the monsoon (May-July). Ligatures were routinely applied to the bitten limb before admission. Thirty-seven patients consulted traditional healers, most of whom made incisions around the bite site. Fifty-eight patients experienced severe neurotoxicity and most suffered swelling and pain of the bitten limb. The use of an Indian polyvalent antivenom in patients exhibiting severe neurotoxicity resulted in clinical improvement but most patients experienced moderate-to-severe adverse reactions. Antivenom did not influence local blistering and necrosis appearing in 19 patients; 12 required debridement. Edrophonium significantly improved the ability of patients to open the eyes, end...
Journal of Venomous Animals and Toxins including Tropical Diseases
Background: Bivalent freeze-dried neurotoxic (FN) antivenom has been the primary treatment since the 1980s for Taiwan cobra (Naja atra) envenomation in Taiwan. However, envenomation-related wound necrosis is a significant problem after cobra snakebites. In the present study, we analyzed the changes in serum venom concentration before and after antivenom administration to discover their clinical implications and the surgical treatment options for wound necrosis. Methods: The patients were divided into limb swelling and wound necrosis groups. The clinical outcome was that swelling started to subside 12 hours after antivenom treatment in the first group. Serum venom concentrations before and after using antivenoms were measured to assess the antivenom's ability to neutralize the circulating cobra venom. The venom levels in wound wet dressing gauzes, blister fluids, and debrided tissues were also investigated to determine their clinical significance. We also observed the evolutional changes of wound necrosis and chose a better wound debridement timing. Results: We prospectively enrolled 15 Taiwan cobra snakebite patients. Males accounted for most of this study population (n = 11, 73%). The wound necrosis group received more
Consecutive bites on two persons by the same cobra: a case report
Journal of Venomous …, 2008
In tropical countries like Bangladesh, persons are bitten by snakes every day and a considerable number of patients die en route to the hospital. An event of consecutive neurotoxic bites on two men by a single snake was observed in the Snake Bite Study Clinic (SBSC) of the Chittagong Medical College Hospital (CMCH). Two brothers, working in their semi-pucca restaurant, were successively bitten by the same cobra on their lower limbs. Within an hour, they were taken to the CMCH. Few minutes after admission, both developed symptoms of neurotoxicity: ptosis, nasal voice, dysphagia, broken neck sign, etc. They received polyvalent antivenom (Haffkine Bio-Pharmaceuticals Company, India) and other auxiliary treatment immediately. Within few hours, neurotoxic features were completely absent. Later, the snake was captured in the restaurant kitchen and identified as monocellate cobra (Naja kauthia) by the SBSC. The elder brother developed significant antivenom reactions and both presented necrosis and ulceration at the bite sites. In these cases, immediate arrival to the hospital and early administration of antivenom resulted in successful recoveries.
Severe neurotoxic envenomation following cobra bite in Northern Nigeria: A report of three cases
Pyramid Journal of Medicine
Cobra is a common snake throughout Africa and Asia, however, there are few literatures reporting neurotoxic cobra bite from Sub-Saharan Africa (SSA), including Northern Nigeria. Here, we report 3 cases that were bitten by cobra in the savannah region of Nigeria. All the 3 cases presented with features of severe neurotoxic envenomation: generalized hypotonia, ptosis, and features of autonomic dysfunction, which include excessive salivation and sweating. One of the 3 victims progressed to develop respiratory paralysis that resulted in death. The other 2 cases survived after receiving polyvalent anti-snake venom.
Development of a Treatment Protocol for Cobra (Naja naja) Bite Envenoming in Dogs
Toxins
There is limited information on clinical profiles, treatment, and management aspects of Indian cobra (Naja naja) bite envenoming in dogs in Sri Lanka. Dogs with cobra bites presented to the Veterinary Teaching Hospital (VTH), University of Peradeniya, were prospectively studied over a period of 72 months; local and systemic clinical manifestations and hematological abnormalities were recorded. We studied 116 cobra bite envenomings in dogs. A grading system was established using a combination of anatomical site of fang marks, as well as local and systemic clinical manifestations. Accordingly, treatment strategies were established using Indian polyvalent antivenom (AVS). Pain and swelling at the bite site were major clinical signs observed, while neurotoxic manifestations (mydriasis, wheezing, and crackles) were detected in most dogs. Leukocytosis was observed in 78% of them. Statistical analysis revealed that the grading scores obtained were compatible to initiate AVS administration ...
Toxicon, 1998
tion of mice by Thai Cobra (Naja kaouthia) venom: tolerable venom concentration and exposure time. Toxicon 36, 809±812, 1998.ÐNaja kaouthia venom appeared in circulation rapidly after intramuscular injection into mice. The venom concentration attained a maximum level with all doses examined after 20 min. The half value of the maximum level was obtained 1 min after injection when a dose of 4LD 50 was used. A critical venom concentration endangering mice was assessed from venom concentration in the sera of mice envenomed with sublethal dose (LD 50 ). A fatal condition was produced within 30 min at a venom concentration of 200±300 ng/ml or within 50 min at a venom concentration of 100±150 ng/ml. #
Clinical Profile and Outcome of patients with Snake Envenomation at Bharatpur Hospital Nepal
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.7\_July2022/IJHSR-Abstract.28.html, 2022
Background: Snake bites are well-known medical emergencies requiring hospital admission. Krait and Cobra are common snakes leading to envenomation in Nepal. Timely identification of the envenomation leads to prompt treatment and decrease the morbidity and mortality. We aimed to study the clinical profile and outcome of patients with snake envenomation at Bharatpur Hospital, Nepal. Materials and Methods: The Study was a descriptive cross-sectional study conducted in the Department of Medicine in Bharatpur hospital from April 2018 to September 2018. The patients of snake bites admitted with signs of neurological, hematological, local or regional envenomation were enrolled in the study. Clinical profile, duration of hospital stay and outcomes were noted and analyzed in the study. Results: Out of 63 patients of snake bite, majority of snakes responsible for envenomation was due to Krait (38.1%) followed by Cobra (9.5%) and only 4 cases (6.3%) were due to Viper envenomation. The most common sign of presentation was Ptosis (69%) followed by difficulty in protruding tongue (42.9%). Mean number of Anti Snake Venom (ASV) vials required was 26.03. The mean duration of hospital stay in neuroparalytic cases was 46.8 hours while 60.5 hours in hematotoxic cases. There was a fatality rate of 11.1%. Conclusion: Snakebite is a common life-threatening emergency in the study area. Majority of the patients were victims of Krait or Cobra bite. Early administration of ASV prevents respiratory paralysis after neuroparalytic snakebite. Timely intubation and mechanical ventilation in respiratory paralysis cases is life saving. The development of new and more effective Antivenom that better targets the species responsible for bites in the region would help in improving future patients' outcome.