In Sri Lanka, the Spectacled cobra (Naja naja) inflicts fatal bites. This hospital-based prospective study describes 25 cases of proven cobra bites, including 10 (40%) males and 15 (60%) females with a median age of 36 years (range 13-70 years). In 22 cases (88%) bites occurred in the daytime and in 13 cases (52%) they occurred at the victim's home compound. The site of the bite was the upper limb in 10 cases (40%), and 12 patients (48%) had applied a tourniquet. There were 5 dry bites (20%), 20 local reactions (80%), 9 cases of neurotoxicity (36%) and 3 cases of coagulopathy (12%). Eight patients (32%) had severe local necrosis-five underwent desloughing and skin grafting and two (including one of the above) had fasciotomy and compartmental decompression of the upper limb. Two patients died (case fatality rate 8%; 95% CI 0.98-26.03) due to rapidly spreading necrosis of the upper limb. Four patients (16%; 95% CI 4.53-36.08) developed respiratory paralysis; their median time from bite to assisted ventilation was 2h (range 2-5h) and the median duration of ventilation was 24h (range 18-24h). Envenomed patients received Indian polyvalent antivenom. The findings highlight the magnitude of local necrosis, respiratory paralysis and antivenom failure in Spectacled cobra bite in Sri Lanka. Coagulopathy requires verification with robust laboratory tests.

MP may reduce mortality in patients with severe leptospirosis, except in cases with established multiple organ dysfunction and comorbidities. Therefore, early administration of MP seems advisable.

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Leptospirosis has emerged as an important infectious disease in Sri Lanka and little information is available on circulating leptospiral species and serogroups in this country. Therefore, we studied circulating leptospiral species and serogroups in patients with acute febrile illness using polymerase chain reaction and the microscopic agglutination test, respectively. Anti-leptospiral antibodies were detected in 26 of 107 serum samples studied (24.3%). The predominant reacting serogroups were Sejroe (9/26, 34.6%) and Icterohaemorrhagiae (5/ 26, 19.2%). Leptospiral DNA was detected in 3 of the 107 serum samples. The deduced leptospiral species were Leptospira interrogans and L. kirschneri (2 and 1 samples, respectively). These results confirm the existence of a wide array of leptospiral species and serogroups in Sri Lanka and would help to thoroughly elucidate the epidemiology of leptospirosis in this country.