Bites by the Monocled Cobra, Naja kaouthia, in Chittagong Division, Bangladesh: Epidemiology, Clinical Features of Envenoming and Management of 70 Identified Cases

Abstract

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, endurance of upward gaze, and peak expiratory flow rate suggesting that a longer-acting anticholinesterase drug (neostigmine) could be recommended for first aid. The study suggested that regionally appropriate antivenom should be raised against the venoms of the major envenoming species of Bangladesh and highlighted the need to improve the training of staff of local medical centers and to invest in the basic health infrastructure in rural communities.

New insights into snakebite epidemiology in Costa Rica: A retrospective evaluation of medical records

“…The degree of snakebite severity is also mediated by other factors, including the amount of venom that is injected, the route and anatomical site of injection, and the physiological and anatomical characteristics of the victim ( Gutiérrez, 2010 ). For example, Faiz et al (2017) found that the severity of neurotoxicity in the monocled cobra Naja kauthia envenomation is dependent on the amount of venom antigen in the circulation; a similar relation was observed in snakebites by Bothrops lanceolatus in Martinique ( Bucher et al, 1997 ). In children, bites tend to be more complicated than in adults, presumably due to their lower body mass and the faster absorption ( De Franco-Montalván et al, 1983 ).…”

Pathogenesis of local necrosis induced by Naja atra venom: Assessment of the neutralization ability of Taiwanese freeze-dried neurotoxic antivenom in animal models

“…Most cases of cobra envenoming will develop local necrosis [24,51,52]. Although this pathological effect is not life threating, it usually leads to an irreversible outcome for snakebite victims.…”

A Rapid and International Applicable Diagnostic Device for Cobra (Genus Naja) Snakebites

“…Mortality and morbidity due to venomous snake bites are a great public health burden in Bangladesh, especially in rural areas. Bites from cobra snakes, including N. kaouthia and N. naja, are one of the leading causes of venomous snake envenomation in Bangladesh [47,48]. Syndromic approaches, not ELISA, are the main diagnostic methods due to the abundance of venomous snakes, including pit vipers, cobras, and kraits, which are variably distributed in Bangladesh [47,48].…”