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Bites by the Monocled Cobra, Naja kaouthia, in Chittagong Division, Bangladesh: Epidemiology, clinical features of envenoming and management of 70 identified cases

Lookup NU author(s): Emeritus Professor John Harris



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2017 by The American Society of Tropical Medicine and Hygiene.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 andmost 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.

Publication metadata

Author(s): Faiz MA, Ahsan MF, Ghose A, Rahman MR, Amin R, Hossain M, Tareq MNU, Jalil MA, Kuch U, Theakston RDG, Warrell DA, Harris JB

Publication type: Article

Publication status: Published

Journal: American Journal of Tropical Medicine and Hygiene

Year: 2017

Volume: 96

Issue: 4

Pages: 876-884

Print publication date: 01/04/2017

Online publication date: 03/01/2017

Acceptance date: 12/12/2016

Date deposited: 14/06/2017

ISSN (print): 0002-9637

ISSN (electronic): 1476-1645

Publisher: American Society of Tropical Medicine and Hygiene


DOI: 10.4269/ajtmh.16-0842


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