title: Bites by the Monocled Cobra,Naja kaouthia, in Chittagong Division, Bangladesh: Epidemiology, Clinical Features of Envenoming and Management of 70 Identified Cases.
abstract: AbstractWe 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 detectingN. kaouthiavenom 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.
authors.affiliation: Dev Care Foundation, Dhaka, Bangladesh.
authors.forename: M A
authors.initials: MA
authors.lastname: Faiz
authors.affiliation: Department of Zoology, University of Chittagong, Chittagong, Bangladesh.
authors.forename: M F
authors.initials: MF
authors.lastname: Ahsan
authors.affiliation: Chittagong Medical College and Hospital, Chittagong, Bangladesh.
authors.forename: A
authors.initials: A
authors.lastname: Ghose
authors.affiliation: Department of Medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh.
authors.forename: M R
authors.initials: MR
authors.lastname: Rahman
authors.affiliation: Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: R
authors.initials: R
authors.lastname: Amin
authors.affiliation: Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: M
authors.initials: M
authors.lastname: Hossain
authors.affiliation: Chittagong General Hospital, Chittagong, Bangladesh.
authors.forename: M N U
authors.initials: MNU
authors.lastname: Tareq
authors.affiliation: Department of Statistics, University of Dhaka, Dhaka, Bangladesh.
authors.forename: M A
authors.initials: MA
authors.lastname: Jalil
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kuch
authors.affiliation: Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: R D G
authors.initials: RDG
authors.lastname: Theakston
authors.affiliation: Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
authors.affiliation: Medical Toxicology Centre and Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: J B
authors.initials: JB
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000627:therapeutic use*; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004491:Edrophonium; D004546:Elapid Venoms / Q000633:toxicity; D017815:Elapidae / Q000502:physiology*; D005260:Female; D005392:First Aid; D006801:Humans; D008297:Male; D008875:Middle Aged; D012909:Snake Bites / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000997:Antivenins; D004546:Elapid Venoms; C521753:Naja kaouthia venom; D004491:Edrophonium