Fatal infective necrotising fasciitis: Complication following Naja nigricincta nigricincta bite (western barred spitting cobra/zebra snake)
DOI:
https://doi.org/10.7196/SAMJ.2022.v112i12.16689Keywords:
Snake bitesAbstract
Wound infections following cytotoxic snakebites are common. Bites from Naja nigricincta nigricincta (an African spitting cobra) usually
present as severe dermonecrosis spreading within the subdermal fascia layer. Primary infections can follow inoculation of the snake’s
oral flora during the bite, worsening the dermonecrosis into infective necrotising fasciitis. We report the case of a 2½-year-old boy who
presented with infective (Proteus vulgaris) necrotising fasciitis after an N. n. nigricincta bite, resulting in multiple-organ failure and death.
A P. vulgaris with the same antibiotic profile was cultured from the mouth of the snake.
References
Buys PJC. Medical Management of Snakebite in Namibia. Windhoek, Namibia: Gamsberg Macmillan, 2003.
Griffen M. The Zebra snake antivenom project. Travel News Namibia, 2001. https://www. travelnewsnamibia.com/news/stories/featured-stories/the-zebra-snake-antivenom-project/ (accessed 22 October 2019).
Warrell DA, Greenwood BM, Davidson NM, Ormerod LD, Prentice CR. Necrosis, haemorrhage and complement depletion following bites by the spitting cobra (Naja nigricollis). Q J Med 1976;45(177):1- 22. https://doi.org/10.1093/oxfordjournals.qjmed.a067448
Tilbury CR. Observations on the bite of the Mozambique spitting cobra (Naja mossambica mossambica). S Afr Med J 1982;61:308-313.
Saaiman E, Buys P. Spitting cobra (Naja nigricincta nigricincta) bites complicated by rhabdomyolysis, possible intravascular haemolysis, and coagulopathy. S Afr Med J 2019;109(10):736-740. https://doi. org/10.7196/SAMJ.2019.v109i10.14103
Blaylock RS. The identification and syndromic management of snakebite in South Africa. S Afr Fam Pract 2005;47(9):46-53. https://doi.org/10.1080/20786204.2005.10873288
World Health Organization. Guidelines for the prevention and clinical management of snakebite in Africa. Brazzaville: World Health Organization Regional Office for Africa, 4 February 2010:44-52.
https://www.who.int/publications/i/item/9789290231684 (accessed 13 April 2016).
Davoudian P, Flint NJ. Necrotizing fasciitis. Contin Educ Anaesth Crit Care Pain 2012;12(5):245-250.
https://doi.org/https://doi.org/10.1093/bjaceaccp/mks033
Zundel S, Lemaréchal A, Kaiser P, Szavay P. Diagnosis and treatment of pediatric necrotizing fasciitis: A systematic review of the literature. Eur J Pediatr Surg 2017;27(2):127-137. https://doi. org/10.1055/s-0036-1584531
Moore-Lotridge SN, Gibson BHY, Duvernay MT, Martus JE, Thomsen IP, Schoenecker JG. Pediatric musculoskeletal infection: An update through the four pillars of clinical care and immunothrombotic similarities with COVID-19. J Pediatr Orthop Soc North Am 2020;2(2). https://doi.org/10.55275/ JPOSNA-2020-124
Hysong AA, Posey SL, Blum DM, et al. Necrotizing fasciitis: Pillaging the acute phase response. J Bone Joint Surg Am 2020;102(6):526-537. https://doi.org/10.2106/JBJS.19.00591
An TJ, Benvenuti MA, Mignemi ME, Thomsen IP, Schoenecker JG. Pediatric musculoskeletal infection: Hijacking the acute-phase response. JBJS Rev 2016;4(9):e4. https://doi.org/10.2106/JBJS. RVW.15.00099
Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med 2017;377(23):2253-2265.
https://doi.org/10.1056/NEJMra1600673
Houcke S, Resiere D, Lontsingoula GR, et al. Characteristics of snakebite-related infection in French Guiana. Toxins (Basel) 2022;14(2):89. https://doi.org/10.3390/toxins14020089
Saravia-Otten P, Gutiérrez J, Arvidson S, Thelestam M, Flock J-I. Increased infectivity of Staphylococcus aureus in an experimental model of snake venom-induced tissue damage. J Infect Dis 2007;196(5):748- 754. https://doi.org/10.1086/520537
Resiere D, Gutierrez JM, Neviere R, Cabie A, Hossein M, Kallel H. Antibiotic therapy for snakebite envenoming. J Venom Anim Toxins Includ Trop Dis 2020;26:e20190098. https://doi.org/10.1590/1678- 9199-jvatitd-2019-0098
Sadeghi M, Barazandeh M, Zakariaei Z, et al. Massive cutaneous complications due to snakebite: A case report and literature review. Clin Case Rep 2021;9(5):e04129. https://doi.org/10.1002/ccr3.4129
Garg A, Sujatha S, Garg J, Acharya NS, Parija SC. Wound infections secondary to snakebite. J Infect Dev Ctries 2009;3(3):221-223. https://doi.org/10.3855/jidc.39
Lin JH, Sung WC, Mu HW, Hung DZ. Local cytotoxic effects in cobra envenoming: A pilot study. Toxins (Basel) 2022;14(2):122. https://doi.org/10.3390/toxins14020122
Wagener M, Naidoo M, Aldous C. Wound infection secondary to snakebite. S Afr Med J 2017;107(4):315-319. https://doi.org/10.7196/SAMJ.2017.v107i4.12084
Kaur H, Mahajan G. An interesting case of snake bite with necrotizing fasciitis: A case report. J Pediatr Crit Care 2018;5(3):91-93. https://doi.org/10.21304/2018.0503.00396
Chidambaram M, Charan MSP, Saraga K, Paramasivam JD, Sujatha B. Necrotizing fasciitis due to Serratia marcescens infection following snake bite. Indian J Pediatr 2022;89(4):414. https://doi. org/10.1007/s12098-021-04031-w
Abhulimhen-Iyoha B, Oguejiofor C, Ogonor E. Venomous snake bite in children: A case report from Nigeria. Int J Med Pharm Case Rep 2018;11(1):1-7. https://doi.org/10.9734/ijmpcr/2018/40082
Tsai Y-H, Hsu W-H, Huang K-C, Yu P-A, Chen C-L, Kuo LT. Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan. Int J Infect Dis 2017;63:30-36. https://doi. org/10.1016/j.ijid.2017.08.005
Banda CH, N’gambi C. Necrotizing fasciitis with mediastinitis following snakebite envenomation. SAGE Open Med Case Rep 2019;7:2050313X18823090. https://doi.org/10.1177/2050313X18823090
Le HQ, Nguyen NTT, Vo TNA, et al. Envenoming by king cobras (Ophiophagus hannah) in Vietnam with cardiac complications and necrotizing fasciitis. Toxicon 2021;200:127-133. https://doi. org/10.1016/j.toxicon.2021.07.007
Chakrabotry RK, Burns B. Systemic inflammatory response syndrome. Treasure Island, Fla.: StatPearls, 2022. https://www.ncbi.nlm.nih.gov/books/NBK547669/ (accessed 12 June 2022).
Published
Issue
Section
License
Copyright (c) 2022 EL Saaiman, PJ (Christo) Buys
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
