{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:43:33Z","timestamp":1787499813804,"version":"build-2736575974"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Necrotising fasciitis following cobra envenomation is an infrequent but life-threatening complication. We report a case of a 72-year-old woman from Khotang who developed a rapidly progressive, discharging wound on her right foot 3\u00a0days after sustaining a cobra bite. Initially treated at a local snakebite center with 30 vials of antivenom, she later presented with tachycardia, low-grade fever, and leukocytosis. Local tissue culture revealed Streptococcus pyogenes, prompting escalation of antibiotics to Piperacillin-Tazobactam. The ensuing extensive tissue necrosis, driven by venom cytotoxicity, facilitated secondary bacterial colonization. Aggressive resuscitation, repeated surgical debridement, and nutritional support with a high-protein diet and multivitamins resulted in robust granulation tissue formation. Definitive reconstruction was achieved with a split-thickness skin graft. This case underscores that while antivenom reverses systemic toxicity, early recognition and prompt surgical intervention are paramount in preventing the devastating progression of local necrosis to necrotising fasciitis.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf309","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T19:27:52Z","timestamp":1746041272000},"source":"Crossref","is-referenced-by-count":1,"title":["Successful treatment of necrotising fasciitis following cobra bite: a case report"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8256-427X","authenticated-orcid":false,"given":"Santosh","family":"Dev","sequence":"first","affiliation":[{"name":"Department of General Surgery, Tribhuvan University Teaching Hospital , Maharajgunj Road, Kathmandu 44600 ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7985-0076","authenticated-orcid":false,"given":"Amit","family":"Yadav","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University , Maharajgunj Road, Kathmandu 44600 ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6725-5575","authenticated-orcid":false,"given":"Prajjwol","family":"Luitel","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University , Maharajgunj Road, Kathmandu 44600 ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8447-6792","authenticated-orcid":false,"given":"Barsha","family":"Dev","sequence":"additional","affiliation":[{"name":"Nepalgunj Medical College Teaching Hospital , Nepalgunj, Banke, Kohalpur 21904 ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7021-8481","authenticated-orcid":false,"given":"Gyaneshwor","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Tribhuvan University Teaching Hospital , Maharajgunj Road, Kathmandu 44600 ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7473-0039","authenticated-orcid":false,"given":"Badal","family":"Karki","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Tribhuvan University Teaching Hospital , Maharajgunj Road, Kathmandu 44600 ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"2025052713414050900_ref1","doi-asserted-by":"publisher","first-page":"874","DOI":"10.4269\/ajtmh.23-0278","article-title":"Snakebite-associated infections: a systematic review and meta-analysis","volume":"110","author":"Bonilla-Aldana","year":"2024","journal-title":"Am J Trop Med Hyg"},{"key":"2025052713414050900_ref2","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3390\/toxins13030183","article-title":"Wound infections from Taiwan cobra (Naja atra) bites: determining bacteriology, antibiotic susceptibility, and the use of antibiotics - a cobra BITE study","volume":"13","author":"Yeh","year":"2021","journal-title":"Toxins (Basel)"},{"key":"2025052713414050900_ref3","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.jmii.2011.04.011","article-title":"Bacterial infection in association with snakebite: a 10-year experience in a northern Taiwan medical center","volume":"44","author":"Chen","year":"2011","journal-title":"J Microbiol Immunol Infect"},{"key":"2025052713414050900_ref4","first-page":"608","article-title":"Post viper bite Pasteurella multocida necrotizing fasciitis complicates with septicaemia and renal failure","volume":"32","author":"Nadiyah","year":"2015","journal-title":"Trop Biomed"},{"key":"2025052713414050900_ref5","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.ijid.2017.08.005","article-title":"Necrotizing fasciitis following venomous snakebites in a tertiary hospital of Southwest Taiwan","volume":"63","author":"Tsai","year":"2017","journal-title":"Int J Infect Dis"},{"key":"2025052713414050900_ref6","first-page":"981","article-title":"Necrotizing fasciitis","volume":"55","author":"Puvanendran","year":"2009","journal-title":"Can Fam Physician"},{"key":"2025052713414050900_ref7","author":"National Guidelines for Snakebite Management in Nepal"},{"key":"2025052713414050900_ref8","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.31729\/jnma.7562","article-title":"Snakebite in the hills and mountains of Nepal","volume":"60","author":"Bogati","year":"2022","journal-title":"JNMA J Nepal Med Assoc"},{"key":"2025052713414050900_ref9","volume-title":"Venomous Snakes of Nepal. A Photographic Guide","author":"Sharma","year":"2013","edition":"English"},{"key":"2025052713414050900_ref10","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1056\/NEJMra2105228","article-title":"Snake envenomation","volume":"386","author":"Seifert","year":"2022","journal-title":"N Engl J Med"},{"key":"2025052713414050900_ref11","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","year":"2023","journal-title":"Int J Surg"},{"key":"2025052713414050900_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.4129","article-title":"Massive cutaneous complications due to snakebite: a case report and literature review","volume":"9","author":"Sadeghi","year":"2021","journal-title":"Clin Case Rep"},{"key":"2025052713414050900_ref13","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1111\/j.1445-2197.2012.06251.x","article-title":"Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study","volume":"83","author":"Bucca","year":"2013","journal-title":"ANZ J Surg"},{"key":"2025052713414050900_ref14","doi-asserted-by":"publisher","first-page":"22","DOI":"10.4103\/0974-2700.173868","article-title":"Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: a single academic center experience","volume":"9","author":"Hadeed","year":"2016","journal-title":"J Emerg Trauma Shock"},{"key":"2025052713414050900_ref15","doi-asserted-by":"publisher","first-page":"892","DOI":"10.7196\/SAMJ.2022.v112i12.16689","article-title":"Fatal infective necrotising fasciitis: complication following Naja nigricincta nigricincta bite (western barred spitting cobra\/zebra snake)","volume":"112","author":"Saaiman","year":"2022","journal-title":"S Afr Medizinhist J"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/5\/rjaf309\/63239198\/rjaf309.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/5\/rjaf309\/63239198\/rjaf309.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T13:41:48Z","timestamp":1748353308000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf309\/8138014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,4,29]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf309","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,4,29]]},"article-number":"rjaf309"}}