{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T15:26:03Z","timestamp":1787325963194,"version":"build-2736575974"},"reference-count":72,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T00:00:00Z","timestamp":1644451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p><jats:italic>Naja atra<\/jats:italic> bites cause wound necrosis, secondary infection, and necrotizing soft tissue infection (NSTI) requiring repetitive surgeries. Little information is known about the predictors for surgery after these bites.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We retrospectively evaluated 161 patients envenomed by <jats:italic>N<\/jats:italic>. <jats:italic>atra<\/jats:italic>, 80 of whom underwent surgery because of wound necrosis and infection. We compared the patients\u2019 variables between surgical and non-surgical groups. To construct a surgical risk score, we converted the regression coefficients of the significant factors in the multivariate logistic regression into integers. We also examined the deep tissue cultures and pathological findings of the debrided tissue.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A lower limb as the bite site, a \u22653 swelling grade, bullae or blister formation, gastrointestinal (GI) effects, and fever were significantly associated with surgery in the multivariate logistic regression analysis. The surgical risk scores for these variables were 1, 1, 2, 1, and 2, respectively. At a \u22653-point cutoff value, the model has 71.8% sensitivity and 88.5% specificity for predicting surgery, with an area under the receiver operating characteristic curve of 0.88. The histopathological examinations of the debrided tissues supported the diagnosis of snakebite-induced NSTI. Twelve bacterial species were isolated during the initial surgery and eleven during subsequent surgeries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion and conclusions<\/jats:title>\n<jats:p>From the clinical perspective, swelling, bullae or blister formation, GI effects, and fever appeared quickly after the bite and before surgery. The predictive value of these factors for surgery was acceptable, with a \u22653-point risk score. The common laboratory parameters did not always predict the outcomes of <jats:italic>N<\/jats:italic>. <jats:italic>atra<\/jats:italic> bites without proper wound examination. Our study supported the diagnosis of NSTI and demonstrated the changes in bacteriology during the surgeries, which can have therapeutic implications for <jats:italic>N<\/jats:italic>. <jats:italic>atra<\/jats:italic> bites.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010066","type":"journal-article","created":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T18:24:39Z","timestamp":1644517479000},"page":"e0010066","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["The development of surgical risk score and evaluation of necrotizing soft tissue infection in 161 Naja atra envenomed patients"],"prefix":"10.1371","volume":"16","author":[{"given":"Chih-Sheng","family":"Lai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8006-4917","authenticated-orcid":true,"given":"Po-Yu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3412-7400","authenticated-orcid":true,"given":"Chi-Hsin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Hsuan","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7490-7527","authenticated-orcid":true,"given":"Wei-Ling","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0867-9612","authenticated-orcid":true,"given":"Kuo-Lung","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1132-5658","authenticated-orcid":true,"given":"Hung-Yuan","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3308-6042","authenticated-orcid":true,"given":"Wen-Loung","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3355-5358","authenticated-orcid":true,"given":"Kuo-Chen","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2534-8436","authenticated-orcid":true,"given":"Yi-Yuan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0334-2666","authenticated-orcid":true,"given":"Chung-Wei","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuang-Ting","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8561-0582","authenticated-orcid":true,"given":"Yan-Chiao","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,2,10]]},"reference":[{"key":"pntd.0010066.ref001","first-page":"3","volume-title":"Clinical Toxinology in Asia Pacific and Africa","author":"Springer","year":"2015"},{"key":"pntd.0010066.ref002","author":"P Uetz","journal-title":"The Reptile Database."},{"issue":"5","key":"pntd.0010066.ref003","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.4269\/ajtmh.15-0667","article-title":"Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy","volume":"94","author":"YC Mao","year":"2016","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"pntd.0010066.ref004","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1080\/15563650.2017.1366502","article-title":"Naja atra snakebite in Taiwan.","volume":"56","author":"YC Mao","year":"2018","journal-title":"Clin Toxicol (Phila)."},{"key":"pntd.0010066.ref005","doi-asserted-by":"crossref","first-page":"103418","DOI":"10.1016\/j.jprot.2019.103418","article-title":"Proteomic insights into short neurotoxin-driven, highly neurotoxic venom of Philippine cobra (Naja philippinensis) and toxicity correlation of cobra envenomation in Asia.","volume":"206","author":"CH Tan","year":"2019","journal-title":"J Proteomics"},{"key":"pntd.0010066.ref006","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/978-94-007-6386-9_43","volume-title":"Clinical Toxinology in Asia Pacific and Africa","author":"YC Mao","year":"2015"},{"issue":"4","key":"pntd.0010066.ref007","first-page":"367","article-title":"Risk factors of surgical intervention in the management of venomous snakebite in Taiwan.","volume":"15","author":"YC Shih","year":"2006","journal-title":"J Plast Surg Assoc ROC"},{"issue":"3","key":"pntd.0010066.ref008","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1097\/SAP.0000000000001002","article-title":"Contributing Factors for Complications and Outcomes in Patients With Snakebite: Experience in a Medical Center in Southern Taiwan","volume":"78","author":"YH Hsieh","year":"2017","journal-title":"Ann Plast Surg"},{"issue":"5","key":"pntd.0010066.ref009","first-page":"435","article-title":"Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?","volume":"22","author":"HY Su","year":"2016","journal-title":"Hong Kong Med J"},{"issue":"4","key":"pntd.0010066.ref010","first-page":"200","article-title":"Sandwich enzyme-linked immunosorbent assay for Taiwan cobra venom","volume":"44","author":"YP Huang","year":"2002","journal-title":"Vet Hum Toxicol"},{"issue":"4","key":"pntd.0010066.ref011","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/S0041-0101(02)00336-7","article-title":"The clinical significance of venom detection in patients of cobra snakebite","volume":"41","author":"DZ Hung","year":"2003","journal-title":"Toxicon"},{"issue":"3","key":"pntd.0010066.ref012","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3109\/15563650.2014.887725","article-title":"Rapid diagnosis of Naja atra snakebites","volume":"52","author":"DZ Hung","year":"2014","journal-title":"Clin Toxicol (Phila)."},{"issue":"4","key":"pntd.0010066.ref013","doi-asserted-by":"crossref","first-page":"e0009331","DOI":"10.1371\/journal.pntd.0009331","article-title":"An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota","volume":"15","author":"YC Mao","year":"2021","journal-title":"PLOS Negl Trop Dis"},{"issue":"1","key":"pntd.0010066.ref014","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/15563650.2020.1762892","article-title":"Clinical manifestations and treatments of Protobothrops mucrosquamatus bite and associated factors for wound necrosis and subsequent debridement and finger or toe amputation surgery","volume":"59","author":"YC Mao","year":"2021","journal-title":"Clin Toxicol (Phila)."},{"issue":"8","key":"pntd.0010066.ref015","first-page":"874","article-title":"Antibiotic use and infection in snakebite victims","volume":"89","author":"R. Blaylock","year":"1999","journal-title":"S Afr Med J"},{"issue":"4","key":"pntd.0010066.ref016","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1046\/j.0007-1323.2002.02063.x","article-title":"Acute compartment syndromes","volume":"89","author":"A Tiwari","year":"2002","journal-title":"Br J Surg"},{"key":"pntd.0010066.ref017","year":"2016"},{"issue":"8","key":"pntd.0010066.ref018","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1067\/j.cpsurg.2014.06.001","article-title":"Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes","volume":"51","author":"TW Hakkarainen","year":"2014","journal-title":"Curr Probl Surg"},{"issue":"2","key":"pntd.0010066.ref019","doi-asserted-by":"crossref","first-page":"e0004368","DOI":"10.1371\/journal.pntd.0004368","article-title":"Neuromuscular Effects of Common Krait (Bungarus caeruleus) Envenoming in Sri Lanka","volume":"10","author":"A Silva","year":"2016","journal-title":"PLOS Negl Trop Dis."},{"key":"pntd.0010066.ref020","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1055\/s-2008-1062266","article-title":"A clinical approach to muscle diseases","volume":"28","author":"CE Jackson","year":"2008","journal-title":"Semin Neurol"},{"issue":"7","key":"pntd.0010066.ref021","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1097\/01.CCM.0000129486.35458.7D","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"CH Wong","year":"2004","journal-title":"Crit Care Med"},{"issue":"2","key":"pntd.0010066.ref022","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.sjbs.2015.10.002","article-title":"The prognostic value of the neutrophil\/lymphocyte ratio in patients with snake bites for clinical outcomes and complications","volume":"24","author":"B Elbey","year":"2017","journal-title":"Saudi J Biol Sci"},{"issue":"2","key":"pntd.0010066.ref023","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1128\/CMR.14.2.244-269.2001","article-title":"Wound microbiology and associated approaches to wound management","volume":"14","author":"PG Bowler","year":"2001","journal-title":"Clin Microbiol Rev"},{"key":"pntd.0010066.ref024","first-page":"95","volume-title":"Vascular Surgery, Neurosurgery, Lower Extremity Ulcers, Antimicrobials, Wound Assessment, Care, Measurement and Repair","author":"Springer","year":"2018"},{"key":"pntd.0010066.ref025","first-page":"26","article-title":"Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis","author":"LC Chiang","year":"2020","journal-title":"J Venom Anim Toxins Incl Trop Dis"},{"issue":"4","key":"pntd.0010066.ref026","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1080\/00034983.1999.11813436","article-title":"Prognostic factors for amputation in the case of envenoming by snakes of the Bothrops genus (Viperidae).","volume":"93","author":"M Jorge","year":"1999","journal-title":"Ann Trop Med Parasitol"},{"issue":"1","key":"pntd.0010066.ref027","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4269\/ajtmh.1998.58.22","article-title":"Prognostic factors of green pit viper bites","volume":"58","author":"P Rojnuckarin","year":"1998","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"pntd.0010066.ref028","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/15563650.2017.1371311","article-title":"Clinical predictors of tissue necrosis following rattlesnake envenomation.","volume":"56","author":"CW Heise","year":"2018","journal-title":"Clin Toxicol (Phila)."},{"issue":"4","key":"pntd.0010066.ref029","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1177\/102490791602300402","article-title":"Can surgery in patient with Protobothrops mucrosquamatus envenomation be predicted in emergency department?","volume":"23","author":"HY Su","year":"2016","journal-title":"Hong Kong J Emerg Med"},{"key":"pntd.0010066.ref030","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13049-015-0179-y","article-title":"Predictors of the development of post-snakebite compartment syndrome","volume":"23","author":"CP Hsu","year":"2015","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"3","key":"pntd.0010066.ref031","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4103\/jmedsci.jmedsci_68_18","article-title":"Descriptive study of snakebite patients in Northern Taiwan: 2009 to 2016.","volume":"39","author":"CH Ho","year":"2019","journal-title":"J Med Sci"},{"issue":"1","key":"pntd.0010066.ref032","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3390\/toxins2010163","article-title":"Bothrops lanceolatus bites: guidelines for severity assessment and emergent management","volume":"2","author":"D Resiere","year":"2010","journal-title":"Toxins"},{"issue":"4","key":"pntd.0010066.ref033","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1001\/jamasurg.2018.5069","article-title":"Does this patient have a severe snake envenomation?: the rational clinical examination systematic review","volume":"154","author":"CJ Gerardo","year":"2019","journal-title":"JAMA Surg"},{"issue":"5\u20136","key":"pntd.0010066.ref034","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/0041-0101(92)90854-X","article-title":"Envenoming by viper bites in France: clinical gradation and biological quantification by ELISA","volume":"30","author":"F Audebert","year":"1992","journal-title":"Toxicon"},{"issue":"10","key":"pntd.0010066.ref035","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1177\/096032719401301006","article-title":"Viper bites in France: clinical and biological evaluation; kinetics of envenomations","volume":"13","author":"F Audebert","year":"1994","journal-title":"Hum Exp Toxicol"},{"key":"pntd.0010066.ref036","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jprot.2015.07.015","article-title":"Cobra venom proteome and glycome determined from individual snakes of Naja atra reveal medically important dynamic range and systematic geographic variation","volume":"128","author":"HW Huang","year":"2015","journal-title":"J Proteomics"},{"key":"pntd.0010066.ref037","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jprot.2016.02.028","article-title":"Proteomic characterization and comparison of venoms from two elapid snakes (Bungarus multicinctus and Naja atra) from China","volume":"138","author":"LL Shan","year":"2016","journal-title":"J Proteomics"},{"issue":"1","key":"pntd.0010066.ref038","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0014-2999(89)90174-X","article-title":"Roles of mast cells and PMN leukocytes in cardiotoxin-induced rat paw edema","volume":"161","author":"JP Wang","year":"1989","journal-title":"Eur J pharmacol"},{"issue":"9","key":"pntd.0010066.ref039","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/0041-0101(90)90145-W","article-title":"Lack of the blocking effect of cobrotoxin from Naja naja atra venom on neuromuscular transmission in isolated nerve muscle preparations from poisonous and non-poisonous snakes","volume":"28","author":"YB Liu","year":"1990","journal-title":"Toxicon"},{"issue":"3","key":"pntd.0010066.ref040","first-page":"377","article-title":"Effects of anti-inflammatory drugs on rat hind-paw swelling caused by phospholipase A2 from Naja naja atra venom","volume":"344","author":"JP Wang","year":"1991","journal-title":"Naunyn-Schmiedeb Arch Pharmacol."},{"issue":"6","key":"pntd.0010066.ref041","first-page":"328","article-title":"Local lesions caused by cardiotoxin isolated from Formosan cobra venom","volume":"71","author":"MK Lai","year":"1972","journal-title":"J Formos Med Assoc"},{"key":"pntd.0010066.ref042","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.toxicon.2016.06.006","article-title":"Pathogenesis of dermonecrosis induced by venom of the spitting cobra, Naja nigricollis: An experimental study in mice","volume":"119","author":"M Rivel","year":"2016","journal-title":"Toxicon"},{"issue":"3","key":"pntd.0010066.ref043","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3390\/toxins12030175","article-title":"Cysteine-Rich Secretory Proteins (CRISPs) from Venomous Snakes: An Overview of the Functional Diversity in a Large and Underappreciated Superfamily","volume":"12","author":"T Tadokoro","year":"2020","journal-title":"Toxins"},{"issue":"10","key":"pntd.0010066.ref044","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1038\/jid.2008.118","article-title":"Skin pathology induced by snake venom metalloproteinase: acute damage, revascularization, and re-epithelization in a mouse ear model","volume":"128","author":"N Jim\u00e9nez","year":"2008","journal-title":"J Invest Dermatol"},{"key":"pntd.0010066.ref045","first-page":"52","article-title":"Venom concentrations in blisters and hemorrhagic bullae in a patient bitten by a Taiwan habu (Protobothrops mucrosquamatus).","author":"CC Lin","year":"2019","journal-title":"Rev Soc Bras Med Trop"},{"issue":"5","key":"pntd.0010066.ref046","doi-asserted-by":"crossref","first-page":"246","DOI":"10.3390\/toxins11050246","article-title":"Proteomic analysis of human blister fluids following envenomation by three snake species in India: Differential markers for venom mechanisms of action","volume":"11","author":"JK Mac\u00eado","year":"2019","journal-title":"Toxins"},{"issue":"3","key":"pntd.0010066.ref047","first-page":"135","article-title":"Cutaneous chemical burns: assessment and early management","volume":"44","author":"N Gnaneswaran","year":"2015","journal-title":"Aust Fam Physician"},{"issue":"1","key":"pntd.0010066.ref048","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jdermsci.2007.05.007","article-title":"Staphylococcal exfoliative toxins:\u201cmolecular scissors\u201d of bacteria that attack the cutaneous defense barrier in mammals","volume":"49","author":"K Nishifuji","year":"2008","journal-title":"J Dermatol Sci"},{"key":"pntd.0010066.ref049","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3389\/fphar.2018.00419","article-title":"Genome analysis of multidrug-resistant Shewanella algae isolated from human soft tissue sample","volume":"9","author":"YT Huang","year":"2018","journal-title":"Front Pharmacol"},{"issue":"4","key":"pntd.0010066.ref050","doi-asserted-by":"crossref","first-page":"431","DOI":"10.2169\/internalmedicine.52.8152","article-title":"Clinical and microbiological features of shewanella bacteremia in patients with hepatobiliary disease","volume":"52","author":"PY Liu","year":"2013","journal-title":"Intern Med"},{"issue":"2","key":"pntd.0010066.ref051","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/0041-0101(86)90115-7","article-title":"A comparison of the actions of cobra cardiotoxin and scorpion toxin II on the guinea-pig taenia coli","volume":"24","author":"S Lin-Shiau","year":"1986","journal-title":"Toxicon"},{"issue":"6","key":"pntd.0010066.ref052","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.toxicon.2008.01.006","article-title":"A snake venom phospholipase A2 with high affinity for muscarinic acetylcholine receptors acts on guinea pig ileum","volume":"51","author":"LF Huang","year":"2008","journal-title":"Toxicon"},{"issue":"3","key":"pntd.0010066.ref053","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1580\/1080-6032(2000)011[0163:ROIEFF]2.3.CO;2","article-title":"Risk of immediate effects from F(ab)2 bivalent antivenin in Taiwan.","volume":"11","author":"JC Chen","year":"2000","journal-title":"Wilderness Environ Med"},{"issue":"6","key":"pntd.0010066.ref054","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.4269\/ajtmh.17-0005","article-title":"Bungarus multicinctus multicinctus Snakebite in Taiwan","volume":"96","author":"YC Mao","year":"2017","journal-title":"Am J Trop Med Hyg"},{"issue":"5","key":"pntd.0010066.ref055","first-page":"283","article-title":"Snakebite complicated with Vibrio vulnificus infection","volume":"43","author":"CH Wu","year":"2001","journal-title":"Vet Human Toxicol"},{"issue":"4","key":"pntd.0010066.ref056","first-page":"1015","article-title":"Septic shock syndrome resulting from snakebite","volume":"68","author":"M Gonzalez","year":"2010","journal-title":"J Trauma"},{"issue":"26","key":"pntd.0010066.ref057","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1056\/NEJM198406283102601","article-title":"Early recognition of potentially fatal necrotizing fasciitis: the use of frozen-section biopsy","volume":"310","author":"I Stamenkovic","year":"1984","journal-title":"N Engl J Med"},{"issue":"7","key":"pntd.0010066.ref058","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.ajpath.2018.03.009","article-title":"Human streptococcal necrotizing fasciitis histopathology mirrored in a murine model","volume":"188","author":"N Keller","year":"2018","journal-title":"Am J Pathol"},{"issue":"4","key":"pntd.0010066.ref059","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1089\/sur.2007.053","article-title":"Outcome of necrotizing skin and soft tissue infections","volume":"9","author":"OL Gunter","year":"2008","journal-title":"Surg Infect"},{"key":"pntd.0010066.ref060","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ijid.2016.07.006","article-title":"Morganella morganii, a non-negligent opportunistic pathogen","volume":"50","author":"H Liu","year":"2016","journal-title":"Int J Infect Dis"},{"issue":"1","key":"pntd.0010066.ref061","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/0002-9610(77)90283-5","article-title":"Bacteriology of necrotizing fasciitis","volume":"134","author":"A Giuliano","year":"1977","journal-title":"Am J Surg"},{"issue":"9","key":"pntd.0010066.ref062","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1097\/CCM.0b013e31821cb246","article-title":"Necrotizing soft-tissue infections","volume":"39","author":"JS Ustin","year":"2011","journal-title":"Crit Care Med"},{"issue":"6","key":"pntd.0010066.ref063","doi-asserted-by":"crossref","first-page":"7s","DOI":"10.1016\/S0002-9610(96)00344-3","article-title":"Soft tissue infections and the diabetic foot","volume":"172","author":"AJ Smith","year":"1996","journal-title":"Am J Surg"},{"issue":"2","key":"pntd.0010066.ref064","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1089\/sur.2019.219","article-title":"Necrotizing soft tissue infections: a focused review of pathophysiology, diagnosis, operative management, antimicrobial therapy, and Pediatrics","volume":"21","author":"JM Tessier","year":"2020","journal-title":"Surg Infect"},{"issue":"3","key":"pntd.0010066.ref065","first-page":"183","article-title":"Oral bacterial flora of the Chinese cobra (Naja atra) and bamboo pit viper (Trimeresurus albolabris) in Hong Kong SAR, China.","volume":"15","author":"KC Shek","year":"2009","journal-title":"Hong Kong Med J"},{"issue":"2","key":"pntd.0010066.ref066","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1136\/emj.2009.086694","article-title":"A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China.","volume":"28","author":"KK Lam","year":"2011","journal-title":"Emerg Med J."},{"issue":"3","key":"pntd.0010066.ref067","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.12968\/bjcn.2004.9.Sup1.12495","article-title":"Defined and refined: criteria for identifying wound infection revisited.","volume":"9","author":"KF Cutting","year":"2004","journal-title":"Br J Community Nurs"},{"issue":"3","key":"pntd.0010066.ref068","first-page":"163","article-title":"Toxoids and antivenoms of venomous snakes in Taiwan.","volume":"16","author":"MY Liau","year":"1997","journal-title":"Toxin Rev"},{"issue":"2","key":"pntd.0010066.ref069","doi-asserted-by":"crossref","first-page":"e0008054","DOI":"10.1371\/journal.pntd.0008054","article-title":"Pathogenesis of local necrosis induced by Naja atra venom: Assessment of the neutralization ability of Taiwanese freeze-dried neurotoxic antivenom in animal models","volume":"14","author":"CC Liu","year":"2020","journal-title":"PLOS Negl Trop Dis"},{"issue":"10","key":"pntd.0010066.ref070","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3390\/toxins10100383","article-title":"Characterization of chicken-derived single chain antibody fragments against venom of Naja naja atra.","volume":"10","author":"CH Lee","year":"2018","journal-title":"Toxins"},{"issue":"3","key":"pntd.0010066.ref071","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1080\/1120009X.2016.1205309","article-title":"Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of Skin and Soft Tissue Infections (SSTIs).","volume":"29","author":"S Esposito","year":"2017","journal-title":"J Chemother"},{"issue":"23","key":"pntd.0010066.ref072","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing soft-tissue infections","volume":"377","author":"DL Stevens","year":"2017","journal-title":"N Engl J Med"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0011035","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010066","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T18:25:14Z","timestamp":1644517514000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010066"}},"subtitle":[],"editor":[{"given":"Timothy Craig","family":"Hardcastle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,10]]},"references-count":72,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010066","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pntd.0011035","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,10]]}}}