{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:28:20Z","timestamp":1791487700564,"version":"4.3.4"},"reference-count":74,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institut Pasteur"}],"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>Species of the genus <jats:italic>Echis<\/jats:italic>, particularly those of the \u2018<jats:italic>ocellatus<\/jats:italic>\u2019 group, are responsible for the majority of snakebite envenomations and deaths in the savannas of sub-Saharan Africa. In a clinical study conducted in Cameroon, we treated a series of patients bitten by formally identified <jats:italic>E. romani<\/jats:italic>. The clinical outcomes are described and discussed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>Specimens brought in by the victim were identified by a herpetologist. Clinical description and therapeutic management followed a standardized protocol applied by trained physicians.<\/jats:p>\n<jats:p>We included 92 patients, 95% of whom (n\u2009=\u200987) were envenomated. More than one third of the bites occurred during agricultural work, and one quarter in the victim\u2019s home. The bite site was the foot in 48 victims (52%) and the hand in 40 others (43%), mostly children and teenagers. Cytotoxic syndrome was observed in 84 of the 87 envenomated patients (97%). Hemostasis disorders were observed in 78 patients (90%), 38 of whom (44%) experienced bleeding during hospitalization. In 5 of the latter (13%), the bleeding recurred, whereas it had stopped after antivenom administration. A further 7 patients, who were not bleeding on arrival, experienced late bleeding despite antivenom administration. Four patients (4.3%), including one pregnant woman, died. All were bleeding on arrival. Finally, 2 patients (2.2%) had permanent sequelae of moderate severity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusion\/Significance<\/jats:title>\n<jats:p>This study confirms the frequency and severity of hemorrhagic complications in <jats:italic>E. romani<\/jats:italic> envenomation. Lethality remains high despite antivenom treatment. Cytotoxic syndromes, present in 95% of victims, rarely progress to extensive necrosis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0013195","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T17:24:49Z","timestamp":1753723489000},"page":"e0013195","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Epidemiologic, clinical, and therapeutic aspects of formally identified Echis romani bites in northern Cameroon"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1976-8568","authenticated-orcid":true,"given":"Jean-Philippe","family":"Chippaux","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Amta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoann","family":"Madec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigue","family":"Ntone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga\u00eblle","family":"No\u00ebl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Clauteaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yap","family":"Boum II","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand S.","family":"Nkwescheu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabien","family":"Taieb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"issue":"4","key":"pntd.0013195.ref001","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.toxicon.2010.12.022","article-title":"Estimate of the burden of snakebites in sub-Saharan Africa: a meta-analytic approach","volume":"57","author":"J-P Chippaux","year":"2011","journal-title":"Toxicon"},{"issue":"12","key":"pntd.0013195.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000569","article-title":"Snake envenoming: a disease of poverty","volume":"3","author":"RA Harrison","year":"2009","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0013195.ref003","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1186\/s12889-019-7363-3","article-title":"High snakebite underreporting rate in the Centre Region of Cameroon: an observational study","volume":"19","author":"D Tchoffo","year":"2019","journal-title":"BMC Public Health"},{"issue":"4","key":"pntd.0013195.ref004","first-page":"307","article-title":"The importance of bites by the saw-scaled or carpet viper (Echis carinatus): epidemiological studies in Nigeria and a review of the world literature","volume":"33","author":"DA Warrell","year":"1976","journal-title":"Acta Trop"},{"issue":"181","key":"pntd.0013195.ref005","first-page":"33","article-title":"Poisoning by bites of the saw-scaled or carpet viper (Echis carinatus) in Nigeria","volume":"46","author":"DA Warrell","year":"1977","journal-title":"Q J Med"},{"issue":"8143","key":"pntd.0013195.ref006","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/S0140-6736(79)91677-5","article-title":"Bites by the carpet viper in the Niger Valley","volume":"2","author":"RN Pugh","year":"1979","journal-title":"Lancet"},{"issue":"8205","key":"pntd.0013195.ref007","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/S0140-6736(80)92608-2","article-title":"Incidence and mortality on snake bite in savanna Nigeria","volume":"2","author":"RN Pugh","year":"1980","journal-title":"Lancet"},{"issue":"3","key":"pntd.0013195.ref008","doi-asserted-by":"crossref","first-page":"291","DOI":"10.4269\/ajtmh.1997.56.291","article-title":"First clinical experiences with a new ovine Fab Echis ocellatus snake bite antivenom in Nigeria: randomized comparative trial with Institute Pasteur Serum (Ipser) Africa antivenom","volume":"56","author":"WP Meyer","year":"1997","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"pntd.0013195.ref009","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/S0035-9203(98)90802-1","article-title":"Clinical safety of a polyvalent F(ab\u2019)2 equine antivenom in 223 African snake envenomations: a field trial in Cameroon. 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