{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:52:00Z","timestamp":1791316320608,"version":"4.3.1"},"reference-count":88,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake\u2019s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake\u2019s mouth and victim\u2019s skin, age of the victim, weight, health status, and victim\u2019s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.<\/jats:p>","DOI":"10.3390\/toxins12110699","type":"journal-article","created":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T20:46:52Z","timestamp":1604436412000},"page":"699","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9666-2636","authenticated-orcid":false,"given":"Alessandro","family":"Feola","sequence":"first","affiliation":[{"name":"Department Experimental Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, via Luciano Armanni 5, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1160-2061","authenticated-orcid":false,"given":"Gian Luca","family":"Marella","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Rome \u201cTor Vergata\u201d, via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0516-8422","authenticated-orcid":false,"given":"Anna","family":"Carfora","sequence":"additional","affiliation":[{"name":"Department Experimental Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, via Luciano Armanni 5, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Della Pietra","sequence":"additional","affiliation":[{"name":"Department Experimental Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, via Luciano Armanni 5, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluca","family":"Zangani","sequence":"additional","affiliation":[{"name":"Department Experimental Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, via Luciano Armanni 5, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2865-0673","authenticated-orcid":false,"given":"Carlo Pietro","family":"Campobasso","sequence":"additional","affiliation":[{"name":"Department Experimental Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, via Luciano Armanni 5, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Williams, D.J., Faiz, M.A., Abela-Ridder, B., Ainsworth, S., Bulfone, T.C., Nickerson, A.D., Habib, A.G., Junghanss, T., Fan, H.W., and Turner, M. 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