{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:31:51Z","timestamp":1760232711987,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T00:00:00Z","timestamp":1669075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Medical Research Council, UK","award":["MR\/W019353\/1"],"award-info":[{"award-number":["MR\/W019353\/1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>India suffers the highest incidence of snakebite envenomation (SBE) in the world. Rural communities within India and other countries have long-held cultural beliefs surrounding snakes and SBE treatments, with snake statues present in numerous Hindu temples. While most cultural beliefs are well respected and do not affect anyone, some people worship live venomous snakes without any safety precautions. Moreover, they practice various inappropriate first aid and traditional treatments that exacerbate SBE-induced complications. We report an unusual case of SBE on the tongue of a patient who was bitten while worshipping Russell\u2019s viper following the advice of an astrologer based on the appearance of a snake in the patient\u2019s dream. Following the bite, the tongue was deeply incised by the priest as a first aid to mitigate SBE-induced complications. The patient suffered profuse bleeding and swelling of the tongue resulting in difficulties in intubating them. The patient regained consciousness after antivenom administration, intranasal ventilation, and blood removal from the mouth. The tongue underwent extensive surgery to restore movement and function. This report advises caution to those undertaking the extremely risky practice of worshipping live snakes and emphasises the urgent need to develop and enforce policies to mitigate such actions and educate rural communities.<\/jats:p>","DOI":"10.3390\/toxins14120817","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T03:15:24Z","timestamp":1669173324000},"page":"817","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["An Unnecessary Russell\u2019s Viper Bite on the Tongue Due to Live Snake Worship and Dangerous First Aid Emphasise the Urgent Need for Stringent Policies"],"prefix":"10.3390","volume":"14","author":[{"given":"Subramanian","family":"Senthilkumaran","sequence":"first","affiliation":[{"name":"Manian Medical Centre, Erode 638001, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. V.","family":"Arathisenthil","sequence":"additional","affiliation":[{"name":"Manian Medical Centre, Erode 638001, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4647-1399","authenticated-orcid":false,"given":"Jarred","family":"Williams","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry F.","family":"Williams","sequence":"additional","affiliation":[{"name":"Toxiven Biotech Private Limited, Coimbatore 641042, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1814-8743","authenticated-orcid":false,"given":"Ponniah","family":"Thirumalaikolundusubramanian","sequence":"additional","affiliation":[{"name":"Department of General Medicine, The Tamil Nadu Dr M.G.R Medical University, Chennai 600032, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ketan","family":"Patel","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-6517","authenticated-orcid":false,"given":"Sakthivel","family":"Vaiyapuri","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/S0140-6736(18)31224-8","article-title":"Vulnerability to snakebite envenoming: A global mapping of hotspots","volume":"392","author":"Longbottom","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kasturiratne, A., Wickremasinghe, A.R., de Silva, N., Gunawardena, N.K., Pathmeswaran, A., Premaratna, R., Savioli, L., Lalloo, D.G., and de Silva, H.J. (2008). The Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths. PLoS Med., 5.","DOI":"10.1371\/journal.pmed.0050218"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e54076","DOI":"10.7554\/eLife.54076","article-title":"Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study","volume":"9","author":"Suraweera","year":"2020","journal-title":"eLife"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Henderson, J.L., and Oakes, M. (1990). The Wisdom of the Serpent the Myths of Death, Rebirth, and Resurrection, Princeton University Press.","DOI":"10.1515\/9780691216171"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s00268-010-0686-y","article-title":"The rod and the serpent: History\u2019s ultimate healing symbol","volume":"35","author":"Antoniou","year":"2011","journal-title":"World J. Surg."},{"key":"ref_6","first-page":"1","article-title":"The Practice of Traditional Rituals in Naga Aradhana (Snake worship): A Case study on Aadimoolam Vetticode Sree Nagarajaswami Temple in Kerala, India","volume":"33","author":"Balasubramanian","year":"2017","journal-title":"SHS Web Conf."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kumar, A. (2006). Snakebite: Sociocultural Anthropological Bias. PLoS Med., 3.","DOI":"10.1371\/journal.pmed.0030412"},{"key":"ref_8","unstructured":"Khan, H. (2022, July 18). A Cobra Is Made to Bite a Man\u2019s Tongue to Please Snake God. Quint World. Available online: https:\/\/www.thequint.com\/videos\/news-videos\/devotee-takes-cobra-bite-on-tongue-to-please-snake-god-in-rajasthan#read-more."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Vaiyapuri, S., Vaiyapuri, R., Ashokan, R., Ramasamy, K., Nattamaisundar, K., Jeyaraj, A., Chandran, V., Gajjeraman, P., Baksh, M.F., and Gibbins, J.M. (2013). Snakebite and its socio-economic impact on the rural population of Tamil Nadu, India. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0080090"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Samuel, S.P., Chinnaraju, S., Williams, H.F., Pichamuthu, E., Subharao, M., Vaiyapuri, M., Arumugam, S., Vaiyapuri, R., Baksh, M.F., and Patel, K. (2020). Venomous snakebites: Rapid action saves lives-A multifaceted community education programme increases awareness about snakes and snakebites among the rural population of Tamil Nadu, India. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008911"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0140-6736(09)61754-2","article-title":"Snake bite","volume":"375","author":"Warrell","year":"2010","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fry, B.G. (2018). Snakebite: When the Human Touch Becomes a Bad Touch. Toxins, 10.","DOI":"10.3390\/toxins10040170"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1083.e1","DOI":"10.1016\/j.ajem.2007.02.047","article-title":"Tongue viability after snakebite\u2014An unusual occupational hazard","volume":"25","author":"Kao","year":"2007","journal-title":"Am. J. Emerg. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S0196-0644(87)80584-X","article-title":"Life-threatening airway obstruction from rattlesnake bite to the tongue","volume":"16","author":"Gerkin","year":"1987","journal-title":"Ann. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e652","DOI":"10.1097\/SCS.0b013e3182710590","article-title":"Snake bite envenomation in tongue","volume":"23","author":"Catunda","year":"2012","journal-title":"J. Craniofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1111\/j.1399-6576.2009.02083.x","article-title":"Life-threatening systemic toxicity and airway compromise from a common European adder bite to the tongue","volume":"53","author":"Hoegberg","year":"2009","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/0035-9203(89)90311-8","article-title":"Snake venoms in science and clinical medicine. 1. Russell\u2019s viper: Biology, venom and treatment of bites","volume":"83","author":"Warrell","year":"1989","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103443","DOI":"10.1016\/j.jprot.2019.103443","article-title":"Phylovenomics of Daboia russelii across the Indian subcontinent. Bioactivities and comparative in vivo neutralization and in vitro third-generation antivenomics of antivenoms against venoms from India, Bangladesh and Sri Lanka","volume":"207","author":"Pla","year":"2019","journal-title":"J. Proteom."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Senji Laxme, R.R., Attarde, S., Khochare, S., Suranse, V., Martin, G., Casewell, N.R., Whitaker, R., and Sunagar, K. (2021). Biogeographical venom variation in the Indian spectacled cobra (Naja naja) underscores the pressing need for pan-India efficacious snakebite therapy. PLoS Negl. Trop. Dis., 15.","DOI":"10.1371\/journal.pntd.0009150"},{"key":"ref_20","unstructured":"Mandt, G. (2000). Fragments of Ancient Beliefs: The Snake as a Multivocal Symbol in Nordic Mythology. ReVision, Heldref Publications."},{"key":"ref_21","unstructured":"Government of India (2022, July 18). The Wild Life (Protection) ACT, 1972. India Code: Digital Repository of All Central and State Acts, Available online: https:\/\/www.indiacode.nic.in\/bitstream\/123456789\/1726\/1\/A1972-53.pdf."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.toxicon.2017.02.025","article-title":"Challenges in diagnosing and treating snakebites in a rural population of Tamil Nadu, India: The views of clinicians","volume":"130","author":"Williams","year":"2017","journal-title":"Toxicon"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1602426","DOI":"10.1183\/13993003.02426-2016","article-title":"Official ERS\/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure","volume":"50","author":"Rochwerg","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1159\/000499361","article-title":"European Consensus Guidelines on the Management of Respiratory Distress Syndrome\u20142019 Update","volume":"115","author":"Sweet","year":"2019","journal-title":"Neonatology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/ALN.0000000000004002","article-title":"2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway","volume":"136","author":"Apfelbaum","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s12630-019-01479-5","article-title":"Managing and securing the bleeding upper airway: A narrative review","volume":"67","author":"Kristensen","year":"2020","journal-title":"Can. J. Anaesth."},{"key":"ref_27","unstructured":"Bentley-York, J. (2022, July 18). SNAKE LIPS Filipino \u2018Snake Man\u2019 Who Claimed He Was Immune to Venom Dies after Cobra Bit Him on the Tongue \u2018as He Tried Kissing It\u2019. Sun. Available online: https:\/\/www.thesun.co.uk\/news\/15592645\/filipino-snake-man-dies-cobra-bit-tongue\/."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/12\/817\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:24:22Z","timestamp":1760145862000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/12\/817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,22]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["toxins14120817"],"URL":"https:\/\/doi.org\/10.3390\/toxins14120817","relation":{},"ISSN":["2072-6651"],"issn-type":[{"type":"electronic","value":"2072-6651"}],"subject":[],"published":{"date-parts":[[2022,11,22]]}}}