{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:05:19Z","timestamp":1789470319918,"version":"build-2803163510"},"reference-count":74,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    In the present article, two cases of envenomation by\n                    <jats:italic>Rhabdophis subminiatus<\/jats:italic>\n                    are reported, including a detailed analysis of the toxicological mechanisms, clinical manifestations, and therapeutic management, along with a systematic review of globally reported cases of\n                    <jats:italic>Rhabdophis subminiatus<\/jats:italic>\n                    envenomation. Both patients (both male, aged 58 years and 55 years, respectively) sought medical treatment several days after being bitten on the hand and developed life-threatening consumptive coagulopathy and hemorrhagic diathesis. The 58-year-old patient (Case 1) presented with local swelling, pain, abdominal hematoma, and shortness of breath. After treatment with antivenom, transfusion of packed red blood cells, fresh-frozen plasma, cryoprecipitate, and mechanical ventilation, his coagulation function returned to nearly normal levels. He was discharged 15 days after admission to the study hospital. The 55-year-old patient (Case 2) presented with oral bleeding and swelling distal to the bite site. After treatment with antivenom and transfusion of fibrinogen concentrate, packed red blood cells, and fresh-frozen plasma, his coagulation function returned to normal. He was discharged 11 days after admission to the study hospital. A literature review revealed more than 50 reported cases worldwide, all of which highlighted hemorrhagic syndrome and profound coagulopathy as hallmark features. Most cases were managed symptomatically, with only a minority receiving antivenom. Although the overall prognosis was generally favorable, the case fatality rate reached 12.7%. Envenomation by\n                    <jats:italic>Rhabdophis subminiatus<\/jats:italic>\n                    constitutes a significant medical emergency that requires early intervention with polyvalent antivenom (such as anti-\n                    <jats:italic>Agkistrodon<\/jats:italic>\n                    \/\n                    <jats:italic>Deinagkistrodon<\/jats:italic>\n                    antivenom) combined with targeted supportive therapy to optimize clinical outcomes.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0443","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T14:45:32Z","timestamp":1764081932000},"page":"368-374","source":"Crossref","is-referenced-by-count":1,"title":["Severe Red-Necked Keel-Back Snake (Rhabdophis subminiatus) Envenomation in Two Cases and a Literature Review"],"prefix":"10.4269","volume":"114","author":[{"given":"Pan Pan","family":"Lu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Yuan","family":"Pan","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing Yi","family":"Wu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong de","family":"Lai","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"2","article-title":"Snake-bite envenoming: A priority neglected tropical disease","volume":"390","year":"2017"},{"key":"b2","series-title":"J Guangxi Med Univ","first-page":"676","article-title":"Clinical study on poisoning caused by Rhabdophis subminiatus bite","volume":"21","author":"Li","year":"2004"},{"key":"b3","series-title":"Guangxi Med J","first-page":"97","article-title":"Clinical analysis of envenomation caused by Rhabdophis subminiatus bites","volume":"37","author":"Chang","year":"2015"},{"key":"b4","series-title":"J Snake","first-page":"115","article-title":"Clinical observation of severe envenomation induced by Rhabdophis subminiatus bites","volume":"2","author":"Wen","year":"2006"},{"key":"b5","series-title":"J Snake","first-page":"284","article-title":"Clinical report of DIC-like syndrome caused by Rhabdophis subminiatus bites","volume":"4","author":"Peng","year":"2007"},{"key":"b6","series-title":"J Snake","first-page":"36","article-title":"Novel approaches to local hemostasis for wounds caused by Rhabdophis subminiatus bites","volume":"24","author":"Lin","year":"2012"},{"key":"b7","series-title":"J Snake","first-page":"123","article-title":"Severe pulmonary hemorrhage following Rhabdophis subminiatus bites","volume":"2","author":"Cao","year":"2007"},{"key":"b8","series-title":"Guangxi Med J","first-page":"1647","article-title":"Fatal envenomation by Rhabdophis subminiatus: A case analysis","volume":"10","author":"Lan","year":"2008"},{"key":"b9","series-title":"J Clinical Emergency","first-page":"644","article-title":"Three cases of envenomation by Rhabdophis subminiatus","volume":"19","author":"Liang","year":"2018"},{"key":"b10","series-title":"Zhejiang Med J","first-page":"1309","article-title":"Management of a Rhabdophis subminiatus bite: A case report","volume":"39","author":"Cai","year":"2017"},{"key":"b11","series-title":"Chinese Journal of Critical Care Medicine","first-page":"1147","article-title":"A case of Rhabdophis subminiatus bite and literature review","volume":"29","author":"Wang","year":"2009"},{"key":"b12","series-title":"Chinese J Crit Care Emerg Med","first-page":"85","article-title":"Epidemiological analysis of 952 snakebite cases in Wuzhou City of Guangxi Zhuang Autonomous Region","volume":"34","author":"Liang","year":"2022"},{"key":"b13","series-title":"Clinical Characteristics of Coagulopathy Induced by Hemorrhagic Venomous Snakes","author":"Li","year":"2012"},{"key":"b14","series-title":"Rev Soc Bras Med Trop","first-page":"520","article-title":"Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: A case report","volume":"49","author":"Nelwan","year":"2016"},{"key":"b15","series-title":"Singapore Med J","first-page":"34","article-title":"Morbidity after a bite from a \u2018non-venomous\u2019 pet snake","volume":"41","author":"Seow","year":"2000"},{"key":"b16","series-title":"J Intern Med","first-page":"351","article-title":"Severe coagulopathy after a bite from a \u2018harmless\u2019 snake (Rhabdophis subminiatus)","volume":"230","author":"Smeets","year":"1991"},{"key":"b17","series-title":"Toxicon","first-page":"1501","article-title":"Hemostatic changes due to the venom gland extract of the red-necked keelback snake (Rhabdophis subminiatus)","volume":"29","author":"Zotz","year":"1991"},{"key":"b18","series-title":"Br Med J","first-page":"1324","article-title":"Severe envenomation from \u201charmless\u201d pet snake","volume":"1","author":"Mather","year":"1978"},{"key":"b19","series-title":"Diagnostics and Therapeutics of Snakebites","author":"Lai","year":"2025"},{"key":"b20","series-title":"JAMA","first-page":"925","article-title":"Prolonged defibrination after a bite from a \u2018nonvenomous\u2019 snake","volume":"251","author":"Cable","year":"1984"},{"key":"b21","series-title":"J Snake","first-page":"202","article-title":"Rear-fanged snakes","volume":"3","author":"Li","year":"2007"},{"key":"b22","series-title":"Chemoecology","first-page":"187","article-title":"Nuchal glands: A novel defensive system in snakes","volume":"22","author":"Mori","year":"2012"},{"key":"b23","series-title":"J Ethology","first-page":"61","article-title":"Comparative experimental tests of natricine antipredator displays, with special reference to the unique displays in the Asian genus, Rhabdophis","volume":"26","author":"Mori","year":"2008"},{"key":"b24","series-title":"Toxins (Basel)","article-title":"Colubrid venom composition: An -omics perspective","volume":"8","author":"Junqueira-DE-Azevedo","year":"2016"},{"key":"b25","series-title":"Arch Toxicol","first-page":"133","article-title":"A current perspective on snake venom composition and constituent protein families","volume":"97","author":"Tasoulis","year":"2023"},{"key":"b26","series-title":"Toxicon","first-page":"19","article-title":"The long road of research on snake venom serine proteinases","volume":"62","author":"Serrano","year":"2013"},{"key":"b27","series-title":"Toxicon X","first-page":"100123","article-title":"The myth 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lateralis","volume":"9","author":"Komori","year":"2017"},{"key":"b32","series-title":"J Toxicol Sci","first-page":"157","article-title":"Characterization of a novel metalloproteinase in Duvernoy\u2019s gland of Rhabdophis tigrinus tigrinus.","volume":"31","author":"Komori","year":"2006"},{"key":"b33","series-title":"J Chem Ecol","first-page":"915","article-title":"New insights into dietary toxin metabolism: Diversity in the ability of the natricine snake Rhabdophis tigrinus to convert toad-derived bufadienolides","volume":"47","author":"Inoue","year":"2021"},{"key":"b34","series-title":"Venomous Bites from Non-Venomous Snakes","author":"Weinstein","year":"2023"},{"key":"b35","series-title":"Ann Trop Med Parasitol","first-page":"339","article-title":"Biological properties of the venom of the red-necked keel-back snake (Rhabdophis subminiatus)","volume":"80","author":"Iddon","year":"1986"},{"key":"b36","series-title":"Toxicon","first-page":"19","article-title":"Keel venom: Rhabdophis subminiatus (Red-Necked Keelback) venom pathophysiologically affects diverse blood clotting pathways","volume":"218","author":"Chowdhury","year":"2022"},{"key":"b37","series-title":"World J Emerg Med","first-page":"333","article-title":"The Chinese guideline for management of snakebites","volume":"15","author":"Lai","year":"2024"},{"key":"b1","series-title":"Lancet","first-page":"2","article-title":"Snake-bite envenoming: A priority neglected tropical disease","volume":"390","year":"2017"},{"key":"b2","series-title":"J Guangxi Med Univ","first-page":"676","article-title":"Clinical study on poisoning caused by Rhabdophis subminiatus bite","volume":"21","author":"Li","year":"2004"},{"key":"b3","series-title":"Guangxi Med J","first-page":"97","article-title":"Clinical analysis of envenomation caused by Rhabdophis subminiatus bites","volume":"37","author":"Chang","year":"2015"},{"key":"b4","series-title":"J Snake","first-page":"115","article-title":"Clinical observation of severe envenomation induced by Rhabdophis subminiatus bites","volume":"2","author":"Wen","year":"2006"},{"key":"b5","series-title":"J Snake","first-page":"284","article-title":"Clinical report of DIC-like syndrome caused by Rhabdophis subminiatus bites","volume":"4","author":"Peng","year":"2007"},{"key":"b6","series-title":"J Snake","first-page":"36","article-title":"Novel approaches to local hemostasis for wounds caused by Rhabdophis subminiatus bites","volume":"24","author":"Lin","year":"2012"},{"key":"b7","series-title":"J Snake","first-page":"123","article-title":"Severe pulmonary hemorrhage following Rhabdophis subminiatus bites","volume":"2","author":"Cao","year":"2007"},{"key":"b8","series-title":"Guangxi Med J","first-page":"1647","article-title":"Fatal envenomation by Rhabdophis subminiatus: A case analysis","volume":"10","author":"Lan","year":"2008"},{"key":"b9","series-title":"J Clinical Emergency","first-page":"644","article-title":"Three cases of envenomation by Rhabdophis subminiatus","volume":"19","author":"Liang","year":"2018"},{"key":"b10","series-title":"Zhejiang Med J","first-page":"1309","article-title":"Management of a Rhabdophis subminiatus bite: A case report","volume":"39","author":"Cai","year":"2017"},{"key":"b11","series-title":"Chinese Journal of Critical Care Medicine","first-page":"1147","article-title":"A case of Rhabdophis subminiatus bite and literature review","volume":"29","author":"Wang","year":"2009"},{"key":"b12","series-title":"Chinese J Crit Care Emerg Med","first-page":"85","article-title":"Epidemiological analysis of 952 snakebite cases in Wuzhou City of Guangxi Zhuang Autonomous Region","volume":"34","author":"Liang","year":"2022"},{"key":"b13","series-title":"Clinical Characteristics of Coagulopathy Induced by Hemorrhagic Venomous Snakes","author":"Li","year":"2012"},{"key":"b14","series-title":"Rev Soc Bras Med Trop","first-page":"520","article-title":"Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: A case report","volume":"49","author":"Nelwan","year":"2016"},{"key":"b15","series-title":"Singapore Med J","first-page":"34","article-title":"Morbidity after a bite from a \u2018non-venomous\u2019 pet snake","volume":"41","author":"Seow","year":"2000"},{"key":"b16","series-title":"J Intern Med","first-page":"351","article-title":"Severe coagulopathy after a bite from a \u2018harmless\u2019 snake (Rhabdophis subminiatus)","volume":"230","author":"Smeets","year":"1991"},{"key":"b17","series-title":"Toxicon","first-page":"1501","article-title":"Hemostatic changes due to the venom gland extract of the red-necked keelback snake (Rhabdophis subminiatus)","volume":"29","author":"Zotz","year":"1991"},{"key":"b18","series-title":"Br Med J","first-page":"1324","article-title":"Severe envenomation from \u201charmless\u201d pet snake","volume":"1","author":"Mather","year":"1978"},{"key":"b19","series-title":"Diagnostics and Therapeutics of Snakebites","author":"Lai","year":"2025"},{"key":"b20","series-title":"JAMA","first-page":"925","article-title":"Prolonged defibrination after a bite from a \u2018nonvenomous\u2019 snake","volume":"251","author":"Cable","year":"1984"},{"key":"b21","series-title":"J Snake","first-page":"202","article-title":"Rear-fanged snakes","volume":"3","author":"Li","year":"2007"},{"key":"b22","series-title":"Chemoecology","first-page":"187","article-title":"Nuchal glands: A novel defensive system in snakes","volume":"22","author":"Mori","year":"2012"},{"key":"b23","series-title":"J Ethology","first-page":"61","article-title":"Comparative experimental tests of natricine antipredator displays, with special reference to the unique displays in the Asian genus, Rhabdophis","volume":"26","author":"Mori","year":"2008"},{"key":"b24","series-title":"Toxins (Basel)","article-title":"Colubrid venom composition: An -omics 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