{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:01:09Z","timestamp":1772740869377,"version":"3.50.1"},"reference-count":64,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    The greater black krait (\n                    <jats:italic>Bungarus niger<\/jats:italic>\n                    ) and the lesser black krait (\n                    <jats:italic>Bungarus lividus<\/jats:italic>\n                    ), venomous snakes of the Elapidae family, pose a significant health risk in Assam, Northeast India. However, their clinical effects remain underreported. A retrospective analysis was performed on 10 cases of envenomation attributed to\n                    <jats:italic>B. niger\/B. lividus<\/jats:italic>\n                    . The patients were admitted to a rural health center and two adjacent hospitals in Assam. The victims exhibited severe neurotoxic symptoms, including ptosis, quadriplegia, respiratory muscle weakness, dysphonia, dysphagia, myalgia, and a gradual generalized neuromuscular weakening culminating in respiratory paralysis. The subjects were administered standard commercial polyvalent antivenom (PAV) targeting the \u201cbig four\u201d snakes of India along with calcium gluconate (20 mg\/kg). Standard antivenom was ineffective in reversing the established neuromuscular blockade; however, early administration of PAV before venom-induced damage to the presynaptic granules was linked to accelerated recovery in certain patients. Supportive care, including elective endotracheal intubation and assisted ventilation, was critical for recovery.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0472","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:45:18Z","timestamp":1766069118000},"page":"584-588","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Case Reports on Black Krait (Bungarus niger\/lividus) Neurotoxic Snakebites in Assam, Northeast India"],"prefix":"10.4269","volume":"114","author":[{"given":"Surajit","family":"Giri","sequence":"first","affiliation":[{"name":"Demow Rural Community Health Centre, Sivasagar, India;"},{"name":"Departement of Internal Medicine, Pragati Hospital and Research Centre, Sivasagar, India;"},{"name":"Department of ICU and Critical Care, Siu-ka-pha Multispeciality Hospital, Sivasagar, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirakjyoti","family":"Kakati","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simanta Jyoti","family":"Taye","sequence":"additional","affiliation":[{"name":"Demow Rural Community Health Centre, Sivasagar, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rentu Kumar","family":"Gam","sequence":"additional","affiliation":[{"name":"Demow Rural Community Health Centre, Sivasagar, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Demow Rural Community Health Centre, Sivasagar, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tongkeswar","family":"Deori","sequence":"additional","affiliation":[{"name":"Departement of Internal Medicine, Pragati Hospital and Research Centre, Sivasagar, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joydeep","family":"Rajkhowa","sequence":"additional","affiliation":[{"name":"Department of ICU and Critical Care, Siu-ka-pha Multispeciality Hospital, Sivasagar, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashis K.","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, India;"},{"name":"Institute of Advanced Study in Science and Technology, Guwahati, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Nat Rev Dis Primers","first-page":"17063","article-title":"Snakebite envenoming","volume":"3","author":"Guti\u00e9rrez","year":"2017"},{"key":"b2","series-title":"Emerg Med J","first-page":"200","article-title":"Snakebite envenoming in Kerala, South India: Clinical profile and factors involved in adverse outcomes","volume":"25","author":"Suchithra","year":"2008"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0012080","article-title":"Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality","volume":"18","author":"Afroz","year":"2024"},{"key":"b4","series-title":"Southeast Asian J Trop Med Public Health","first-page":"960","article-title":"Fatal neurotoxic envenomation from the bite of a lesser black krait (Bungarus lividus) in Nepal","volume":"42","author":"Kuch","year":"2011"},{"key":"b5","series-title":"The \u2018Big Four\u2019 Snakes of India: Venom Composition, Pharmacological Properties and Treatment of Envenomation","author":"Mukherjee","year":"2021"},{"key":"b6","series-title":"Brain","first-page":"3181","article-title":"The greater black krait (Bungarus niger), a newly recognised cause of neuro-myotoxic snake bite envenoming in Bangladesh","volume":"133","author":"Faiz","year":"2010"},{"key":"b7","series-title":"Clinical Toxinology in Asia Pacific Africa","first-page":"115","author":"Whitaker","year":"2015"},{"key":"b8","series-title":"Toxicon","first-page":"107175","article-title":"A retrospective analysis of epidemiology, clinical features of envenomation, and inpatient management of snakebites in a model secondary hospital of Assam, North-east India","volume":"230","author":"Kakati","year":"2023"},{"key":"b9","series-title":"Amphibians and Reptiles of Northeast India: A Photographic Guide","author":"Ahmed","year":"2009"},{"key":"b10","series-title":"Toxicon","first-page":"66","article-title":"Venom of several Indian green pit vipers: Comparison of biochemical activities and cross-reactivity with antivenoms","volume":"210","author":"Thakur","year":"2022"},{"key":"b11","series-title":"Toxicon","first-page":"106990","article-title":"Recurrent neurotoxity in Naja kaouthia envenomation: A case report from Assam, India","volume":"222","author":"Giri","year":"2023"},{"key":"b12","series-title":"Common Indian Snakes: A Field Guide","author":"Whitaker","year":"2006"},{"key":"b13","series-title":"Sauria","first-page":"3","article-title":"A new record for the snake fauna of Nepal: Bungarus niger Wall, 1908 (Reptilia: Serpentes: Elapidae)","volume":"23","author":"Tillack","year":"2001"},{"key":"b14","series-title":"J Venom Anim Toxins Incl Trop Dis","first-page":"19","article-title":"Fatal neurotoxic envenomation following the bite of a greater black krait (Bungarus niger) in Nepal: A case report","volume":"22","author":"Pandey","year":"2016"},{"key":"b15","series-title":"Toxicon","first-page":"108406","article-title":"Kraits of Indian subcontinent: Natural history, risks, venom variation, lethality and treatment strategies\u2014A comprehensive review","volume":"262","author":"Talukdar","year":"2025"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"458","article-title":"Distinctive epidemiologic and clinical features of common krait (Bungarus caeruleus) bites in Sri Lanka","volume":"79","author":"Ariaratnam","year":"2008"},{"key":"b17","series-title":"Wilderness Environ Med","first-page":"257","article-title":"Envenoming by the common krait (Bungarus caeruleus) and Asian cobra (Naja naja): Clinical manifestations and their management in a rural setting","volume":"15","author":"Bawaskar","year":"2004"},{"key":"b18","series-title":"Postgrad Med J","first-page":"276","article-title":"Common krait (Bungarus caeruleus) bite in Anuradhapura, Sri Lanka: A prospective clinical study, 1996\u201398","volume":"78","author":"Kularatne","year":"2002"},{"key":"b19","series-title":"Brain","first-page":"2987","article-title":"Envenoming bites by kraits: The biological basis of treatment-resistant neuromuscular paralysis","volume":"128","author":"Prasarnpun","year":"2005"},{"key":"b20","series-title":"Am J Pathol","first-page":"447","article-title":"Nerve terminal damage by \u03b2-bungarotoxin: Its clinical significance","volume":"154","author":"Dixon","year":"1999"},{"key":"b21","series-title":"Toxins (Basel)","first-page":"2533","article-title":"Secreted phospholipases A2 of snake venoms: Effects on the peripheral neuromuscular system with comments on the role of phospholipases A2 in disorders of the CNS and their uses in industry","volume":"5","author":"Harris","year":"2013"},{"key":"b22","series-title":"Acta Trop","first-page":"105460","article-title":"Comparative venom proteomics of banded krait (Bungarus fasciatus) from five geographical locales: Correlation of venom lethality, immunoreactivity and antivenom neutralization","volume":"207","author":"Hia","year":"2020"},{"key":"b23","series-title":"Southeast Asian J Trop Med Public Health","first-page":"518","article-title":"Clinical features of 60 consecutive ICU-treated patients envenomed by Bungarus multicinctus.","volume":"40","author":"Hung","year":"2009"},{"key":"b24","series-title":"Toxicon","first-page":"1070","article-title":"Hyponatraemia, rhabdomyolysis, alterations in blood pressure and persistent mydriasis in patients envenomed by Malayan kraits (Bungarus candidus) in southern Viet Nam","volume":"56","author":"Trinh","year":"2010"},{"key":"b25","series-title":"J Med Toxicol","first-page":"393","article-title":"A controlled clinical trial of a novel antivenom in patients envenomed by Bungarus multicinctus.","volume":"6","author":"Hung","year":"2010"},{"key":"b26","series-title":"Br J Clin Pharmacol","first-page":"446","article-title":"Adverse reactions to snake antivenom, and their prevention and treatment","volume":"81","author":"de Silva","year":"2016"},{"key":"b27","series-title":"Toxins (Basel)","first-page":"393","article-title":"Antibody cross-reactivity in antivenom research","volume":"10","author":"Ledsgaard","year":"2018"},{"key":"b28","series-title":"Toxicon","first-page":"15","article-title":"The in\u00a0vitro laboratory tests and mass spectrometry-assisted quality assessment of commercial polyvalent antivenom raised against the \u2018Big Four\u2019 venomous snakes of India","volume":"192","author":"Patra","year":"2021"},{"key":"b29","series-title":"Res J Med Sci","first-page":"180","article-title":"Clinical case control study of injection calcium gluconate in krait snake bite at tertiary care centre in Tamilnadu","volume":"19","author":"Rajarajan","year":"2025"},{"key":"b30","series-title":"Toxicon","first-page":"1","article-title":"Unusually prolonged neuromuscular weakness caused by krait (Bungarus caeruleus) bite: Two case reports","volume":"193","author":"Gupta","year":"2021"},{"key":"b31","series-title":"J Med Sci Clin Res","first-page":"496","article-title":"A case of krait snake bite responding to calcium gluconate therapy","volume":"7","author":"Sreedevi","year":"2019"},{"key":"b32","series-title":"Prague Med Rep","first-page":"153","article-title":"Severe snakebite envenoming in intensive care","volume":"117","author":"Valenta","year":"2016"},{"key":"b1","series-title":"Nat Rev Dis Primers","first-page":"17063","article-title":"Snakebite envenoming","volume":"3","author":"Guti\u00e9rrez","year":"2017"},{"key":"b2","series-title":"Emerg Med J","first-page":"200","article-title":"Snakebite envenoming in Kerala, South India: Clinical profile and factors involved in adverse outcomes","volume":"25","author":"Suchithra","year":"2008"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0012080","article-title":"Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality","volume":"18","author":"Afroz","year":"2024"},{"key":"b4","series-title":"Southeast Asian J Trop Med Public Health","first-page":"960","article-title":"Fatal neurotoxic envenomation from the bite of a lesser black krait (Bungarus lividus) in Nepal","volume":"42","author":"Kuch","year":"2011"},{"key":"b5","series-title":"The \u2018Big Four\u2019 Snakes of India: Venom Composition, Pharmacological Properties and Treatment of Envenomation","author":"Mukherjee","year":"2021"},{"key":"b6","series-title":"Brain","first-page":"3181","article-title":"The greater black krait (Bungarus niger), a newly recognised cause of neuro-myotoxic snake bite envenoming in Bangladesh","volume":"133","author":"Faiz","year":"2010"},{"key":"b7","series-title":"Clinical Toxinology in Asia Pacific Africa","first-page":"115","author":"Whitaker","year":"2015"},{"key":"b8","series-title":"Toxicon","first-page":"107175","article-title":"A retrospective analysis of epidemiology, clinical features of envenomation, and inpatient management of snakebites in a model secondary hospital of Assam, North-east India","volume":"230","author":"Kakati","year":"2023"},{"key":"b9","series-title":"Amphibians and Reptiles of Northeast India: A Photographic Guide","author":"Ahmed","year":"2009"},{"key":"b10","series-title":"Toxicon","first-page":"66","article-title":"Venom of several Indian green pit vipers: Comparison of biochemical activities and cross-reactivity with antivenoms","volume":"210","author":"Thakur","year":"2022"},{"key":"b11","series-title":"Toxicon","first-page":"106990","article-title":"Recurrent neurotoxity in Naja kaouthia envenomation: A case report from Assam, India","volume":"222","author":"Giri","year":"2023"},{"key":"b12","series-title":"Common Indian Snakes: A Field Guide","author":"Whitaker","year":"2006"},{"key":"b13","series-title":"Sauria","first-page":"3","article-title":"A new record for the snake fauna of Nepal: Bungarus niger Wall, 1908 (Reptilia: Serpentes: Elapidae)","volume":"23","author":"Tillack","year":"2001"},{"key":"b14","series-title":"J Venom Anim Toxins Incl Trop Dis","first-page":"19","article-title":"Fatal neurotoxic envenomation following the bite of a greater black krait (Bungarus niger) in Nepal: A case report","volume":"22","author":"Pandey","year":"2016"},{"key":"b15","series-title":"Toxicon","first-page":"108406","article-title":"Kraits of Indian subcontinent: Natural history, risks, venom variation, lethality and treatment strategies\u2014A comprehensive review","volume":"262","author":"Talukdar","year":"2025"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"458","article-title":"Distinctive epidemiologic and clinical features of common krait (Bungarus caeruleus) bites in Sri Lanka","volume":"79","author":"Ariaratnam","year":"2008"},{"key":"b17","series-title":"Wilderness Environ Med","first-page":"257","article-title":"Envenoming by the common krait (Bungarus caeruleus) and Asian cobra (Naja naja): Clinical manifestations and their management in a rural setting","volume":"15","author":"Bawaskar","year":"2004"},{"key":"b18","series-title":"Postgrad Med J","first-page":"276","article-title":"Common krait (Bungarus caeruleus) bite in Anuradhapura, Sri Lanka: A prospective clinical study, 1996\u201398","volume":"78","author":"Kularatne","year":"2002"},{"key":"b19","series-title":"Brain","first-page":"2987","article-title":"Envenoming bites by kraits: The biological basis of treatment-resistant neuromuscular paralysis","volume":"128","author":"Prasarnpun","year":"2005"},{"key":"b20","series-title":"Am J Pathol","first-page":"447","article-title":"Nerve terminal damage by \u03b2-bungarotoxin: Its clinical significance","volume":"154","author":"Dixon","year":"1999"},{"key":"b21","series-title":"Toxins (Basel)","first-page":"2533","article-title":"Secreted phospholipases A2 of snake venoms: Effects on the peripheral neuromuscular system with comments on the role of phospholipases A2 in disorders of the CNS and their uses in industry","volume":"5","author":"Harris","year":"2013"},{"key":"b22","series-title":"Acta Trop","first-page":"105460","article-title":"Comparative venom proteomics of banded krait (Bungarus fasciatus) from five geographical locales: Correlation of venom lethality, immunoreactivity and antivenom neutralization","volume":"207","author":"Hia","year":"2020"},{"key":"b23","series-title":"Southeast Asian J Trop Med Public Health","first-page":"518","article-title":"Clinical features of 60 consecutive ICU-treated patients envenomed by Bungarus multicinctus.","volume":"40","author":"Hung","year":"2009"},{"key":"b24","series-title":"Toxicon","first-page":"1070","article-title":"Hyponatraemia, rhabdomyolysis, alterations in blood pressure and persistent mydriasis in patients envenomed by Malayan kraits (Bungarus candidus) in southern Viet Nam","volume":"56","author":"Trinh","year":"2010"},{"key":"b25","series-title":"J Med Toxicol","first-page":"393","article-title":"A controlled clinical trial of a novel antivenom in patients envenomed by Bungarus multicinctus.","volume":"6","author":"Hung","year":"2010"},{"key":"b26","series-title":"Br J Clin Pharmacol","first-page":"446","article-title":"Adverse reactions to snake antivenom, and their prevention and treatment","volume":"81","author":"de Silva","year":"2016"},{"key":"b27","series-title":"Toxins (Basel)","first-page":"393","article-title":"Antibody cross-reactivity in antivenom research","volume":"10","author":"Ledsgaard","year":"2018"},{"key":"b28","series-title":"Toxicon","first-page":"15","article-title":"The in\u00a0vitro laboratory tests and mass spectrometry-assisted quality assessment of commercial polyvalent antivenom raised against the \u2018Big Four\u2019 venomous snakes of India","volume":"192","author":"Patra","year":"2021"},{"key":"b29","series-title":"Res J Med Sci","first-page":"180","article-title":"Clinical case control study of injection calcium gluconate in krait snake bite at tertiary care centre in Tamilnadu","volume":"19","author":"Rajarajan","year":"2025"},{"key":"b30","series-title":"Toxicon","first-page":"1","article-title":"Unusually prolonged neuromuscular weakness caused by krait (Bungarus caeruleus) bite: Two case reports","volume":"193","author":"Gupta","year":"2021"},{"key":"b31","series-title":"J Med Sci Clin Res","first-page":"496","article-title":"A case of krait snake bite responding to calcium gluconate therapy","volume":"7","author":"Sreedevi","year":"2019"},{"key":"b32","series-title":"Prague Med Rep","first-page":"153","article-title":"Severe snakebite envenoming in intensive care","volume":"117","author":"Valenta","year":"2016"}],"container-title":["The American Journal of Tropical Medicine and 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