Fatal infective necrotising fasciitis: Complication following Naja nigricincta nigricincta bite (western barred spitting cobra/zebra snake).

Wound infections following cytotoxic snakebites are common. Bites from Naja nigricincta nigricincta (an African spitting cobra) usually present as severe dermonecrosis spreading within the subdermal fascia layer. Primary infections can follow inoculation of the snake's oral flora during the bite, worsening the dermonecrosis into infective necrotising fasciitis. We report the case of a 2½-year-old boy who presented with infective (Proteus vulgaris) necrotising fasciitis after an N. n. nigricincta bite, resulting in multiple-organ failure and death. A P. vulgaris with the same antibiotic profile was cultured from the mouth of the snake.

Spitting cobra (Naja nigricincta nigricincta) bites complicated by rhabdomyolysis, possible intravascular haemolysis, and coagulopathy.

Zebra snake (Naja nigricincta nigricincta) bite is a significant health problem in Namibia. Although fatalities are thought to be rare, the severe cytotoxic effects and debilitating consequences of neglected bites are well documented. The focus of our treatment has always been the urgent treatment of necrosis. Although there have been a few reports of infant fatalities, acute renal failure and mild coagulation problems, systemic effects after envenomation were not well documented. Three case reports of patients with rhabdomyolysis, intravascular haemolysis and coagulopathy following N. n. nigricincta bites are presented.