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. 2025 Jul 7;19(7):e0013271.
doi: 10.1371/journal.pntd.0013271. eCollection 2025 Jul.

The frequency, clinical characteristics and outcomes of Naja species related injuries in Malaysia consulted to Remote Envenomation Consultancy Services from 2020-2023

Ahmad Khaldun Ismail  1 , Zhi Xuan Ng  1 , Syahirah Rezwan Eskandar  1 , Hamelda Tanisha Ganaprakasam  1 , Zainalabidin Mohamed Ismail  2
Affiliations

The frequency, clinical characteristics and outcomes of Naja species related injuries in Malaysia consulted to Remote Envenomation Consultancy Services from 2020-2023

Ahmad Khaldun Ismail et al. PLoS Negl Trop Dis. .

Abstract

Naja species bites and envenomation are common in Malaysia. This is a retrospective cohort study of diagnosed Naja species cases consulted to Remote Envenomation Consultancy Services (RECS) from 2020 to 2023. This study aimed to identify the frequency, geographical distribution, clinical features, treatments, and outcomes of Naja species-related injuries. Data was extracted following the approval of the institutional research ethics committee and all patient's information were kept anonymous. From 4474 RECS consultations, 512 were diagnosed as caused by Naja species. Naja kaouthia cases were mostly from the northern and central Peninsular Malaysia, while Naja sumatrana was recorded nationwide. There were 184 (35.9%) cases diagnosed as undifferentiated Naja species bites, 144 (28.1%) N. sumatrana bites, 121 (23.6%) N. kaouthia bites, 61 (11.9%) venom ophthalmia and 2 (0.4%) involved bites and venom ophthalmia from N. sumatrana. The mean age was 36.2 years old (SD ± 20.7), and 69.9% were male. The median bite to door time was 1 h (IQR: 0-2 h). The most frequent anatomical region involved was the lower limb (52.1%). Local envenomation is the commonest manifestation (n = 366, 81.2%). Pain (n = 386) and swelling (n = 310) were frequent signs of local envenomation, while vomiting (n = 54) and ptosis (n = 37) were commonest signs of systemic envenoming. Antivenom was administered in 157 (30.7%) cases and 78.3% were Thai Red Cross Cobra antivenom. The median time interval for door to receiving the first dose of antivenom was 12 h (IQR: 5.5-14.5 h). Surgical intervention was performed in 53 (11.8%) cases, mostly were for wound debridement. Four deaths were documented and were due to secondary complications. No antivenom usage, morbidity or death following venom ophthalmia incident. These findings highlight the importance of expert support for healthcare professionals for early clinical decision-making to reduce complications and enhance outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Morphological features of N. kaouthia and N. sumatrana.
(A) Ventral view of N. kaouthia. Image credit: M.K. Arif. (B) Dorsal view of N. kaouthia. Image credit: M.K. Arif. (C) Ventral view of N. sumatrana. Image credit: M.K. Arif. (D) Dorsal view of N. sumatrana. Image credit: M.K. Arif.
Fig 2
Fig 2. Frequency and diagnosis of Naja spp. related injuries consulted to RECS from 2020-2023.
The consultations with RECS remained similar during COVID-19 pandemic and endemic phase.
Fig 3
Fig 3. Geographical distribution of confirmed Naja spp. related injuries patients.
Most N. sumatrana cases were from Johor and N. kaouthia cases were from Selangor. There were also N. kaouthia cases from Pahang, Terengganu, Johor, Negeri Sembilan and Sarawak. Base map static image and data from OpenStreetMap and OpenStreetMap Foundation. (Copyright OpenStreetMap contributors, https://www.openstreetmap.org/#map=6/4.23/108.24).
See this image and copyright information in PMC

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