Venom ophthalmia caused by venoms of spitting elapid and other snakes: Report of ten cases with review of epidemiology, clinical features, pathophysiology and management

Toxicon

Volumn 56, Issue 3, 2010, Pages 259-272

  Chu, Edward R ^a   Weinstein, Scott A ^b   White, Julian ^b   Warrell, David A ^c  

^a ROYAL ADELAIDE HOSPITAL   (Australia)

^b WOMEN S AND CHILDREN S HOSPITAL   (Australia)

^c UNIVERSITY OF OXFORD   (United Kingdom)

Author keywords

Spitting elapids; Venom ophthalmia

Indexed keywords

ADRENALIN; ANALGESIC AGENT; ANESTHETIC AGENT; ANTIBIOTIC AGENT; ANTIHISTAMINIC AGENT; BRONCHODILATING AGENT; CORTICOSTEROID; CYCLOPLEGIC AGENT; HEPARIN; SNAKE VENOM; STEROID; TETRACYCLINE; VASODILATOR AGENT;

AFRICA; ASIA; BLEPHARITIS; BLEPHAROSPASM; BLINDNESS; CILIARY MUSCLE SPASM; CLINICAL FEATURE; CONTACT DERMATITIS; CORNEA EROSION; CORNEA OPACITY; DEFENSE MECHANISM; DRUG CONTRAINDICATION; DRUG EFFICACY; ENVENOMATION; EYE DISEASE; EYE INJURY; EYE LAVAGE; EYE PAIN; EYE TOXICITY; FLUORESCENCE ANALYSIS; HUMAN; HYPEREMIA; HYPOPYON; KERATOCONJUNCTIVITIS; NONHUMAN; OUTCOME ASSESSMENT; PATHOPHYSIOLOGY; PREVALENCE; PRIORITY JOURNAL; REVIEW; SECONDARY INFECTION; SLIT LAMP; SNAKE; SNAKEBITE; STEVENS JOHNSON SYNDROME; THERAPY DELAY; TOXIN ANALYSIS; ULCER HEALING; UVEA DISEASE; VENOM OPHTHALMIA; WHEEZING;

ANIMALS; ELAPID VENOMS; ELAPIDAE; ENDOPHTHALMITIS; HUMANS; SNAKE BITES;

ANIMALIA; ELAPIDAE; HEMACHATUS; NAJA; SERPENTES; VIPERIDAE;

EID: 77954142818     PISSN: 00410101     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.toxicon.2010.02.023     Document Type: Review

References (137)

1. Aeliani C., 1832. De Natura Animalium Historiæ Ægypti Naturalis. Pars Prima. Qua continentur Rerum Ægyptiarum. Jenae, Friderico Jacobs: Book iii,33.
2. Afifiyan F., Armugam A., Gopalakrishnakone P., Tan N.H., Tan C.H., Jeyaseelan K. Four new postsynaptic neurotoxins from Naja naja sputatrix venom: cDNA cloning, protein expression, and phylogenetic analysis. Toxicon 1998, 36:1871-1885.
3. Afifiyan F., Armugam A., Tan C.H., Gopalakrishnakone P., Jeyaseelan K. Postsynaptic alpha-neurotoxin gene of the spitting cobra, Naja naja sputatrix: structure, organization, and phylogenetic analysis. Genome Res. 1999, 9:259-266.
4. Ahmad T., Lawrence A.J. Purification and activation of phospholipase A2 isoforms from Naja mossambica mossambica (spitting cobra) venom. Toxicon 1993, 31:1279-1291.
5. Ajao O.G., Hawtin J.G. Snakebite and snake venom ophthalmia. J. Natl. Med. Assoc. 1980, 72:961-964.
6. Allon N., Kochva E. The quantities of venom injected into prey of different size by Vipera palaestinae in a single bite. J. Exp. Zool. 1974, 188:71-75.
7. Alpini P., 1735. Historiæ Ægypti Naturalis. Lugduni Batavorum, Gerardum Potvliet.
8. Azuma H., Sekizaki S., Akizawa T., Yasuhara T., Nakajima T. Activities of novel polyhydroxylated cardiotonic steroids purified from nuchal glands of the snake, Rhabdophis tigrinus. J. Pharm. Pharmacol. 1986, 38:388-390.
9. Barboza du Bocage J.V. Herpétologie d'Angola et du Congo 1895, Ministeere de la Marine et des Colonies, Lisbonne, p. 133.
10. Bartlett C.R. Curious habit of the African Cobra (Naga haje). J. Roy. Army. Med. Corps. 1904, 3:360.
11. Batchelor D.M. Some notes on the snakes of Asahan, Malacca. Malay. Nat. J. 1958, 12:103-111.
12. Bavay M. Le serpent cracheur de la côte occidentale d'Afrique. Bull. Soc. Zool. Franc. 1895, 20:210-213. and Arch. Med. Navale. 64, 427-9.
13. Bérenger-Féraud Note sur les accidents de kerato-conjonctivite produits par le venin d'un serpent du Sénégal. Arch. Med. Navale 1892, 57:241-243.
14. Bernheimer A.W., Weinstein S.A., Linder R. Isoelectric analysis of some Australian elapid snake venoms with special reference to phospholipase B and hemolysis. Toxicon 1986, 24:841-849.
15. Blaylock R.S.M. The treatment of snakebite in Zimbabwe. Cent. Afr. J. Med 1982, 28:237-246.
16. Blaylock R., 2002. The syndromic and specific management of snakebite in South Africa. MD Thesis, Department of Surgery, University of Durban: 273-278.
17. Blaylock R. Epidemiology of snakebite in Eshowe, KwaZulu-Natal, South Africa. Toxicon 2004, 43:159-166.
18. Blaylock R.S. The identification and syndromic management of snakebite in South Africa. SA. Fam. Pract. 2005, 47:48-53.
19. Bogert C.M. Dentitional phenomena in cobras and other elapids, with notes on adaptive modification of fangs. Bull. Am. Mus. Nat. Hist. 1943, 81:285-360.
20. Bosman W. A New and Accurate Description of the Coast of Guinea, Divided into the Gold, the Slave, and the Ivory Coasts 1705, James Knapton, London. first ed.
21. Broadley D.G., Wuster W. A review of the southern African 'non-spitting' cobras (Serpentes: Elapidae: Naja). Afr. J. Herpetol. 2004, 53:101-122.
22. Cantrell F.L. Ocular exposure to rattlesnake venom. J. Toxicol. Clin. Toxicol. 2003, 41:605-606.
23. Cascardi J., Young B.A., Husic H.D., Sherma J. Protein variation in the venom spat by the red spitting cobra, Naja pallida (Reptilia; Serpentes). Toxicon 1999, 37:1271-1279.
24. Cham G., Pan J.C., Lim F., Earnest A., Gopalakrishnakone P. Effects of topical heparin, antivenom, tetracycline and dexamethasone treatment in corneal injury resulting from the venom of the black spitting cobra (Naja sumatrana), in a Rabbit Model. Clin. Toxicol. (Phila) 2006, 44:287-292.
25. Chu ER, White J, Weinstein S.A. Is There Any Role for Intravenous Antivenom for Snake Venom Ophthalmia? J Emerg Med. in press, epub ahead of print.
26. Corkill N.L. Snake poisoning in the Sudan. Venoms 1956, 331-339. American Association for the Advancement of Science, Washington DC. E.E. Buckley, N. Porges (Eds.).
27. David P., Tong H. Translations of recent descriptions of Chinese pit vipers of the Trimeresurus-complex (Serpentes, Viperidae), with a key to the complex in China and adjacent areas. Smithsonian. Herpetol. Inf. Serv. 1997, 112:1-31.
28. Davidson R.A. Case of African cobra bite. Br. Med. J. 1970, 4:660.
29. Duke-Elder, S., 1952. Textbook of Ophthalmology. 5, 4933.
30. Ebell M.H., Siwek J., Weiss B.D., Woolf S.H., Susman J., Ewigman B., Bowman M. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am. Fam. Phys. 2004, 69:548-556.
31. Ehlers, J.P., Shah, C.P., 2008. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, fifth ed. Lippincott, Philadelphia.
32. Fitzsimons F.W. The Snakes of South Africa, Their Venom and the Treatment of Snake Bite 1910, EH Walton, Port Elizabeth.
33. Fraser, T.R., 1911. A note on the Sudan spitting snake. 4th Report Wellcome Tropical Research Lab. Gordon Memorial College, Khartoum-B. (Gen. Sci): 201.
34. Fraunfelder F.W. Corneal toxicity from topical ocular and systemic medications. Cornea 2006, 25:1133-1138.
35. Freyvogel T.A., Honneger C.G. Der " Speiakt" von Naja nigricollis. Acta. Tropica 1965, 22:289-302.
36. Garrett T.R.H. Spitting cobras. Nature 1911, 86:381.
37. Gilkes M.J. Snake venom conjunctivitis. Br. J. Ophthalmol. 1959, 43:638-639.
38. Goring Jones M.D. Can a cobra eject its venom?. J. Bombay. Nat. Hist. Soc. 1900, 13:376.
39. Greene H. Snakes: the evolution of mystery in nature 1997, University of California Press, Berkeley.
40. Greenham R. Spitting Cobra (Naja mossambica pallida) bite in a Kenyan child. Trans. R. Soc. Trop. Med. Hyg. 1978, 72:674-675.
41. Grüntzig J., Lenz W., Mebs D. Licht-, raster- und transmissionselektronmikroskopische Untersuchungen zur Spei-Kobra-Verletzung. Fortschr. Ophthalmol. 1984, 81:231-233.
42. Grüntzig J., Lenz W., Berkemeier B., Mebs D. Experimental studies on the spitting cobra ophthalmia (Naja nigricollis). Graefes. Arch. Clin. Exp. Ophthalmol. 1985, 223:196-201.
43. Gumprecht A., Boyer D.M., Tepedelen K. Die Grubenottern der Gattung Trimeresurus (sensu lato) Lacépède, Teil I: Anmerkungen zur Biologie, Haltung und Nachzucht von Ermia mangshanensis (Zhao 1990). Sauria 2002, 24:1-11.
44. Hansen E.A., Stein E.A., Mader T.H., Mazzoli R.A. Spitting cobra ophthalmia in United Nations Forces in Somalia. Am. J. Ophthalmol. 1994, 117:671.
45. Harvey A.L. Snake Toxins 1991, Pergamon, New York.
46. Hayes W. Venom metering by juvenile prairie rattlesnakes (Crotalus v. viridis): effects of prey size and experience. Anim. Behav. 1995, 50:33-40.
47. Hayes W., Herbert S., Reeling G., Gennaro J. Factors that influence venom expenditure by vipers and other snakes during predatory and defensive contexts. Biology of the Vipers 2002, Biological Sciences Press, Traverse City. G.W. Schuett, M. Höggren, H.W. Greene (Eds.).
48. Hayes W.K., Herbert S.S., Harrison J.R., Wiley K.L. Spitting versus Biting: Differential Venom Gland Contraction Regulates Venom Expenditure in the Black-Necked Spitting Cobra, Naja nigricollis nigricollis. J. Herpetol 2008, 42:453-460.
49. Horton C.W. On the mechanism of spitting in the African spitting cobras. Copeia 1948, 1:23-25.
50. Hutchinson D.A., Mori A., Savitzky A.H., Burghardt G.M., Wu X., Meinwald J., Schroeder F.C. Dietary sequestration of defensive steroids in nuchal glands of the Asian snake, Rhabdophis tigrinus. Proc. Natl. Acad. Sci. U.S.A. 2007, 104:2265-2270.
51. Ismail M., Ellison A.C. Ocular effects of the venom from the spitting cobra (Naja nigricollis). J. Toxicol. Clin. Toxicol. 1986, 24:183-202.
52. Ismail M., al-Bekairi A.M., el-Bedaiwy A.M., Abd-el Salam M.A. The ocular effects of spitting cobras: I. The ringhals cobra (Hemachatus haemachatus) venom-induced corneal opacification syndrome. J. Toxicol. Clin. Toxicol. 1993, 31:31-41.
53. Ismail M., al-Bekairi A.M., el-Bedaiwy A.M., Abd-el Salam M.A. The ocular effects of spitting cobras: II. Evidence that cardiotoxins are responsible for the corneal opacification syndrome. J. Toxicol. Clin. Toxicol. 1993, 31:45-62.
54. Jackson K. The evolution of venom-delivery systems in snakes. Zool. J. Linn. Soc. 2003, 137:337-354.
55. Jeyaseelan K., Poh S.L., Nair R., Armugam A. Structurally conserved alpha-neurotoxin genes encode functionally diverse proteins in the venom of Naja sputatrix. FEBS. Lett. 2003, 553:333-341.
56. Johnson R. Ophthalmic exposure to crotalid venom. J. Emerg. Med. 2009, 36:37-38.
57. Kao P.H., Chen K.C., Lin S.R., Chang L.S. The structural and functional contribution of N-terminal region and His-47 on Taiwan cobra phospholipases A2. J. Pept. Sci. 2008, 14:342-348.
58. Kao P.H., Wu M.J., Chang L.S. Membrane bound conformation of Naja nigricollis toxin gamma affects its membrane-bound damaging activity. Toxicon 2009, 53:342-348.
59. Kardong K.V. Snake toxins and venoms: an evolutionary perspective. Herpetologica 1996, 52:36-46.
60. Kawamoto F., Kumada N. A case report of eye-injury caused by cervical gland venom of a snake, Rhabdophis tigrinus (Boie). Japan. J. Sanit. Zool. 1989, 40:211-212.
61. Khalil M. Snake bite. (Discussions by Ibrahim B p195). Bull. Ophth. Soc. Egypt 1958, 51:687-695.
62. Koch M., Sachs W.B. Über zwei giftspeiende Schlangen, Sepedon haemachates und Naia nigricollis. Zool. Anz. 1927, 70:155-159.
63. Kopstein, F., 1930. De Javaansche giftslangen en haar beteekenis voor den mensch. Weltevreden, Visser. 16-31.
64. Lam A., N'Diaye M.R. Traumatismes oculaires au Sénégal: bilan épidemiologique et statistique de 1872 cas. Med Afr Noire 1992, 39:810-815.
65. Lath N.K., Patel M.M. Treatment of snake venom ophthalmia. Cent. Afr. J. Med. 1984, 30:175-176.
66. Lee Y., Chan S.I. Effect of lysolecithin on the structure and permeability of lecithin bilayer vesicles. Biochemistry 1977, 16:1303-1309.
67. Leisewitz A.L., Blaylock R.S., Kettner F., Goodhead A., Goddard A., Schoeman J.P. The diagnosis and management of snakebite in dogs - a southern African perspective. J.S. Afr. Vet. Assoc. 2004, 75:7-13.
68. Lim L.K., Lee T.M. Fascinating Snakes of Southeast Asia: An Introduction 1989, Tropical Press, Kuala Lumpur, pp. 19.
69. Lobetti R.G., Joubert K. Retrospective study of snake envenomation in 155 dogs from the Onderstepoort area of South Africa. J.S. Afr. Vet. Assoc. 2004, 75:169-172.
70. Maclaud Notes sur le naja cracheur et le serum antivenimeux du Dr Calmette. Arch. Med. Navale 1896, 66:392-398.
71. Matthews J. A Voyage to the River Sierra-Leone, on the Coast of Africa 1788, B. White and Son, London, pp. 42-46.
72. McNally S.L., Reitz C.J. Victims of snakebite. A 5-year study at Shongwe Hospital, Kangwane, 1978-1982. S. Afr. Med. J. 1987, 72:855-860.
73. Mebs D. Venomous and Poisonous Animals 2002, Medpharm, Stuttgart, pp. 339.
74. Meyer D. Essential topical ocular diagnostic drugs for the family practitioner. S.A. Fam. Pract. 2004, 46:16-18.
75. Minton S.A. Venom Diseases 1974, Thomas, Springfield, pp. 235.
76. Minton S.A., Minton M.R. Venomous Reptiles 1980, Charles Scribner's Sons, New York, pp. 308.
77. Mole R.R. The Trinidad snakes. Proc. Zool. Soc. Lond. 1924, 1:235-278.
78. Namiranian S., Hider R.C. Use of HPLC to demonstrate variation of venom toxin composition in the Thailand cobra venoms Naja naja kaouthia and Naja naja siamensis. Toxicon 1992, 30:47-61.
79. Patterson J.H. The Man-eaters of Tsavo 1907, Macmillan, London, pp. 163-165.
80. Patterson W. A Narrative of Four Voyages into the Country of the Hottenttots and Caffraria 1798, J. Johnson, London.
81. Payne T., Warrell D.A. Effects of venom in eye from spitting cobra. Arch. Ophthalmol. 1976, 94:1803.
82. Pe T., Htut T., Myint A.A., Tun M.T. Venom ophthalmia following spitting of venom into the eye by spitting cobra (Naja mandalayensis) in Myanmar. Myanmar Health Sci. Res. J. 2002, 14:42-44.
83. Pergola A. Affezioni oculari da veleno di " Naja Nigricollis" (Osservazioni cliniche). Boll. Asoc. Italiano.Med. Igenia. Trop. 1942, 1:80-90.
84. Petit L. Sur le serpent cracheur. Bull. Soc. Zool. Franc. 1895, 20:239.
85. Pharmakakis N.M., Katsimpris J.M., Melachrinou M.P., Koliopoulos J.X. Corneal complications following abuse of topical anesthestics. Eur. J. Ophthalmol. 2002, 12:373-378.
86. Pliny the Elder, 1855-57. The natural history of Pliny. Tr., with copious notes and illustrations, by the late John Bostock and H.T. Riley. London, H.G. Bohn.
87. Prescott R.A., Potter P.C. Hypersensitivity to airborne spitting cobra snake venom. Ann. Allergy. Asthma. Immunol. 2005, 94:600-603.
88. Pugh R.N., Theakston R.D., Reid H.A. Malumfashi Endemic Diseases Research Project, XIII. Epidemiology of human encounters with the spitting cobra, Naja nigricollis, in the Malumfashi area of northern Nigeria. Ann. Trop. Med. Parasitol. 1980, 74:523-530.
89. Reid H.A. Cobra-bites. Br. Med. J. 1964, 2:540-545.
90. Ridley H. Snake venom ophthalmia. Br. J. Ophthalmol. 1944, 28:568-572.
91. Rodger F.C. Blindness in West Africa 1959, H.K.Lewis, London.
92. Roosevelt T. African Game Trails: An account of the African wanderings of an American Hunter-Naturalist 1910, Charles Scribner's Sons, New York.
93. Rosenwasser G.O. Complications of topical ocular anesthetics. Int. Ophthalmol. Clin. 1989, 29:153-158.
94. Rouvin B., Kone M., N'Diaye M., Seck M., Diatta B. Cobras cracheurs: 2 observations à Djibouti. Médicine Tropicale (Mars.) 2010, 70(1):95-96.
95. Ruata V. Oftalmologia dei Paesi Caldi 1938, Hoepli, Milan.
96. Saint Girons H. Les Serpents du Cambodge. Mémoires du Muséum National d'Histoire Naturelle Série A 1972, 74. 1-170 + plates.
97. Sarnelli T. Manifestazioni oculare del'ofidismo e congiuntiviti da sputo di serpenti nelle nostre colonie. Arch. Ital. Sci. Med. Trop. Parassitol. 1935, 16:769-789.
98. Sawai Y., Kawamura Y., Toriba M., Kobayashi T., Wang N.P., Li C.B., Li B.Y., Li Z.Y., Li H.P., Tang S.X. An epidemiological study on the snake bites in Guangxi Zhuang autonomous region, China in 1990. Snake 1992, 24:1-15.
99. Shattock F.M. Injuries caused by wild animals. Lancet 1968, 1:412-415.
100. Sinha A.K. Cobra-venom conjunctivitis. Lancet 1972, 6:1026.
101. Slowinski J. Letter from the field. On the Road from Mandalay Where the Spitting Cobras Play California Wild 53:2 http://research.calacademy.org/calwild/2000spring/stories/letterfromfield.html.
102. Slowinski J.B., Wüster W. A new species of cobra (Elapidae: Naja) from Myanmar (Burma). Herpetologica 2000, 56:257-270.
103. Smith A. Illustrations of the zoology of South Africa. Reptilia 1849, vol. 3. Smith, Elder, London.
104. Spawls S. Notes on spitting by a red spitting cobra Naja mossambica pallida. E. African. Nat. Hist. Soc. Bull. 1976, 70-71.
105. Stones P.B. Nigerian snakes - a brief conspectus. Nigerian. Field 1949, 14:151-157.
106. Strover H.M. Snake bite and its treatment. Trop. Dis. Bull. 1955, 52:421-426.
107. Strover H.M. Snakebite and its treatment. Cent. Afr. J. Med. 1961, 7:84-87.
108. Strover H.M. Observations on two cases of snake-bite by Naja nigricollis ss mossambica. Cent. Afr. J. Med. 1973, 19:12-13.
109. Sun M.H., Huang S.C.M., Chen T.L., Tsai R.J.F. Topical ocular anesthetic abuse: case report. Chang Gung Med. J. 2000, 23:377-381.
110. Taylor E.H. The Snakes of the Philippine Islands 1922, Bureau of Printing, Manila, pp. 1-132.
111. Taylor E.H. The serpents of Thailand and adjacent waters. Univ. Kansas. Sci. Bull. 1965, 45:609-1096.
112. Taylor E.H., Leonard A.B., Smith H.M., Pisani G.R. Edward H. Taylor: Recollections of an Herpetologist. Monograph of the Museum of Natural History, the University of Kansas; no. 4 1975, Museum of Natural History, University of Kansas, Lawrence.
113. Tilbury C.R. Observations on the bite of the Mozambique spitting cobra (Naja mossambica mossambica). S. Afr. Med. J. 1982, 61:308-313.
114. Troutman W.G., Wilson L.E. Topical ophthalmic exposure to rattlesnake venom. Am. J. Emerg. Med. 1989, 7:307-308.
115. Wang C.H., Liu J.H., Lee S.C., Hsiao C.D., Wu W.G. Glycosphingolipid-facilitated membrane insertion and internalization of cobra cardiotoxin. The sulfatide cardiotoxin complex structure in a membrane-like environment suggests a lipid-dependent cell-penetrating mechanism for membrane binding polypeptides. J. Biol. Chem. 2006, 281:656-667.
116. Warrell D.A., Greenwood B.M., Davidson N.M., Ormerod L.D., Prentice C.R. Necrosis, haemorrhage and complement depletion following bites by the spitting cobra (Naja nigricollis). Q. J. Med. 1976, 45:1-22.
117. Warrell D.A., Ormerod L.D. Snake venom ophthalmia and blindness caused by the spitting cobra (Naja nigricollis) in Nigeria. Am. J. Trop. Med. Hyg. 1976, 25:525-529.
118. Warrell D.A. Clinical toxicology of snakebite in Africa and the Middle East/Arabian Peninsula. Handbook of Clinical Toxicology of Animal Venoms and Poisons 1995, 433-492. CRC Press, Boca Raton. J. Meier, J. White (Eds.).
119. Warrell D.A. Clinical toxicology of snakebite in Asia. Handbook of Clinical Toxicology of Animal Venoms and Poisons 1995, 493-594. CRC Press, Boca Raton. J. Meier, J. White (Eds.).
120. Warrell D.A. WHO/SEARO guidelines for the clinical management of snake bites in the Southeast Asian region. Southeast Asian J. Trop. Med. Pub. Health 1999, 30:1-85.
121. Warrell D.A. Epidemiology, clinical features and management of snake bites in Central and South America. Venomous Reptiles of the Western Hemisphere 2004, 709-761. Cornell University Press, Ithaca. J. Campbell, W.W. Lama (Eds.).
122. Warrell D.A. Management of exotic snake bites. Q. J. Med. 2009, 102:593-601.
123. Weinstein S.A., Schmidt J.J., Smith L.A. Cross-neutralization and lethal toxins of venoms from the African water cobras (Boulengerina annulata annulata and Boulengerina christyi). Toxicon 1991, 29:1315-1327.
124. Weinstein S.A., Kardong K.V. Properties of Duvernoy's secretions from opisthoglyphous and aglyphous colubrid snakes. Toxicon 1994, 32:1161-1185.
125. Weinstein S.A., Smith T., Kardong K.V. Reptile venom glands: form, function and future. Handbook of Reptile Venoms and Toxins 2009, 65-94. CRC Press, Boca Raton. S.P. Mackessy (Ed.).
126. Westhoff G., Tzschätzsch K., Bleckmann H. The spitting behavior of two species of spitting cobras. J. Comp. Physiol. A. Neuroethol. Sens. Neural. Behav. Physiol. 2005, 191:873-881.
127. Winterbottom T.M. An Account of the Native Africans in the Neighbourhood of Sierra Leone 1803, C. Whittingham, London.
128. Wüster W., Thorpe R.S. Dentitional phenomena in cobras revisited: spitting and fang structure in the Asiatic species of Naja (Serpentes: Elapidae). Herpetologica 1992, 48:424-434.
129. Wüster W., Thorpe R.S. Naja siamensis, a cryptic species of venomous snake revealed by mt DNA sequencing. Experientia 1994, 50:75-79.
130. Wüster W. Taxonomic changes and toxinology: systematic revision of the Asiatic cobras (Naja naja species complex). Toxicon 1996, 34:399-406.
131. Wüster W., Warrell D.A., Cox M.J., Jintakune P., Nabhitabhata J. Redescription of Naja siamensis (Serpentes: Elapidae), a widely overlooked spitting cobra from SE Asia: geograpic variation, medical importance and designation of a neotype. J. Zool. Lond. 1997, 243:771-788.
132. Wüster W., Crookes S., Ineich I., Mané Y., Pook C.E., Trape J.F., Broadley D.G. The phylogeny of cobras inferred from mitochondrial DNA sequences: evolution of venom spitting and the phylogeography of the African spitting cobras (Serpentes: Elapidae: Naja nigricollis complex). Mol. Phylogenet. Evol. 2007, 45:437-453.
133. Yaya G., Danaï A. Treatment of ocular lesions due to Elapidae venom spitting in Central African Republic: epidemiological and clinical aspects. Bull. Soc. Pathol. Exot. 2007, 100:111-114.
134. Young B.A., Dunlap K., Koenig K., Singer M. The buccal buckle: the functional morphology of venom spitting in cobras. J. Exp. Biol. 2004, 207:3483-3494.
135. Young B.A., O'Shea M. Analysis of venom spitting in African Cobras. Afr. Zool. 2005, 40:71-76.
136. Young B.A., Boetig M., Westhoff G. Functional bases of the spatial dispersal of venom during cobra " spitting" Physiol. Biochem. Zool. 2009, 82:80-89.
137. Zanettin G. Osservazioni sulle lesioni oculari determinate dal veleno della " Naja Nigricollis" in Eritrea. Arch. Ital. Sci. Med. Colon 1935, 16:856-858.