A snake bites once, but its picture is used twice

For some people, a venomous snake is a venomous snake — and evidently, some of those people include journal editors.  

The authors of a 2019 case report describing the unfortunate case of an African farmer killed by the bite of a lethal snake have lost the article because the mug shot of the reptilian culprit didn’t match its description in the paper. 

The paper, “Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report,” appeared in BMC Emergency Medicine, a Springer Nature title. 

It described the case of a 47-year-old Cameroonian woman who was bitten by the deadly West African carpet viper while farming — whose bite leads to more deaths than all other species of African snake combined. After first seeking treatment with a local “traditional healer,” who offered her herbal remedies that did not improve her condition, the woman eventually was taken to Yaoundé Central Hospital, where, 10 hours after being admitted — and despite the reported administration of three vials of antivenin — she died of the injury. 

According to the paper:

The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting.

The article includes a picture of the beheaded snake — see the image at the top of this post — and therein lies the tale.

As it happens, that image is not of a carpet viper, but of another fearsome reptile, the black cobra (also called the black and white-lipped, or forest, cobra). 

Here’s a carpet viper for comparison: 

Clearly different animals — and, for a herpetologist, a bit like a canine specialist mistaking a Doberman for a dachshund. 

Here’s the notice, which also points out another serious flaw: 

The authors have retracted this case report [1] because the head of the snake shown in Figure 1 and described as being that of a viper (Echis occellatus) is identical to the head of a snake shown in Figure 1 of a different case report [2] where it was identified as being Naja melanoleuca, a member of the Elapidae family. The authors do not have records of the manufacturer and batch numbers of the 3 vials of anti-venom serum administered to the patient in [1]. All authors agree with this retraction.

That second paper was:

Tianyi F, Agbor VN, Tochie JN, et al. Community-based audits of snake envenomations in a resource-challenged setting of Cameroon: case series. BMC Res Notes. 2018;11:317 https://doi.org/10.1186/s13104-018-3409-3.

We note that both journals are published by Springer Nature.

We’re hoping that the reason the victim died of the bite was not because she received the wrong anti-venin, and that the image mixup was, well, post-production. 

We asked the corresponding author about the discrepancies but haven’t heard back. We also sought comment from the journal about the paper but haven’t received a response.

Meanwhile, here’s a reference guide to snakes that might come in handy the next time around.

You know what they say: Once bitten, twice, well, something.

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