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Injuries Were More Extensive After Zebra Spitting Cobra Bites Than Puff Adder Bites in Namibia

Puff adder in natural habitat
Conservation · Human–wildlife conflict

A prospective hospital study in Namibia, in which patients were followed from admission onward, found clear differences in the clinical patterns after bites attributed to zebra spitting cobras (Naja nigricincta nigricincta) and puff adders (Bitis arietans). Tissue necrosis developed in 11 of 12 zebra spitting cobra cases and four of eight puff adder cases. Cobra cases also had more laboratory evidence of systemic involvement—effects extending beyond the bite area—whereas puff adder cases mainly involved local tissue injury. The study was published on 24 July 2026 in BioMed Research International.

The researchers followed 20 patients admitted to Katutura Intermediate Hospital and Windhoek Central Hospital between December 2020 and March 2022. Twelve cases were attributed to zebra spitting cobras and eight to puff adders. Species identification relied on patient or witness reports, photographs from the scene and, in some cases, direct examination of a snake brought to hospital. Because these were referral hospitals, the sample was likely weighted toward more severe bites.

The bites occurred in different settings

The circumstances also differed between the two species. Seven of the eight puff adder bites occurred outdoors, and six of the eight patients were children aged 15 years or younger. Zebra spitting cobra bites occurred mainly indoors and often while people were sleeping. The authors relate the outdoor pattern of puff adder bites to the snake’s ground-dwelling ambush behaviour.

Severe local tissue injury occurred in both groups

Severe local tissue damage occurred in both groups, but it was more frequent in the zebra spitting cobra cases. Clinically suspected compartment syndrome — dangerous pressure building within a closed muscle compartment and threatening local circulation and tissue — was recorded in seven of 12 cobra cases and two of eight puff adder cases. Across all 20 patients, 12 underwent at least one surgical procedure and three required an amputation; two amputations followed zebra spitting cobra bites and one followed a puff adder bite. Only three patients received antivenom, too few for the study to determine how effective it was.

Cobra cases showed more effects beyond the bite area

The laboratory results showed the clearest contrast. Zebra spitting cobra cases included anaemia, haemolysis — breakdown of red blood cells — rhabdomyolysis, meaning breakdown of skeletal-muscle tissue, and signs of liver or kidney involvement. Puff adder cases showed little evidence of comparable effects beyond the bite area. No deaths occurred. The authors stress that the sample was small and non-random, and that laboratory testing was incomplete for some patients. They present it as baseline clinical evidence for snakebite care in Namibia rather than as an estimate of how often these outcomes occur among all people bitten by either species.

Sources and image credit

  1. Ndongi, Nepolo & Hunter (2026), BioMed Research International — Clinicopathological Features, Management, and Outcomes of Zebra Spitting Cobra (Naja nigricincta nigricincta) and Puff Adder (Bitis arietans) Snakebites in NamibiaPrimary peer-reviewed open-access prospective observational study, first published 24 July 2026. Followed 20 hospitalized patients at two referral hospitals in Namibia, including eight puff adder bites and 12 zebra spitting cobra bites; documents local tissue pathology, laboratory findings, treatment and outcomes. The authors explicitly note limitations including small sample size, convenience sampling, referral bias toward severe cases and incomplete laboratory investigations.

Image: Bernard DUPONT — wild puff adder photographed at Sweni, S37 Road east of Satara, Kruger National Park, South Africa, on 2 February 2022; Wikimedia Commons / Flickr; representative image of one of the two snake species compared in the Namibian hospital study · CC BY-SA 2.0 — https://creativecommons.org/licenses/by-sa/2.0/ · Source

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