Category Archives: toxin

More dangers of centipedes?

Sometimes, when you’re in Rome, you shouldn’t act like Romans. This case report comes from Taiwan, where the authors got to take care of this intriguing case. A 49 year old male patient presented to the hospital with bullous lesions on his upper extremities. He noticed them upon waking up from his bender of 600mL of 53% ABV fortified wine. Not surprisingly, he slept on the floor the night previously, and was apparently wedged in a narrow space.

Of note, he also had neurologic deficits of his bilateral hands. Labs showed leukocytosis, rhabdomyolysis, and acute kidney injury. While all of them could be explained by blacking out in an awkward position, the confounding variable was what was in the wine.

You see, many traditional Chinese therapies involve alcohol with plant or animal “infusions.” This particular wine was made with a 14cm Scolopendra subspinipes mutilans centipede. And since there are reports of skin necrosis, neuropathies, rhabdomyolysis, and kidney injury from centipede venom in the literature, there is a possibility that some of his condition was secondary to the centipede. In the end though, it is still most likely that it was all related to the alcohol, as I can’t find data showing that centipede venom is stable in either alcohol or stomach acid.

All the same, I wouldn’t recommend you drink a little or a lot of a wine made from a venomous creature. While these wines are not as prevalent today as they were historically, you can still go into stores in China and Southeast Asia and find bottles containing snakes, scorpions, centipedes, and other animals.

Rhabdomyolysis, Acute Renal Failure, and Multiple Focal Neuropathies After Drinking Alcohol Soaked with Centipede
http://www.ncbi.nlm.nih.gov/pubmed/15083930

The shocking pink dragon millipede

Imagine you’re caving in Thailand, and you see a pink millipede. Against your better judgement, you bend over and pick it up. Then you smell almonds…

This is a slightly different type of article that may or may not have much clinical relevance, but it is an interesting creature nonetheless. At 3cm long, it’s certainly not huge, but it’s bright pink. And that almond smell? The millipede produces hydrogen cyanide from defensive glands. It doesn’t produce enough to kill through skin absorption, but it could certainly ruin your day if you tried to eat one.

Best part of the (relatively dry) article: “We think that such an unusually coloured, conspicuous millipede deserves more than a Latin name and suggest calling it “The shocking pink dragon millipede” (in Thai: Mangkorn Chomphoo).” Who knew that biologists had such a sense of humor?

The shocking pink dragon millipede, Desmoxytes purpurosea, a colorful new species from Thailand (Diplopoda: Polydesmida: Paradoxosomatidae)
http://zoologi.snm.ku.dk/Zm_billeder_container/Enghoff.pdf

Why do my hands feel so cold?

Ciguatera, the illness caused by eating foods contaminated by ciguatoxin, can ruin your day, week, or month.  The problem starts with Gambierdiscus toxicus, a dinoflagellate that is eaten by small fish.  They produce ciguatoxins, which biaccumulate up the food chain until they are present in toxic levels in larger reef fish.

The article gives an in depth review of ciguatera. It likely affects somewhere between 10,000 and 50,000 people per year.  It is reportable to the health department in many states.   Unfortunately, no tests can detect it in humans, so it remains a diagnosis based on history and physical. The symptoms are quite variable in patients, so much so that the author uses 1.5 pages of a table to demonstrate this. The hot/cold reversal that is pathognomic of this disease at ABEM General is not always present in patients with CFP.  It can also be present in Neurotoxic Shellfish Poisoning, so buyer beware.

Treatments have sadly been wanting.  Few well designed trials have demonstrated a benefit of certain treatments, but there are some that show promise.  IV Mannitol is the most studied, and is recommended as a treatment if given in the first 48-72 hours after symptom onset.  All other treatments are purely symptomatic based on symptoms, such as atropine for bradycardia, TCAs for paresthesias and headaches, and antiemetics. They note that opiates should be avoided due to possible effects with maitotoxin, which can be present in fish with ciguatoxin. No herbal remedies are recommended due to lack of evidence.

Interestingly, the authors report that alcohol, nuts, caffeine, fish, pork, chicken, and physical activity have all caused recurrence of symptoms, but again, the effect is variable. They also list a large list of fish that commonly cause ciguatera, and the usual commentary on not eating viscera or roe of the same.

The authors do point out that only 17% of the physicians in one study gave mannitol to a classic CFP patient, and less than half knew it was a reportable condition(in the state they practiced).  They end with an exhaustive, 11 point list of recommendations for “best practice” that is far too long to post here.

Ciguaterra Fish Poisoning: Treatment, Prevention, and Management
http://www.ncbi.nlm.nih.gov/pubmed/19005579
Open Access: http://www.mdpi.com/1660-3397/6/3/456
Image courtesy of http://www.myfloridaeh.com/medicine/aquatic/ciguatera.html