Arizona hinshawii Septicemia Associated with Rattlesnake
Powder -- California
In November 1982, a 61-year-old Hispanic woman who had been
undergoing palliative chemotherapy for an unresectable primary
adenocarcinoma of the gall bladder was hospitalized in Oakland,
California, with abdominal discomfort, rigors, fever to 39.4 C (103
F), and a neutropenia of 264 white blood cells per mm((3)).
Admission
blood cultures grew A. hinshawii.
Initial questioning revealed no apparent source for infection.
After reading a report of overwhelming infection with Arizona
hinshawii in a cancer patient who had taken snake powder capsules
(1),
her physician asked about this and other non-prescribed remedies.
A
daughter had administered snake capsules to her mother daily, along
with medicine prescribed by her physician. One such capsule
obtained
from the daughter grew Escherichia coli, E. cloacae, enterococcus,
Salmonella phoenix, Staphylococcus epidermidis, and A. hinshawii.
After treatment with ampicillin, the patient's white blood cell
count returned to normal, and blood cultures became negative, but
fever persisted. Chloramphenicol was started, and she gradually
improved and returned home.
Joint investigation by state and federal food and drug agencies
at
the Oakland retail herb and medicine shop where the capsules were
purchased led to a state embargo and seizure of the rattlesnake
powder
(Pulvo de Vibora). Recovered capsules grew Salmonella species S.
newport, S. poona, S. anatum, and several A. hinshawii serotypes.
Two
Los Angeles importers selling these folk remedies were identified;
both agreed to discontinue importation and sale of Pulvo de Vibora.
The source of the rattlesnake capsules in Mexico was not
determined.
Editorial Note
Editorial Note: Arizona hinshawii is a gram-negative bacillus in
the
Enterobacteriaceae family and resembles the genus Salmonella
antigenically, clinically, and epidemiologically. It was first
recovered in 1939 from diseased reptiles in Arizona and was
initially
called "S. dar-es-saalam variety from Arizona." It was later
distinguished from Salmonella, but as of July 1, 1983, CDC
reclassified A. hinshawii with the genus Salmonella, as Salmonella
(Arizona) and the appropriate serotypic reference. Reptiles
constitute the main natural reservoir, but man, poultry, and other
animals have also developed disease from A. hinshawii. Human
infection with this pathogen should suggest inquiries of a possible
connection with reptiles (also poultry and eggs); in the case
reported
here, it led to public health action involving state embargo of
rattlesnake powder that had been used as a cancer remedy.
Because cancer patients are often severely immunocompromised,
neutropenic, and cachectic, they are at high risk of infection.
Their
infections tend to be serious and often fatal. Yet, such patients
are
known to consume high-risk foods and drugs, such as raw liver, raw
beef, raw milk, and, as in this case, raw rattlesnake powder.
Rattlesnake powder (ground rattlesnake) may be widely available
in
California and elsewhere in the nation. The California State Food
and
Drug Branch continues to monitor herb stores in Hispanic areas, and
the U.S. Food and Drug Administration has increased its
surveillance
of imports from Mexico.
Reported in California Morbidity, July 1, 1983 (25), by JB Marzouk,
MD, P Joseph, MD, TK Lee, MD, Oakland; T Livermore, MD, R Benjamin,
MD, Alameda County Health Dept; WD Crawford, G Nygaard, SB Warner,
MD,
California Dept of Health Svcs; L Frank, C Quint, Communicable
Diseases
Bureau, Alameda County Health Care Svcs, Oakland, California.
References
Fainstein V, Yancey R, Trier P, Bodey GP. Overwhelming
infection
in a cancer patient caused by Arizona hinshawii: its relation
to
snake pill ingestion. Am J Infect Control 1982:10;147-53.
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