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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

  1. 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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