Epidemiologic Notes and Reports Mucuna pruriens-
Associated Pruritus -- New Jersey
On October 6, 1985, a Paterson, New Jersey, Fire Department
ambulance responded to a call reporting two people with severe
pruritus. On arrival, the two emergency medical technicians (EMTs)
found a Spanish-speaking couple living above a beauty salon who
described severe itching, which they attributed to "voodoo beans"
found in their beds. They displayed several fuzzy bean pods. Soon
after their arrival, the EMTs developed pruritus. All four
individuals went to an emergency room complaining of itching and
skin
discomfort. On examination, both members of the couple had
erythematous macular rashes on their extremities and bodies; the
EMTs
had rashes on their arms. There were no respiratory problems.
Because of the unknown etiology of the symptoms, two were given
epinephrine injections; the others received antihistamines and
topical
steroid cream. Symptoms resolved within 1-2 hours of treatment.
The
admitting nurse, who put an arm around one patient, developed a
pruritic erythematous area on her inner forearm approximately 20
minutes later. This resolved an hour after washing her skin with
soap
and water. A policeman who went to the apartment and a worker who
collected trash outside the following day also developed itching
and
received similar emergency-room treatment. Patrons and employees
of
the shop below and neighbors of the couple had no similar symptoms
over the 2-day period.
An industrial hygienist with the local health department went
to
the site in complete protective gear to look for possible chemical
contamination from the beauty salon. Visual inspection and screens
for ionizable organic vapors were negative, but he retrieved
another
bean pod. The botanical samples were sent to Rutgers University,
where the plant was identified as Mucuna pruriens. Recommended
decontamination procedures for the apartment included steam
cleaning
of all fabrics and rugs, HEPA Vac cleaning of floors and
countertops,
and destruction of any fabrics that could not be cleaned.
Reported by D Fairbrothers, MD, E Kirby, MD, Rutgers University,
New
Brunswick, Barnert Memorial Hospital Center, Paterson, RM Lester,
PC
Wegmann, Paterson Div of Health, F Marshall, WE Parkin, DVM, State
Epidemiologist, New Jersey Dept of Health; Div of Field Svcs,
Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: Mucuna pruriens, a legume known from Medieval
Latin
botanical works with the Latin synonym Stizolobium pruriens (1),
was
first described in the English literature in 1804. The plant is
variously called cowitch, cowhage (derived from the Hindu name,
"kiwach" or "bad rubbing"), kaunch, and pica-pica (2); the common
names are not specific. It grows wild in the tropics, including
India, and tropical islands, including the Bahamas (3,4); its range
may extend to southern Florida.
Each 10- to 13-cm fruiting pod bears approximately 5,000
barbed,
easily detachable spicules measuring 2 mm by 20 um that cause
dermatitis through an inflammatory response, presumably an
immediate
hypersensitivity reaction. Hairs from dried pods, as in herbarium
specimens, remain potent (5). The spicules have been sold
commercially as itching powder and, at least through 1950, as an
oral
vermifuge (1,6).
In 1955, studies showed that introduction of one spicule
through
the epidermis with friction or pressure led to a burning itch
lasting
up to 30 minutes (1). Spicules could be removed from the skin by
washing or by applying an adhesive tape. Mucunain, a protein with
endopeptidase and dipeptidase activity, was identified as the
active
pruritic agent. The protein was extractable only from spicules
using
aqueous solutions and could be inactivated by autoclaving, changing
the pH, or using a similar denaturing process that did not change
the
spicule structure. Further investigations confirmed the
biochemical
nature of the pruritic agent, identified as a thermolabile protein
of
molecular weight 40,000 (7).
Emergency-room personnel should be alert to the possibility
that
members of some subcultures in this country may be exposed to
Mucuna
pruriens. Pods and contaminated fabrics should be handled with
caution. Symptoms resolve spontaneously within several hours, but
antihistaminic therapy appears to be effective for faster
resolution.
References
Shelley WB, Arthur RP. Studies on cowhage (Mucuna pruriens)
and
its pruritogenic protease, mucunain. AMA Arch Dermatol
1955;72:399.
Bentley R, Trimen H. Medicinal plants. Vol II. London: J. &
A.
Churchill, 1880.
Britton NL, Millspaugh CF. The Bahama flora. New York,
1920:188-9.
Maheshwari JK. The flora of Delhi. New Delhi: Council of
Scientific and Industrial Research, 1963:129.
Lewis WH, Elvin-Lewis MPF . Medical botany. New York: John
Wiley & Sons, 1977:78-81.
Denman ST, Wuepper KD. Histologic and biochemical
characteristics
of mucuna pruriens. Clin Res 1982;30:581A.
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