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Case of snake-bite by Atractaspis corpulenta
279 TRANSACTIONS OF THE ROYAL SOCIETY OF
TROPICAL MEDICINE AND HYGmNE. Vol. 54. No. 3. May, 1960.
CORRESPONDENCE To the Editor
A POSSIBLEWILD ANIMAL RESERVOIROF THE FLEA, Tunga penetrans (LINN.) SIR,--May I draw attention to a possible African reservoir of the jigger flea, T. penetrans? While it is possible for any fleshy footed mammal to act as host, this flea has not been recorded as infesting the African porcupine (Hystrix L.), yet the feet of one trapped in my garden at Kerugoya on the Mount Kenya foothills in the Embu District of Kenya Colony were heavily infested. Jigger-flea bodies extracted from the feet of this porcupine were sent to Mr. G. H. E. Hopkins, O.B.E., at the British Museum, Tring, in the hope that the minute heads of the fleas might still be attached to the greatly distended bodies. Mr. Hopkins was able to find some heads and very kindly identified them as those of T. penetrans. Casual inspection of the porcupine's feet would scarcely lead one to suspect the presence of these fleas, since the black skin covers up the infected site and signs of inflammation were absent. T h e gardens at Kerugoya are situated on the top of a small steep hill. T h e porcupines, which live in a warren at the base of the hill, raid the gardens at night and sometimes wander close to the European houses where they could shed jigger-flea eggs. Porcupines are numerous in the Mount Kenya foothills and local Africans suffer crippling infections of the feet as a result of jigger flea infestation. It is not unusual to meet people whose feet lack all the smaller toes and in the Jombeni Mountains of the Meru District, a little to the north, some had lost them all [ Porcupine warrens may be sites of permanent jigger infestation for the burrows ramify well over twenty yards into the steep hillsides and include small caverns up to ten feet in diameter and over six feet high in which adult Tunga have been seen on several occasions. I am, etc., G. A. WALTON',
Colonial Medical Research. Department of Entomology, London School of Hygiene and Tropical Medicine. 15 th February, 1960.
CASE OF SNAKE-BITEBY Atractaspis corpulenta SIR,--In Transactions (1954, 48, 376) Drs. Corkill and Kirk reported on the venom and bites of snakes of the genus Atractaspis in 23 cases, and Corkill et al. reported a further 22 cases (1959, 53, 95). Of these bites two were due to A. corpulenta--where one and the same snake bit two Europeans (Cases 18 and 19 in the earlier series). We should like to report a recent case where poisoning was due to a bite by A. corpulenta.
280
CORRESPONDENCE
One of us (H.J.W.) saw the snake at night crossing an asphalt road on the Firestone Rubber Plantation, at Harbel, Central Province of Liberia. Th e snake was picked up with caution, but managed to inflict a bite, with one fang, into the medial aspect of the left thumb, about the mid-nail level. Because of the poor light the actual stabbing was not observed. T h e immediate sensation was one of a sharp stabbing p a i n - - n o t unlike a deep needle prick, and this was followed by a stinging sensation which lasted for about two minutes. T h e wound bled freely, and this flow increased when the thumb was squeezed. T e n minutes later, while driving himself, the patient felt pain and numbness in the triangular area between the thumb, the index finger and the wrist. There was a general sub-surface dull tenderness, no paraesthesia, and, subjectively, a loss of sensitivity. T h e patient was seen in the clinic about 30 minutes after having been bitten. At that time there were no signs of systemic involvement ; the pulse rate was 90, and there was some flushing. T h e back of the left hand, wrist and distal forearm were moderately swollen ; this area was hyperaemic except for a central ischaemic strip, which was ivory coloured rather than dead-white. There were no petechiae. T h e patient was given 10 ml. of polyvalent antivenin (Behringwerke) intramuscularly and 30 rag. of codeine phosphate, and the wound was incised at his request. On admission to hospital, of an hour later, a further two doses of serum were given (intravenously and locally) although there had been no change in the patient's condition. There were two abnormal findings in the laboratory tests : the first urine voided contained 2-4 R.B.C. and 1-2 W.B.C. per high-power field, and no albumin ; the prothrombin time was lengthened. Thirteen hours after the bite the prothrombin time was 61 per cent. of normal, and at 33 hours it was 38 per cent.--when 50 mg. of a vitamin K preparation were given intravenously. Six hours later the prothrombin time was back to 61 per cent., and the patient was discharged. We believe this to be the first record of prothrombin time estimations following an Atractaspis bite. T h e moderate swelling of the back of the hand persisted for 4 days. Pain was confined to the region initially ischaemic ; the pain and ischaemia had disappeared after 48 hours. However, the patient noted a dull ache (" rheumatic-like ") in the muscles of the left forearm from the 3rd to the 7th day. There was no adenopathy and no necrosis. On the 7th day following the bite there appeared a dry, non-pruritic, maculo-papular eruption on the anterior triangle of the neck and the shoulder of the affected side. T h e papules were small and mostly discrete. T h e eruption disappeared 5-6 days later (antihistamines were given). T h e snake was 608 ram. long, and 17 mm. in diameter. T h e head was about the same width as the cylindrical body and not noticeably set off from it ; the eye was very small. T h e tail was but 51 ram. long. T h e skin was quite smooth and satiny, a dark brownish grey, and on the posterior half of the tail it was creamy white. There were 25 mid-body scale rows. T h e rostral region was quite lengthened, so that the fangs were hinged well back from the front of the mouth. Although the fangs were rather short, when retracted their tips almost reached the posterior angle of the mouth. T h e left fang was 3.8 ram. long from the tip to the orifice of the venom duct. We are, etc., A. E. GLrNDERS, H. J. WALTER,
The Liberlan Institute of the American Foundation for Tropical Medicine, Inc. E. ETZEL, Harbel, Liberia. The Firestone Plantations Company. 8th March, 1960. We should like to thank Dr. K. H. Franz, Medical Director of the Firestone Plantations Company, for permission to report this case.
SCHISTOSOMIASIS IN THAILAND
S m , - - I n 1958 a case of carcinoma of the rectum was admitted to Siriraj Hospital, Bangkok, Thailand. T h e tumour was removed and Sehistosoma japonicum eggs were seen in the cancer tissue and in sections of colon biopsy (Lira et al., Transactions, 1960, 54, 5). T h e patient was a native of NakornSritharmaraj, a Province in the South of Thailand. In August, 1959, a survey was made which included the examination of 426 specimens of stool from individuals of all ages from the Chawang district of the Province. Seven contained S. japonicum eggs.
TROPICAL MEDICINE AND HYGmNE. Vol. 54. No. 3. May, 1960.
CORRESPONDENCE To the Editor
A POSSIBLEWILD ANIMAL RESERVOIROF THE FLEA, Tunga penetrans (LINN.) SIR,--May I draw attention to a possible African reservoir of the jigger flea, T. penetrans? While it is possible for any fleshy footed mammal to act as host, this flea has not been recorded as infesting the African porcupine (Hystrix L.), yet the feet of one trapped in my garden at Kerugoya on the Mount Kenya foothills in the Embu District of Kenya Colony were heavily infested. Jigger-flea bodies extracted from the feet of this porcupine were sent to Mr. G. H. E. Hopkins, O.B.E., at the British Museum, Tring, in the hope that the minute heads of the fleas might still be attached to the greatly distended bodies. Mr. Hopkins was able to find some heads and very kindly identified them as those of T. penetrans. Casual inspection of the porcupine's feet would scarcely lead one to suspect the presence of these fleas, since the black skin covers up the infected site and signs of inflammation were absent. T h e gardens at Kerugoya are situated on the top of a small steep hill. T h e porcupines, which live in a warren at the base of the hill, raid the gardens at night and sometimes wander close to the European houses where they could shed jigger-flea eggs. Porcupines are numerous in the Mount Kenya foothills and local Africans suffer crippling infections of the feet as a result of jigger flea infestation. It is not unusual to meet people whose feet lack all the smaller toes and in the Jombeni Mountains of the Meru District, a little to the north, some had lost them all [ Porcupine warrens may be sites of permanent jigger infestation for the burrows ramify well over twenty yards into the steep hillsides and include small caverns up to ten feet in diameter and over six feet high in which adult Tunga have been seen on several occasions. I am, etc., G. A. WALTON',
Colonial Medical Research. Department of Entomology, London School of Hygiene and Tropical Medicine. 15 th February, 1960.
CASE OF SNAKE-BITEBY Atractaspis corpulenta SIR,--In Transactions (1954, 48, 376) Drs. Corkill and Kirk reported on the venom and bites of snakes of the genus Atractaspis in 23 cases, and Corkill et al. reported a further 22 cases (1959, 53, 95). Of these bites two were due to A. corpulenta--where one and the same snake bit two Europeans (Cases 18 and 19 in the earlier series). We should like to report a recent case where poisoning was due to a bite by A. corpulenta.
280
CORRESPONDENCE
One of us (H.J.W.) saw the snake at night crossing an asphalt road on the Firestone Rubber Plantation, at Harbel, Central Province of Liberia. Th e snake was picked up with caution, but managed to inflict a bite, with one fang, into the medial aspect of the left thumb, about the mid-nail level. Because of the poor light the actual stabbing was not observed. T h e immediate sensation was one of a sharp stabbing p a i n - - n o t unlike a deep needle prick, and this was followed by a stinging sensation which lasted for about two minutes. T h e wound bled freely, and this flow increased when the thumb was squeezed. T e n minutes later, while driving himself, the patient felt pain and numbness in the triangular area between the thumb, the index finger and the wrist. There was a general sub-surface dull tenderness, no paraesthesia, and, subjectively, a loss of sensitivity. T h e patient was seen in the clinic about 30 minutes after having been bitten. At that time there were no signs of systemic involvement ; the pulse rate was 90, and there was some flushing. T h e back of the left hand, wrist and distal forearm were moderately swollen ; this area was hyperaemic except for a central ischaemic strip, which was ivory coloured rather than dead-white. There were no petechiae. T h e patient was given 10 ml. of polyvalent antivenin (Behringwerke) intramuscularly and 30 rag. of codeine phosphate, and the wound was incised at his request. On admission to hospital, of an hour later, a further two doses of serum were given (intravenously and locally) although there had been no change in the patient's condition. There were two abnormal findings in the laboratory tests : the first urine voided contained 2-4 R.B.C. and 1-2 W.B.C. per high-power field, and no albumin ; the prothrombin time was lengthened. Thirteen hours after the bite the prothrombin time was 61 per cent. of normal, and at 33 hours it was 38 per cent.--when 50 mg. of a vitamin K preparation were given intravenously. Six hours later the prothrombin time was back to 61 per cent., and the patient was discharged. We believe this to be the first record of prothrombin time estimations following an Atractaspis bite. T h e moderate swelling of the back of the hand persisted for 4 days. Pain was confined to the region initially ischaemic ; the pain and ischaemia had disappeared after 48 hours. However, the patient noted a dull ache (" rheumatic-like ") in the muscles of the left forearm from the 3rd to the 7th day. There was no adenopathy and no necrosis. On the 7th day following the bite there appeared a dry, non-pruritic, maculo-papular eruption on the anterior triangle of the neck and the shoulder of the affected side. T h e papules were small and mostly discrete. T h e eruption disappeared 5-6 days later (antihistamines were given). T h e snake was 608 ram. long, and 17 mm. in diameter. T h e head was about the same width as the cylindrical body and not noticeably set off from it ; the eye was very small. T h e tail was but 51 ram. long. T h e skin was quite smooth and satiny, a dark brownish grey, and on the posterior half of the tail it was creamy white. There were 25 mid-body scale rows. T h e rostral region was quite lengthened, so that the fangs were hinged well back from the front of the mouth. Although the fangs were rather short, when retracted their tips almost reached the posterior angle of the mouth. T h e left fang was 3.8 ram. long from the tip to the orifice of the venom duct. We are, etc., A. E. GLrNDERS, H. J. WALTER,
The Liberlan Institute of the American Foundation for Tropical Medicine, Inc. E. ETZEL, Harbel, Liberia. The Firestone Plantations Company. 8th March, 1960. We should like to thank Dr. K. H. Franz, Medical Director of the Firestone Plantations Company, for permission to report this case.
SCHISTOSOMIASIS IN THAILAND
S m , - - I n 1958 a case of carcinoma of the rectum was admitted to Siriraj Hospital, Bangkok, Thailand. T h e tumour was removed and Sehistosoma japonicum eggs were seen in the cancer tissue and in sections of colon biopsy (Lira et al., Transactions, 1960, 54, 5). T h e patient was a native of NakornSritharmaraj, a Province in the South of Thailand. In August, 1959, a survey was made which included the examination of 426 specimens of stool from individuals of all ages from the Chawang district of the Province. Seven contained S. japonicum eggs.