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Stepping on venomous caterpillars a fatal mistake for young Canadian traveller |
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Written by Helen Branswell, THE CANADIAN PRESS
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Monday, 14 July 2008 |
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TORONTO - It was a freak encounter with tragic consequences.
A Canadian woman who had travelled to South America last year died 10 days after stepping, barefoot, on venomous caterpillars, a team of Edmonton doctors reported Monday in the Canadian Medical Association Journal.
Her case should be a cautionary tale for people embarking on exotic trips to far-flung places, her doctors and others suggest.
"Obviously the more exotic we get in where we travel, the more opportunities there are that we're going to interface with bizarre things," said Dr. Kevin Kain, a Toronto-based travel and tropical medicine expert who did not treat the woman but was asked to comment on the report.
"There are some bad things out there. They're rare, but they're bad."
The woman, who was in northeastern Peru on an organized jungle trek, accidentally stepped on five caterpillars of the Lonomia genus, which secrete a toxin that causes hemorrhaging in humans.
There are two species of the caterpillars known to cause hemorrhagic syndromes in humans. Found in parts of South America, including Venezuela and Brazil, the insects emit venom through bristles or hairs that cover their bodies and have been blamed for many deaths in the Amazon.
The Canadian woman's story, presented in a section of the journal dedicated to teaching doctors about difficult-to-diagnose cases, concluded with a warning that as adventure travel increases in popularity, doctors will need to develop the tools to rapidly recognize and treat conditions they've never encountered before.
"People are engaging in more adventure travel ... They are pushing the boundaries to some extent and we are getting people who otherwise wouldn't do adventure travel routinely engaging in adventure travel," said Dr. Sean Bagshaw, a critical-care specialist and one of the doctors who cared for the unidentified woman at the University of Alberta Hospital.
Bagshaw said travellers also bear responsibility for learning about the hazards they might face and how to avoid them. "I think it's important that people do a little bit of homework before they engage in any adventure travel to understand what health risks may be posed by that."
Privacy laws prevent Bagshaw from revealing much about the woman. She was 22 and a resident of Alberta. He said she sought care at the hospital late last summer or in the early fall, seven days after returning from Peru and four days after bruising on her legs began to appear.
Early in the course of the investigation, she told the doctors of having stepped on caterpillars and feeling a burning pain in her foot that radiated up to her thigh. She developed a headache. But about 12 hours later, both symptoms subsided and she didn't seek treatment locally.
That probably was unwise in this case and would be in others as well, said Kain, director of travel and tropical medicine at Toronto's University Health Network.
That's because antivenin products made to counteract toxins generated by rare creatures are often only available where those creatures live.
Even if Canadian doctors can get their hands on the right antivenin in time, getting permission to use it could be tough, given the legal liability their institutions would probably face. "Because none of this kind of stuff will have been approved," Kain said.
In this case, the woman's doctors diagnosed her problem using online medical resources, including Google Scholar - a section of the popular search engine that scours scientific literature. There they found references to venom-emitting caterpillars, which induced symptoms that matched those of the patient.
Through their local poison control centre they contacted doctors in Brazil, who recommended immediate treatment with an antivenin produced in that country. But it took 48 hours to arrive, by which point the patient's condition had worsened.
They began treatment, but she died of multi-organ failure the same day.
Kain noted that more common - and preventable - threats are more likely to sicken travellers while they are abroad, if they don't get the appropriate shots or take the appropriate pills. But he said the reality of rapid global travel means the odd, rare and difficult to diagnose case will come up.
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