Bitten: True Medical Stories of Bites and Stings

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9780312318222: Bitten: True Medical Stories of Bites and Stings
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We've all been bitten. And we all have stories.

The bite attacks featured in this dramatic book take place in big cities, small towns, and remote villages around the world and throughout history. Some are as familiar and contemporary as encounters with mosquitoes in New York City and snakes in southern California's Hollywood Hills or as exotic and foreign as the tsetse in equatorial Africa, the camel in Riyadh, and the Komodo dragon in Indonesia. While others, such as people biting other people---well, these are in a category of their own.

Among the startling stories and fascinating facts in Bitten.
o A six-year-old girl descends into weeks of extreme lassitude until a surgeon plucks an engorged tick from her scalp.
o A diabetic living in the West Indies awakes one morning to a rat eating his left great and second toes.
o A twenty-eight-year-old man loses a third of his nose to a bite by his wife.
o In San Francisco, after a penile bite, a man develops "flesh-eating strep," which spreads to his lower abdomen.
o Severe bites by rabid animals to the face and digits, because of their rich nerve supply, are the most likely to lead to rabies and have the shortest incubation periods.
o Following the bite of a seal or contact with its tissues, sealers develop such agonizing pain and swelling in their bites that, far from medical care, they sometimes amputate their own fingers.
o Perhaps the most devastating human bite wound injuries are those involving the nose; doctors in Boroko near Papua, New Guinea, reported a series of ninety-five human bites treated in the Division of Surgery from 1986 to 1992---twelve were to the nose, nine in women, and three in men, and in most of the cases, the biter was an angry spouse.

With reports from medical journals, case histories, colleagues, and from her own twenty-eight-year career as a practicing physician and infectious diseases specialist, Pamela Nagami's Bitten offers readers intrigued by human infection and disease and mesmerized by creatures in p0the wild a compulsively readable narrative that is entertaining, sometimes disgusting, and always enjoyable.

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About the Author:

Pamela Nagami, M.D., is a practicing physician in internal medicine and infectious diseases with the Southern California Permanente Medical Group and a clinical associate professor of Medicine at The David Geffen School of Medicine at UCLA. She lives with her husband in Encino, California.

Excerpt. Reprinted by permission. All rights reserved.:

Bitten
1Invincible InvadersIn a chronic-care facility in Houston, Texas, on a routine morning check, nursing home attendants discovered one of their patients--a ninety-year-old woman who suffered from a weak heart and "moderately severe" dementia--fully conscious but covered with thousands of rice-sized insects. The tiny creatures had been crawling in and out of her mouth and swarming over her body, conceivably for hours. However, due to the woman's general debility, she had been unable to summon help. After the attendants washed away the creatures, they discovered multiple welts all over her body. Over the next six hours, the reaction spread to her lungs, and, despite attentive hospital care, she died. 
 
 
The red fire ant, Solenopsis invicta, the species responsible for the woman's death, is one of over eight thousand species of ants worldwide. All ants are social insects, living together in colonies.They are heat-loving creatures--only a few species live in Alpine or arctic regions. The first fossil ants appear in European and North American rock strata dating back about sixty million years, around the same time that the dinosaurs were dying out.Ants have large heads and oval abdomens joined to the thorax by a narrow waist. The antennae have an elbowlike bend, and the mouth is equipped with two sets of jaws, the outer pair for carrying and digging and the inner set for chewing. Like their close relatives, the bees, many species have a powerful stinger at the tip of the abdomen, which in ants can be used repeatedly without damaging the owner.Solenopsis invicta is not native to North America. It arrived on ships from South America in the 1930s through the port of Mobile, Alabama. Since then, fire ants have invaded the southern and southeastern United States and Puerto Rico. Every year, between 30 and 60 percent of people living in these areas experience their painful stings. The ant grasps the skin with its tiny, powerful jaws, arches its body, and then injects venom through the stinger. If allowed to do so, the ant will rotate itself about its anchored head and create a whole circle of stings. There's an immediate burning sensation, followed by hours to days of intense itching. Virtually everyone who is stung by a fire ant reacts with a red welt that, over several days, turns into a pus-filled pimple. Up to half of the victims will experience larger local reactions, and occasionally surgical drainage and amputation are necessary because of complicating infections.Fire ant venom may be toxic to the nervous system, as illustrated by two cases reported by Dr. Roger Fox and his colleagues at the University of South Florida in 1982. The first patient was a thirty-nine-year-old tree trimmer who was cutting palm trees when roughly one hundred fire ants bit his arms and shoulders. Ten months later, about two hundred fire ants attacked his armsand shoulders, and the next workday about the same number of ants bit him again. Following this final attack, his right hand and forearm gradually became numb, and over the next thirty-six hours his wrist became weak. The hand returned to normal in a month, but no further information on the patient was available; after the last attack, he moved and left no forwarding address.The other patient in Dr. Fox's report was a four-year-old boy who was with his father, a neurosurgeon, when he was stung by twenty red fire ants on his right foot. A half hour later the child had two convulsions, from which he recovered without ill effects.The most dangerous physical response to a fire ant sting is called an anaphylactic reaction, which is the same kind of reaction some people have to bee stings. This is not surprising, since ants belong to the same insect order as bees, the Hymenoptera.An anaphylactic reaction begins with faintness, itching, chest tightness, and wheezing, and ends with a precipitous fall in blood pressure and sometimes death. In parts of the southern United States where fire ants are prevalent, fatal allergic reactions to their venom are more common than deaths from bee stings. In sensitive people, only a sting or two is necessary to provoke the reaction.A typical case was that of the thirty-one-year-old man who arrived in an emergency department in Augusta, Georgia, thirty minutes after a fire ant stung him on the thumb. He told the doctors that within two or three minutes of the sting he had a strange metallic taste in his mouth. Then there was a sudden pain in his temples--he called it "the worst headache of [his] life." He felt shaky and had a sensation of pins and needles all over his body. His heart pounded, and his face turned red. This man, however, had the presence of mind to swallow two tablespoons of Dimetapp before he came to the emergency room. The liquid antihistamine got into his bloodstream quickly enough to save his life.Others have not been as fortunate. In 1989, Dr. Robert Rhoades and his colleagues reported the case of a thirty-two-year-old junior high school teacher who succumbed to anaphylaxis following fire ant stings. The patient had suffered a severe reaction to a sting in the past and had consulted an allergist, who recommended a course of desensitizing injections to prevent another reaction. She had declined treatment and, some time later, she sustained ten stings to her feet and ankles. Immediately she began gasping for breath as the air passages in her lungs squeezed shut. Although she was still alive on arrival to the emergency room, an electrocardiogram showed signs of severe heart strain and lack of oxygen. Shortly thereafter, her heartbeat stopped. The doctors were unable to resuscitate her.This young teacher had such a severe allergy to fire ant venom that even one sting would likely have proved fatal. If such a highly allergic victim were to succumb immediately as the result of one or two stings, it is conceivable that, in the absence of history, the cause of death could remain unknown. Physicians in areas where fire ants are plentiful speculate that a certain percentage of unexplained cases of cardiac arrest may be caused by unseen fatal allergic reactions to stings.Although lethal reactions to fire ant venom are uncommon, they are only the smallest part of a larger problem. A 1971 survey of physicians in Alabama, Georgia, and Mississippi revealed that over a three-year period doctors treated ten thousand patients for fire ant stings. Probably at least ten times that number were stung but did not seek medical attention. An estimated one half to one percent of fire ant stings result in severe allergic reactions, and a 1989 survey of 29,300 physicians practicing in fire ant--infested areas identified thirty-two confirmed deaths due to sting-induced anaphylaxis. It is probably safe to say that this figure is an underestimation. In some patients, as in the elderly woman in thenursing home, whose case opened this chapter, it is difficult to determine whether their deaths occurred as a result of allergic reactions or simply from a lethal dose of venom due to multiple stings. In small children suffering a large number of stings, this distinction may be impossible to make, as in this tragic case, also reported by Dr. Rhoades.A healthy, sixteen-month-old girl was "bumped by the family dog" and fell into a fire ant mound. The child suffered innumerable stings over her entire body. Her mother, a registered nurse, brushed off as many ants as she could and then bathed the child to remove those remaining, but it was already too late. The girl began gasping, and the mother started mouth-to-mouth breathing and dialed 911. By the time she arrived in the emergency room, the toddler was in full cardiac arrest. After she spent six days on a ventilator machine without signs of brain recovery, life support was stopped, and the child died.But fire ants are more than a medical menace. They threaten agriculture, animal husbandry, native plants and animals, and even roadways and electrical installations. To understand this invading insect enemy, it is necessary to return to its homeland, the Pantanal. The Pantanal is the vast flood plain of the headwaters of the Paraguay River, which includes areas in southwest Brazil, eastern Bolivia, Paraguay, and northern Argentina.In the Pantanal, fire ants build four- to six-inch mounds along roadsides. One egg-laying queen controls each mound, and is supported by one to two hundred thousand sterile female workers. Unlike bees, which use their venom only for defense, foraging fire ants are stinging predators. They subdue other invertebrates, consume their body fluids, and return with these nutrients to the nest. Fire ants are omnivorous and adaptable. They are efficient scavengers, feeding on dead animals, plant tissues, seeds, and sap flows. Where aphids are plentiful, they may turn from hunters to herders,tending and milking these tiny insects for their sweet secretions.However, in their homeland, fire ant populations are limited by competition from other species of ants and by disease-producing parasites. When baits were set up in the fire ant's habitat in Brazil, only thirteen percent of the traps with ants contained Solenopsis invicta. Other species of ants were equally common.Over twenty species of viruses, fungi, protozoa, roundworms, and flies attack fire ants in South America. Thelohania, a one-celled animal, or protozoan, multiplies inside the abdomen of worker fire ants, filling them with debilitating cysts. A tiny roundworm may also infect the stomach of the ant. However, the most bizarre of the South American fire ant parasites are the gnat-sized phorid flies. The females dive-bomb fire ants and inject their eggs into the animal's body. When the larva hatches, it burrows into the ant's head, where it releases enzymes that cause the host's head to fall off. Inside the detached head, the larva continues to grow until it emerges as a mature fly.But between 1930 and 1940, some lucky colonies of red fire ants left all of this behind. Their nests were loaded, most likely as ballast, onto cargo ships carrying lightweight agricultural goods from South America to Mobile, Alabama. In Mobile, the accidental stowaways were unloaded so that heavy machinery could be stowed in the ship's hold for the return trip.Upon its arrival in the Mobile, Alabama, area, Solenopsis invicta found the soil already colonized with native ants as well as an earlier arrival from South America, Solenopsis ricteri, the black fire ant. By 1950, the native species had all but disappeared; black ants had been pushed out of many of their habitats or had formed hybrid tribes with the invaders.Fire ant mounds are bigger in the United States than in South America, and often stand a foot and a half high, with tunnels that may radiate out over a hundred feet. Colonies are larger,numbering up to four hundred thousand individuals, and there are about nine times as many mounds in infested areas of Alabama as there are in similar habitats in Brazil.The red fire ant is known as a "tramp" or "weed" species. It thrives in recently opened or disturbed areas. Following World War II, there was rapid population growth in the "Sunbelt," and fire ants quickly invaded land cleared for homes, recreational areas, and industry. A survey of the infestation in 1950 showed that ants had spread from the port area halfway up the border between Mississippi and Alabama. In 1957, the United States Department of Agriculture attempted to quarantine the species, but overlooked the spread of the ants hiding in nursery stock. By 1989, Solenopsis invicta had invaded all the southern states.The red fire ant can survive in areas where the average minimum temperature is 10 degrees Fahrenheit (about negative 12 degrees Celsius). They have recently been reported in California and, based on annual average temperatures, they could spread from Arizona, through Southern California, and along the West Coast as far north as the Canadian border.But it was not only the welcoming climate and lack of competition and of diseases that allowed the wildfire spread of Solenopsis invicta across the south. The red fire ant itself was changing in ominous ways, probably as a result of genetic mutations.Every fire ant colony begins with a queen, a winged, half-inch-long female who has mated with a winged male while in flight. Upon landing, the mated female sheds her wings and burrows three to ten inches into the earth, sealing the entrance with soil. Within one day she lays ten to twenty eggs, which give rise to the first workers, her attendants. If many newly mated females land in the same area, they may aggregate and found a colony together. However, as the colony becomes established, the workers will eventually execute all the queens but one. The workers thenfiercely defend the area around their mound from the incursions of workers from neighboring mounds. The number of mounds in a given area is thus strictly limited by the territorial instincts of red fire ant workers.However, in the early 1970s scientists in several locations began to report colonies with multiple queens. These colonies contain workers who, despite being genetically unrelated, cooperate over extended areas without territorial hostility. Mound densities increased three to ten times, and some mound systems contain millions of individuals.Once the red fire ants in a given area evolve these multiple-queen--or polygyne--colonies, other species of invertebrates cannot compete, and the ecological diversity of that environment is severely damaged. Sanford Porter and Dolores Savignano at the University of Texas in Austin studied a 32-hectare tract at the Brackenridge Field Laboratory near that city, using pitfall and bait traps to measure invertebrate abundance and diversity. At infested sites, the investigators found a ten- to thirtyfold increase in the total number of ants, of which over 99 percent were Solenopsis invicta. The abundance of isopods, mites, and scarab beetles declined severely, leaving the field to a few types of roaches, ground crickets, and beetles adapted to life with ants. Overall, there were a third fewer different species of invertebrates, and individual populations dropped to one quarter of their original size, pointing to severe ecological disruption by this foreign invader.Although red fire ants sometimes feed on agricultural pests, the damage they do to crops, particularly seeds and germinating seedlings, outweighs their beneficial role as insect predators. In addition, the presence of fire ant colonies in a field can lower crop yields, because the cutting bars of harvesting machinery have to be raised to avoid damage from the hard, heaped-up mounds.Fire ants will attack and kill a newborn calf, bird hatchling,disabled animal, or any confined animal that cannot avoid their stings. Furthermore, livestock may starve in the field when swarms of fire ants render their food inaccessible. Animals have been blinded by their attacks or suffered bites in mouth, rectum, or preexisting wounds. Even fish are not immune to the ant invasion; thousands of trout have died of venom poisoning after eating swarms of winged males and queens that have flown into lakes.Fire ants attack not only plants and animals. Attracted to the heated asphalt, they build mounds under rural roads, which then collapse as the undermined soil subsides. In 1977, a survey of forty miles of roadway in North Carolina revealed an average of twenty fire ant colonies per mile, with some undermin...

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