This week we find ourselves in the Caribbean so it seems fitting to write a few informative blogs about medical emergencies, specifically potential poisons that are peculiar to this part of the world.
Manchineel Tree Poisoning: The Death Apple
Recorded on the internet is an account of what happened to two curious gentlemen while staying on a Caribbean island: Strolling along a beautiful, deserted beach in the Caribbean, they found some fruit that looked like small green apples under a large tree overhanging the beach. After one of the gentlemen took a bite of an apple and found it to be quite sweet and tasty, his friend and he both then each ate one and found them very satisfying. After 10 minutes or so, they noticed an unusual burning sensation in their mouths that evolved into swelling and tightness of the throat and difficulty swallowing. Alcohol seemed to make the symptoms worse.
One particular toxic plant worth mentioning is the manchineel tree, Hippomane mancinella, also known as the beach apple or death apple. This tree grows on the shores of islands and coastlines of the Caribbean Sea. A large deciduous tree that has a small green apple-like fruit, it is considered to be one of the most poisonous plants on earth. Given this distinction, it is a tree worth being able to recognize when traveling in this part of the world. Do not sit under it, even during a rain storm, as the droplets of water falling off it contain enough toxic latex to cause a severe contact dermatitis. For the same reason do not touch the leaves, the bark, or burn the wood. The apple-like fruit of the tree contains a potentially deadly poison. The two adventurers mentioned in the preceding paragraph might well have expired from their experimental taste-test.
This tree contains tigliane phorbol esters. Skin contact can cause blistering, burns, erythema, swelling, and inflammation. If ingested, it will cause burning and swelling of the oral mucosa, esophageal ulcerations, edema, and cervical lymphadenopathy, making it impossible to swallow, difficult to talk, and hard to breathe.
Treatment consists of cleansing the skin with soap and water to remove the plant latex, being careful to avoid further exposure and using antihistamines to minimize the immune response and the edema.
There is more information about this and other ocean-related toxins in a recent Wilderness Medicine Newsletter, entitled Poisonous Pearls.
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