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Pamela Nagami - Bitten: True Medical Stories of Bites and Stings

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Pamela Nagami Bitten: True Medical Stories of Bites and Stings
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Weve 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 Californias 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 Nagamis 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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Table of Contents It is a pleasure to acknowledge the following - photo 1
Table of Contents

It is a pleasure to acknowledge the following colleagues, patients, friends, and family: Sylvan Cohen, who shared both his knowledge of dangerous animals and his considerable library, my subjects Helene and Albert Eliah, my son Paul Nagami for skillful editing and topic suggestions, my daughter Ellen Nagami for the books title, librarians Elliott M. Gordon, Marsha L. Edenburn, and Annette Wolfson, dermatologist Paul Wolfish and pathologist Jeffrey Shiffer, Susan Novak and Michael Collier for laboratory support, my clinic assistant Zoraida Medina, and the staff of the Infusion Center at the Kaiser Foundation Hospital in Woodland Hills.
Special thanks to Frank Steurer and James Mcguire at the Centers for Disease Control and Prevention, to my agent B. J. Robbins, and to my editor Marie Estrada.
The Woman with a Worm in Her Head
In writing Bitten, I was dazzled by the variety of survival strategies that animals have evolved. A tiny spider overwhelms prey many times its size, and swarms of little ants devour hatchlings in their nests. Powerful toxins make cone snails deadly predators, and insubstantial jellies, armed with stinging cells, draw heavy fish into their diaphanous mouths.
Larger than most animals, humans coerce a living from the worldthanks to brute force and a big brain. But to the tsetses, sandflies, and mosquitoes we are simply supersized blood meals.
When ecologists tell us that all life on earth is interconnected, we tend to think of the big picture, of the atmosphere enriched by oxygen from ocean phytoplankton or polluted by greenhouse gases. But sometimes the connections are more intimate and more direct: a bite from a spider we offend in our sleep or an opponents tooth at the end of our own punching fist.
Acetylcholine. A compound released from nerve endings that may depress heart contraction, dilate blood vessels, and cause intestinal spasms. Animal venoms may cause its massive release.
Aeromonas hydrophila. Rod-shaped bacteria that stain pink on Grams stain and inhabit fresh and brackish water. They are an important cause of infections in traumatic injuries involving water exposure, including animal bites by aquatic species, such as alligators.
Amino acids. The basic structural units of proteins, which link together in chains.
Anaerobic bacteria, or anaerobes. Bacteria that fail to grow in air (eighteen-percent oxygen).
Anaphylactic reaction. A catastrophic, often lethal, allergic reaction that occurs within minutes after contact with a substance to which a person is previously allergic. The symptoms are hives, wheezing, and low blood pressure with shock.
Antivenin, or antivenom. A serum, usually produced in animalsby injecting them with gradually increasing amounts of venom. It contains antibodies capable of neutralizing the venoms toxic effects.
Arachnida. The class of arthropods (joint-footed animals without backbones) that includes the araneida, or spiders, as well as scorpions, ticks, and mites.
Atrax robustus. The worlds most lethal spider, the Sydney funnel web.
Autonomic nervous system. The nerves serving the heart, blood vessels, glands, and other organs that are not under conscious control. This system maintains such automatic functions as blood pressure, digestion, and perspiration.
B-virus, or herpes B virus, Herpevirus simiae, Cercopithecine herpesvirus. 1. A DNA virus that causes mild skin and genital infection in macaques but serious and often fatal infection of the brain and spinal cord in humans.
Botulism. An intoxication due to a protein produced by the bacterium Clostridium botulinum, usually foodborne, that causes a descending paralysis, first of the face and eye muscles and then of the muscles controlling breathing.
Capnocytophaga canimorsus. A long, thin, rod-shaped bacterium that stains pink with the Grams stain and lives in the mouths of members of the dog family. It may cause fatal infections in dog-bite victims who lack a spleen.
Carukia barnesi. A small jellyfish of the tropical waters off the northern Australian coast, whose stings cause the Irukandji syndrome.
Central nervous system. The brain, spinal cord, and their immediate connections such as the optic nerves and the olfactory organs.
Cerebrospinal fluid or spinal fluid. A clear fluid secreted inside the brain, in which the organ is suspended. In a lumbar puncture (spinal tap) this fluid is sampled with the aid of a long needle.
Cone snails. A large group of often strikingly beautiful but uniformly venomous predatory snails inhabiting warm coastal waters in Hawaii and the Southern Hemisphere.
Desensitization therapy. Sometimes called allergy shots. A series of injections of a substance to which a patient is allergic, such as fire ant venom, meant to induce antibodies that can block an anaphylactic reaction.
Disseminated intravascular coagulation. A state of uncontrolled clotting and bleeding, which may be initiated by bloodstream invasion by infectious agents.
Eflornithine, or the resurrection drug. A promising new treatment for all stages of West African (Gambian) sleeping sickness.
Elapidae. A family of snakesincluding cobras, mambas, coral snakes, sea snakes, and venomous snakes in Australiain which the upper jawbone is shortened and not hinged, and in which there is a pair of short, fixed, hollow, poisoned fangs in front.
Encephalitis. An inflammatory condition of the brain.
Enzyme. A protein produced by cells, which acts as a catalyst to induce chemical changes in other substances without itself being consumed in the reaction.
Epinephrine. Also known as adrenaline. One of the hormones of the adrenal glands, it stimulates the heart, relieves wheezing, supports blood pressure, and is used to treat anaphylactic shock.
Epizootic. An outbreak of disease occurring among animals.
Fascia. The tough tissue that extends from skin to bone, enveloping the body and the muscle groups.
Gangrene. Tissue death caused by obstruction of its blood supply.
Gastropods. The class of mollusks that includes snails, slugs, and sea hares.
Grams stain. A procedure developed by Dr. Hans Gram in which specimens are smeared on a glass slide and stained with asequence of dyes so that the bacteria stand out from the background of cellular debris. Gram-positive bacteria stain blue, while Gram-negatives stain pink.
Guillain-Barr syndrome. An illness consisting of ascending weakness caused by the production in the patient of antibodies that impair nerve conduction to the muscles.
Hemoglobinuria. The presence of the oxygen-carrying compound hemoglobin and its breakdown products in the urine which may color it orange or red.
Hemolysis. Destruction of red blood cells releasing the oxygen-carrying compound hemoglobin.
Histamine. One of the compounds whose release induces the hives, wheezing, and dilatation of blood vessels that constitute an allergic reaction, sometimes progressing to fatal anaphylaxis.
Incubation period. The interval between the time an infection first enters the body and the time it manifests signs or symptoms of disease.
Ion channels. Protein portals in the cell through which sodium, potassium, and calcium move in and out.
Irukandji syndrome. Illness caused by the sting of the small jellyfish Carukia barnesi and consisting of restlessness, severe muscle spasms of the abdominal wall, vomiting, and, rarely, leakage of fluid into the lungs.
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