Substances & Homeopatic Remedies

Mancinella venenata

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A Danish tourist to Antigua in the West Indies, ate a fruit of Hippomane mancinella and developed acute poisoning with blistering of the oral mucosa and diarrhoea and a streptococcal superinfection. Ignorant tourists and their travel advisers are warned against this potentially deadly apple-tree-like plant and its tempting fruits.

 Contact dermatitis form Hippomane mancinella L. (manchineel) is commonly observed in Caribbean and Central American Coast land. Its sap from leaf exudate and from the fruit induce severe dermatitis that may involve oral, ocular, genital mucous membranes and skin, depending on the mediate or direct type of contact. Intense itching or burning sensation occurs within an hour and is followed by painful erythema, vesicles, bullae or pustulae, the latter being highly suggestive of mancheneel. Oropharyngeal and ocular lesions may by very severe. The brief delay and the burnlike appearance of the lesions suggest an orthoergic mechanism due to a caustic that could be similar to the substance identified in an other species of Euphorbiacae as phorbol esters. Traditional and native remedies are presented herein.

From the hydrophobic fraction of the latex of Hippomane mancinella, weak or nonirritant mixture of esters of polyfunctional diterpene parent alcohols of the tigliane and daphnane types were isolated belonging to the structural type of "cryptic" irritants. The cryptic factor group M'z (tigliane type) represents 12-deoxyphorbol-13,20-diesters, and the cryptic factor groups M'y and M'x (daphnane type) represent mixtures of 9,13,14-orthoesters-20-esters of resiniferonol and 5beta-hydroxyresiniferonol-6 alpha,7 alpha-oxide, respectively. All of them carry in the 20-position homologous long-chain fatty acids, ranging from C15 to C26. They may be "activated" by mild transesterification reactions yielding corresponding irritant factor groups with free hydroxyl functions at C-20. From the hydrophilic fraction of the latex, the irritant factor M3 (tigliane type) and the factor group Mx (daphnane type) were isolated. According to spectral data, factor M3 represents the 13-(hexadeca-2,4,6-trienoic acid) ester of the parent 12-deoxy-5 beta-hydroxyphorbol-6 alpha,7 alpha-oxide. Factor group Mx consists of two esters inseparable by tlc (silica gel). One is identical with huratoxin; the other represents a hexadeca-2,4,6-trienoic acid orthoester. Mx is also obtained by transesterification of M'x and exhibits irritant and tumor-promoting activity comparable to that of TPA. Some aspects on structure activity relation are deduced from selected chemical-reaction products of factor group Mx.

Ann Dermatol Venereol. 1985;112(1):51-6.
[Dermatitis caused by the manchineel tree]
Guillet G, Helenon R, Guillet MH.

Contact dermatitis form Hippomane mancinella L. (manchineel) is commonly observed in Caribbean and Central American Coast land. Its sap from leaf exudate and from the fruit induce severe dermatitis that may involve oral, ocular, genital mucous membranes and skin, depending on the mediate or direct type of contact. Intense itching or burning sensation occurs within an hour and is followed by painful erythema, vesicles, bullae or pustulae, the latter being highly suggestive of mancheneel. Oropharyngeal and ocular lesions may by very severe. The brief delay and the burnlike appearance of the lesions suggest an orthoergic mechanism due to a caustic that could be similar to the substance identified in an other species of Euphorbiacae as phorbol esters. Traditional and native remedies are presented herein.

J Fr Ophtalmol. 1995;18(6-7):461-7.   
Ocular burns caused by latex from manchineel trees
Merle H, Trode M, Richer R, Ayeboua L, Sainte-Rose NJ.

OBJECTIVE OF THE STUDY: The objective of this study is to enter on an inventory and to appreciate the severity of the ocular burn caused by the latex of manchineel tree and to propose a therapeutic attitude. MATERIAL AND METHOD: We report on the results of a prospective study included 11 patients examined in the Department of Ophthalmology (Centre Hospitalier Universitaire de Fort-de-France) between November 1992 and November 1993. All of them presented with ocular burn due to a contact with the latex of the manchineel tree. RESULTS: The study included 11 patients, 8 adults and 3 children, the mean age was 22.9 years (range 4-40). All of them had hyperhemia and conjunctival erosions of various intensity. Ten patients had corneal lesions: superficial punctate keratitis in 5 cases and corneal ulcers in 5 cases. Three cases of corneal ulcerations were associated with an inflammatory reaction of the anterior segment. Both eyes were affected in 4 cases (37%), and only the right one in the other cases (63%). Seven patients had cutaneous lesions (63%), of whom 4 periocular burns of superficial second degree. Full recovery was obtained within 15 days for all the patients. CONCLUSION: Ocular lavage is the first treatment, as for all chemical burns. Local antibiotherapy is used systematically to prevent superinfection. With a proper treatment, a complete recovery with no sequelae is obtained.

 Br J Ophthalmol. 1993 May;77(5):284-8.
Manchineel keratoconjunctivitis.
Pitts JF, Barker NH, Gibbons DC, Jay JL.
Tennent Institute of Ophthalmology, Glasgow, Scotland.

The Manchineel tree is an evergreen widely distributed in tropical regions. The toxic nature of Manchineel has been known since the early sixteenth century. Contact with its milky sap (latex) produces bullous dermatitis and acute keratoconjunctivitis. We identified 19 patients who had ocular injuries caused by Manchineel between 1985 and 1990 and were able to review 12. All of these patients had been treated by lavage, cycloplegia, and topical antibiotics. Of 20 episodes of exposure 14 affected both eyes. The cornea was damaged in 16 episodes, the extent varying from large corneal epithelial defects to superficial punctate keratitis. The epithelial changes had resolved in a mean period of 3.75 days (range 1 to 14 days). Two episodes caused stromal infiltration to appear and in one of these a stromal opacity remained 5 years later. The final visual acuity was 6/9 or better in all eyes except in one patient who had visual impairment because of glaucoma. Our results suggest that despite the severity of the acute reaction, the long term visual prognosis is excellent in Manchineel keratoconjunctivitis. The historical and toxicological literature on Manchineel is reviewed.

J Nat Prod. 1984 May-Jun;47(3):482-96.
On the active principles of the spurge family, X. Skin irritants, cocarcinogens, and cryptic cocarcinogens from the latex of the manchineel tree.
Adolf W, Hecker E.

From the hydrophobic fraction of the latex of Hippomane mancinella, weak or nonirritant mixtures of esters of polyfunctional diterpene parent alcohols of the tigliane and daphnane types were isolated belonging to the structural type of "cryptic" irritants. The cryptic factor group M'z (tigliane type) represents 12-deoxyphorbol-13,20-diesters, and the cryptic factor groups M'y and M'x (daphnane type) represent mixtures of 9,13,14-orthoesters-20-esters of resiniferonol and 5 beta-hydroxyresiniferonol-6 alpha,7 alpha-oxide, respectively. All of them carry in the 20-position homologous long-chain fatty acids, ranging from C15 to C26. They may be "activated" by mild transesterification reactions yielding corresponding irritant factor groups with free hydroxyl functions at C-20. From the hydrophilic fraction of the latex, the irritant factor M3 (tigliane type) and the factor group Mx (daphnane type) were isolated. According to spectral data, factor M3 represents the 13-(hexadeca-2,4,6-trienoic acid) ester of the parent 12-deoxy-5 beta-hydroxyphorbol-6 alpha,7 alpha-oxide. Factor group Mx consists of two esters inseparable by tlc (silica gel). One is identical with huratoxin; the other represents a hexadeca-2,4,6-trienoic acid orthoester. Mx is also obtained by transesterification of M'x and exhibits irritant and tumor-promoting activity comparable to that of TPA. Some aspects on structure activity relations are deduced from selected chemical-reaction products of factor group Mx.