Stingray bite and Multiple Sclerosis

[Babolious]

In January 2005, my wife was stung by a stingray (similar sea creature) on the right thigh.  Three months later, she began to get numb toes on her right foot ans started to struggle with chronic fatigue.  Now 2 and half years later, she needs about 12 hours of sleep per day (yet still feels tired), has the numb toe as well as a sore patch on her lower right arm.  In that time, she has visited a neurologist a few times, had an MRI scan done (which was inconclusive), and spent much time with her family doctor, tired several different diet ideas, and is now seeing a natural path.  Any thoughts on whether or not the sting ray has anything to do with her chronic fatigue?

[Quixotic1]

You ask an interesting question.  My first question is, in what way was the MRI "inconclusive?"  Do you have the entire report and would you be willing to share it?

First, let me preface my answer with making sure you know that what I am saying is pure supposition, based on some clinical experiences.  I spent 3 years in the Indian Health Service in Yuma, AZ and in Nevada.  I treated a large number of venomous bites and stings, specifically rattlesnake, scorpion and black widow spider.  Venom is a protein, for the most part, and it is a potent stimulator of the immune system.  So is anti-venom.

In several cases I had patients respond to their envenomations with delayed hypersensitivity reactions.  The most common was serum sickness.  This occurred in every snake bite victim who got antivenom.  But it also occurred in victims of a scorpion sting and a black widow bite who did not receive antivenom.

Serum sickness is a systemic response about 2 weeks after the sting/bite that involves fever, hives and flushing, diffuse and often severely painful joints.  Sometimes the joints actually do swell and become red, diffuse muscle pain and headache.  It's like influenza with hives (pretty miserable)  and it's treated with steroids for a couple weeks.  The syndrome can recur weeks and months later.

The only reason I tell you this is to demonstrate that venom can throw the immune system into overload and result in real suffering.  You are on an MS site and I have never read or heard of MS being attributable to an envenomation.  But, from what you have told us, it isn't clear that your wife has or doesn't have MS.  And I would have to know the mechanism by which the sea creature does it's damage.  It's really not my field of knowledge.

But, it is possible that your wife has Chronic Fatigue and Immune Dysfunction which is currently the preferred name for CFS.  It is felt to caused by some insult which has dysregulated the immune system, and immune abnormalities are associated with CFIDS.

Of course, it is also possible that the chronic fatigue and neurological symptoms that your wife has are not related to the stingray incident.

She needs to be fully evaluated for this kind of incapacitating fatigue - which I know all too intimately.  I need a minimum of 10 hours per night, usually get 12 and sometimes 16 and rarely feel rested.  Has she had a sleep study?  She should have one.  And I would recommend that she be evaluated by an academic Immunologist.  These doctors are similar to Rheumatologists and treat many of the same illnesses, but they also delve more deeply into the specific immune function.  You find them at university medical centers.

I'm sure you've read extensively about  chronic fatigue and understand that it's cause(s) are not well understood nor are the treatments often very effective, but a thorough search for a treatable cause is very important.  This would include infections, neuro diseases, autimmune diseases and endocrine abnormalities, especially thyroid.

But, I was tantalized by the possible association with the venom of the stingray and by my experience with people's immune problems immediately afterward.  By the way, I wasn't in a position to know if any of those patients had problems with fatigue or their immune systems further on in time.

I would still like to hear about this "inconclusive" MRI, and when the plans are to repeat it.

Quix

[Quixotic1]

I implied that I didn't think this was MS.  I can't say one way or the other.  I could certainly imagine that the venom and an immune reaction to it in a susceptible person with other circumstances being right - could conceivably initiate MS.  There is good evidence for the role of an immune-stimulating infection in triggering MS, with the most well-documented (but not proven) one being Epstein Barr Virus.

Quix

[Johnny Utah]

  Quix is dead on about venom and the reaction in the human body. I spent six years in South America and saw first hand the delayed effect a bite can have. I would not rule out the connection. But again, they could be unrelated.

Johnny

[JI Jo]

Just thought (since Stingrays are one of our islands biggest attractions) I'd post some information on Stingray venom as an FYI on this one;

"The 'sting' which gives these fishes their common name is a modified dermal denticle mounted near the base of the tail, about one-third along its total length. The sting consists of a blade-like barb with serrations along both edges and a venom gland at the base. The serrae point toward the base of the spine, making removal difficult and very painful. The venom is a fairly powerful nerve toxin which affects the heart in complex and dangerous ways. But like most fish toxins, stingray venom is a large protein that can be broken down by heat. First aid should begin with immersion of the wound in hot but non-scalding water (110 to 113° F) for 30 to 90 minutes. The wound should then be cleaned with soap and water and any broken bits of stingray spine should be removed; no attempt should be made to tape or sew the wound closed, unless necessary to stop excessive bleeding. If the wound shows signs of infection (redness, swelling, pus), administer antibiotics. Treatment by a physician is indicated in any stingray envenomation."


"A stingray's venom is not necessarily fatal, but it hurts a lot. It's composed of the enzymes 5-nucleotidase and phosphodiesterase and the neurotransmitter serotonin. Serotonin causes smooth muscle to severely contract, and it is this component that makes the venom so painful. The enzymes cause tissue and cell death. If the venom is introduced into an area like the ankle, it can usually be treated. Heat breaks down stingray venom and limits the amount of damage it can do."

As far as I know, and this is not a medical opinion by any means, but just from experience of living in the only place in the world that has a free water marine 'park' dedicated to stingrays...we've never had a case of a permanent reaction like what you've mentioned. At any case I think your wife's body should have broken the venom down a long time ago..

Just my two cents

Jolene

[Quixotic1]

Wow!  Thanks!  I know  a lot more about stingrays.

The damage to the wife's immune system hypothetically would not be from the persistence of the venom, but to the immune reaction stimulated by exposure to it.  That immune activation would be what would persist and conceivably cause a reaction.

Q

[Momzilla]

I am going to skip my regular half hour of Discovery Channel tonight.  Thanks, you wonderful people!

Zilla*