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By Carol A. Kemper, MD, FACP
Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center
Dr. Kemper reports no financial relationships relevant to this field of study.
SOURCE: Bottichio L, Webb LM, Leos G, et al. Notes from the field: Salmonella oranienburg infection linked to consumption of rattlesnake pills — Kansas and Texas, 2017. MMWR Morb Mortal Wkly Rep 2018;67:502-503.
Of all Salmonella serotypes, Salmonella oranienburg is an unusual cause of clinical illness. Occasional infections and small outbreaks have occurred worldwide, and a recent 2016 CDC posting attributed a small outbreak of S. oranienburg in three states involving eight individuals to shell eggs from Missouri. National Salmonella surveillance data, last published for 2016, indicate that 1.5% of 32,271 clinical Salmonella isolates reported from humans were due to S. oranienburg. Parallel 2016 data from the National Veterinary Services Laboratory described 5,258 clinical isolates from animals, including reptiles, with none ascribed to S. oranienburg.
A bottle of rattlesnake pills seized by the Texas Department of State Health Services during an investigation of Salmonella infection yielded S. oranienburg. The isolate was forwarded to PulseNet, the national molecular subtyping network, which identified multiple similar isolates by pulsed-field gel electrophoresis (PFGE). These cases included a man in Kansas with a recent S. oranienburg infection. During his initial interview, which included various questions about vitamins and supplements, the individual did not report taking rattlesnake pills. On a subsequent interview, he admitted to purchasing such pills in Mexico and took five capsules in the week before getting sick.
Rattlesnake “pills” are basically dehydrated, ground up rattlesnake meat stuffed into gel caps. These may be sold locally in health food stores and are available online. The FDA has not reviewed nor approved this item. A quick search found an advertisement for a bottle of 150 “capsulas vibora de cascabel” for acne for only $24, promising that snake pills “clean out your system and gets rid of built up toxins.” Other ads target individuals with cancer and HIV, and soap products made from rattlesnake are purported to be useful for rashes and psoriasis. In December 2017, the CDC issued a health alert warning that rattlesnake meat or pills may be a source for Salmonella infection. In addition to S. oranienburg, rattlesnake pills and meat have resulted in infection from S. enterica spp. arizonae.
Financial Disclosure: Internal Medicine Alert’s Physician Editor Stephen Brunton, MD, is a retained consultant for Abbott Diabetes, GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Salix, Allergan, Janssen, Lilly, Novo Nordisk, and Sanofi; he serves on the speakers bureau of Salix, Allergan, Janssen, Lilly, Sanofi, Novo Nordisk, AstraZeneca, and Boehringer Ingelheim. Peer Reviewer Gerald Roberts, MD; Editor Jonathan Springston; Executive Editor Leslie Coplin; and Editorial Group Manager Terrey L. Hatcher report no financial relationships relevant to this field of study.