First successful curative use of digoxin-specific Fab antibody fragments in a life-threatening coconut crab (Birgus latro L.) poisoning

• Published in: Toxicon (Oxford) Vol. 60; no. 6; pp. 1013 - 1017
• Main Authors: Maillaud, C., Barguil, Y., Mikulski, M., Cheze, M., Pivert, C., Deveaux, M., Lapostolle, F.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.11.2012; Elsevier
• Subjects: Adult; Animal poisons toxicology. Antivenoms; Animals; Anomura - chemistry; antibodies; Biological and medical sciences; Birgus latro L; blood serum; Cardenolides - blood; Cardenolides - poisoning; Cardenolides - urine; Chromatography, High Pressure Liquid; Coconut crab; crabs; Crustacea; Digoxin-specific Fab antibody fragments; Electrocardiography; Female; Food Contamination; Foodborne Diseases - drug therapy; Humans; Immunoglobulin Fab Fragments - therapeutic use; ingestion; Medical sciences; Middle Aged; Neriifolin; New Caledonia; patients; Poisoning; Tandem Mass Spectrometry; Toxicology; Treatment Outcome; urine; New Caledonia; Melanesia; Oceania; Poisoning; Digoxin-specific Fab antibody fragments; Coconut crab; Birgus latro L; New Caledonia; Neriifolin; Cardiotonic agent; Digoxin; Antibody; Coconut; Brachyura; Fab-Fragment; Crustacea; Crab; Edible crustacean; Arthropoda; Glycoside; Decapoda; Invertebrata; Digitalis drug; Food
• ISSN: 0041-0101; 1879-3150
• DOI: 10.1016/j.toxicon.2012.06.017

We wish to report the first curative use of digoxin-specific Fab antibody fragments in a coconut crab Birgus latro L. poisoning in New Caledonia. The female patient, aged sixty-three with a previous history of cardiovascular and metabolic dysfunctions, showed marked first-degree atrio-ventricular block and several atrial pauses, and was given 760 mg of digoxin-specific Fab antibody fragments. Shortly after the perfusion her electrocardiogram returned to close to normal with only slight first-degree atrio-ventricular block and no more atrial pauses. Neriifolin LC-MS/MS tests performed on the patient's serum and urine samples confirmed cardenolide poisoning. Another, younger patient, with high neriifolin levels in her serum and urine samples only experienced gastro-intestinal symptoms and was discharged without specific treatment. The consumption of coconut crab in New Caledonia should be avoided even though the first of the two cases reported suggests that digoxin-specific Fab antibody fragments can be effective in the treatment of life-threatening poisoning caused by the ingestion of this crustacean.