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CASE SERIES
 
Ageusia following cobra envenomation:Myth and fact on venom sucking
S Senthilkumaran1, Rishya Manikam2, N Balamurgan1, P Thirumalaikolundusubramanian3, Girija Sivakumar4, Nasir Mohamad5
1Sri Gokulam hospital & research institute, Salem, India.
2Department of Emergency Medicine, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia.
3Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, India.
4Karpaga Vinayaga Institute of Medical Sciences, Maduranthagam, Kanchipuram, India.
5Department of Emergency Medicine, School of Medical Science, University Sains Malaysia, 16150 Kubang Kerian, Kelantan.

doi:10.5348/ijcri-2011-04-26-CR-1

Address correspondence to:
Dr. Nasir Mohamad
Department of Emergency Medicine
School of Medical Science
University Sains Malaysia
16150 Kubang Kerian, Kelantan
Malaysia
Phone: +60199388078/ +6097489951
Fax: +6097489951;
Email: drnasirmohamadkb@yahoo.com

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How to cite this article:
S Senthilkumaran, Rishya Manikam, N Balamurgan, P Thirumalaikolundusubramanian, Girija Sivakumar, Nasir Mohamad. Ageusia following cobra envenomation: Myth and fact on venom sucking. International Journal of Case Reports and Images 2011;2(4):1-5.


Abstract
Introduction: Snakebite is prevalent in rural areas of Asia. Although the myth of direct sucking of snake venom may be life-threatening, it is commonly practiced in such areas.
Case Series: Two cases of cobra venom exposure to oral cavity with development of ageusia following sucking of tissue materials from the bitten site are discussed. Taste sensations were recovered in both cases in the order of sweet, salty, sour and bitter on day four, day five, day seven and day nine respectively following exposure. Both patients received antivenom due to their systemic manifestation. Exposure of the venom in the oral cavity might have disrupted the taste transduction pathways and signaling mechanisms thus resulting in ageusia as no macroscopic changes were noticed in the oral cavity, epiglottis or oropharynx. The taste sensation recovery in sweet, salty, sour and bitter order without zinc supplementation suggested that the ageusia might be due to dysfunction of sensory nerve endings and/or disruption of receptor cell activities rather than damage to taste buds, which takes more time to recover. Moreover, phased recovery of different types of taste indicates that ageusia is likely attributable to peripheral mechanisms rather than a part of systemic manifestation, as these two cases recovered from other neurological manifestations within 24 hours completely.
Conclusion: In the absence of any other likely explanation, we consider that ageusia could be due to the effect of venom on taste receptors. Further clinical studies are needed to evaluate the effect of snake venom on taste perception in snakebite victims.

Key Words: Traditional myth, Ageusia, Life-threatening

Abbreviations: PaO2 - Partial pressure of oxygen in the arterial blood; PaCO2 - Partial pressure of carbon dioxide in the arterial blood; HCO3 - Bicarbonate; BE - Base excess; PT - Prothrombin time; INR - International normalized ratio; PTT - Partial thromboplastin time; RBCs - Red blood cells; WBCs - White blood cells; ALT - Alanine transaminase; AST - Aspartate transaminase; ALP - Alkaline phosphatase; TBIL - Total bilirubin

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Acknowledgement:
Dr. K. Arthanari, M S, for his logistical support.
Author Contributions:
S Senthilkumaran - Conception of design, Acquisation of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Rishya Manikam - Conception of design, Acquisation of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
N Balamurgan - Conception of design, Acquisation of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
P Thirumalaikolundusubramanian - Conception of design, Acquisation of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Girija Sivakumar - Conception of design, Acquisation of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Nasir Mohamad - Conception of design, Critical revision of the article, Final approval of the version to be published
Guarantor of submission:
The corresponding author and the first author are the guarantor of submission.
Source of support:
None
Conflict of interest:
The author(s) declare no conflict of interests
Copyright:
© S Senthilkumaran et. al. 2010; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)