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Toad Poisoning in Laos

We describe two patients who developed severe illness after eating the skin and eggs of a toad, probably Bufo melanostictus Schneider, in southeastern Laos. One boy died, and one developed a digoxin toxicity–like syndrome with bradycardia and heart failure but survived. A telephone survey of 16 Lao provincial hospitals suggested that toad poisoning occurs in at least six provinces. That 93% of villagers in three villages in southeastern Laos were aware that toads are poisonous but that 51% had encountered patients with toad toxicity suggests that the potential gravity is not appreciated. These data indicate that toad poisoning may be underestimated and that education on the seriousness of toad toxins could be a useful public health measure.

Received May 26, 2007. Accepted for publication August 4, 2007.

Acknowledgments: We thank Stuart Blacksell, Jutta Krahn, Arlyne Johnson, and Michael Hedemark. Phanmala Baysi kindly helped with interviewing. The digoxin assays were performed by RAI and Ramathibodi Hospital, Bangkok, laboratories.

Financial support: This work was supported by the Wellcome Trust of Great Britain. PNN and MM are supported by the Wellcome Trust.

^* Address correspondence to Paul N. Newton, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. E-mail paul{at}tropmedres.ac

Authors’ addresses: Sommay Keomany, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and Fax: 856-21-242168 and Salavan Provincial Hospital, Salavan Province, Lao PDR. Mayfong Mayxay and Phouthalavanh Souvannasing, Wellcome Trust Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and Fax: 856-21-242168 and Department of Post Graduates and Research, Faculty of Medical Science, National University of Laos, Lao PDR. Chanthala Vilayhong, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and Fax: 856-21-242168. Bryan L. Stuart, The Field Museum, Department of Zoology, Division of Amphibians & Reptiles, Chicago, IL, 60605-2496. Leila Srour, Health Frontiers, Muang Sing, Luang Nam Tha, and Vientiane, Lao PDR. Paul N. Newton, Wellcome Trust Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and Fax: 856-21-242168 and Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK.