CME INDIA Presentation by Dr. N.K. Singh, MD, FICP, Director, Diabetes and Heart Research Centre, Dhanbad, Jharkhand, India. Editor, www.cmeindia.in.

The Sting Felt Like a Bolt from The Blue.

First identify this Plant

What happened to me?

Date – 19th Feb, 2022

• I was at Kurseong (WB) for a diabetes conference.
• Around 10.30 am, I decided to go for a short tour of the main town.
• Upon arrival, I opened the door of the car to get down.
• Nearby, there was a wall with a variety of plants.
• My index finger came in contact with this leave for fraction of second. Instantly, I felt an intense burning sensation – similar to that of a scorpion bite.
• It was extremely agonising.
• The intense burning and tingling had made my life hell.
• After 8 hours when still things were worse, I posted my case in all CME INDIA WhatsApp groups.
• No external lesions seen:

• What has happened to me, what to do? Over 28 physicians were around me.

CME INDIA Discussion on My Case

 Dr. Akash Singh, Baroda:

• The sap is clear, stinging hairs are present.
• Contact with the stinging hairs can result in local reddening and itching, swelling and an intense burning sensation. These symptoms are usually of short duration but may last up to 36 hours in sensitive individuals.
• Category 3 toxicity: Irritant to skin or eyes from sap, prickles, spines or stinging hairs. Keep out of reach of toddlers and children.

Dr. Anupama Ramkumar, Physician, Clinical Researcher, Ahmedabad:

• The species is called Urtica, and is the root word for urticaria!!!
• Dr. Singh, you literally went to the root cause of hives!!  (Spiny plants now have non-spiny varieties available).

Dr. Suresh Kubavat, HOD, Dept. of Med, Baroda medical college

• This is very similar to the Indian Stinging Nettle, also called “Bicchuu” plant, found in the Northern Hills.
• You will survive.
• Treatment will be to wash area, and perhaps some lotion.
• Self-care for nettle stings:
  • Wash the area with soap and water as soon as possible to relieve the sting and remove the nettle hairs. If no water is available, clean the area with a cloth or other available material.
  • Local symptoms of pain and itching can be relieved by applying a moistened cloth and/or ice pack to the area. It is also important to refrain from scratching or rubbing the itchy areas.
  • Antihistamines may be effective in relieving local itching and swelling, while creams such as hydrocortisone containing creams can help reduce inflammation.
  • These are available at your local pharmacy.
  • Use cool, light, bedding and clothing as this will also help relieve itching.
  • Avoid extreme heat – have lukewarm baths and showers.
  • Take anti-histamine like hydroxyzine 25 mg thrice a day on the first day and then twice a day. May take Inj Dexona 1 ml twice a day x 2 days.
  • Also, apply Betamethasone or beclomethasone cream thrice a day to reduce the allergic or irritation response.

(Responses from different friends)

Dr. N. K. Singh

• Now it is approximately 20 hrs.
• Now feeling almost good.
• No tingling or agonising sensation.
• After getting symptoms how I consulted? This is the soul of Clinical Medicine, I believe:

In Conference group, Dr. Arunnangshu Chakravarti, Tata Medical Centre, Kolkata told me to:

Dr. Ananda Bagchi, Kolkata:

• Dr. Singh, please apply local anaesthetic gel like xylocaine jelly. You will get relief.
• It looks like Bichuti pata. Jal bichuti.
• Betamethasone skin cream.
• If needed ring block with lignocaine – in proper setup. Ask Local physicians treating such cases must be knowing.

Dr. Kavita Bhattacharya, MD, Kolkata:

• During childhood in hilly areas people used to punish the child with this herb.

Dr. Rajeev Jayadeven, Gastroenterotolist, Chochin

• Saw your plant sting post late, Dr Singh. Glad you are better. I have an interest in plants since I was a kid.
• Things are easier with internet. I now use an app called Plant Net to identify plants and read about them.
• The plant that “bit you” is Urtica Chamaedryoides and has sharp needles all along its stem and leaves. It is known to cause an insect bite-like sting exactly as you described.

Dr. Arvinda J, Bengaluru:

• Just relax. Antihistamines for 5 days. If severe, a shot of H Cort should be ok.

Dr. Anil Motta, Delhi:

• Nettle dermatitis:
  • Anti-itch drugs, usually in the form of creams containing antihistamines or hydrocortisone, may provide relief from nettle dermatitis. 

Dr. Sanjay Gandhi, Pune:

• There are almost invisible spikes to the leaves and the stem … definitely plant poison …but treatment…same …you could have tried vinegar, wash immediately.

Dr. Awadhesh K. Singh, DM Endo., Kolkata:

• This is stinging nettle plant.
• Nothing will happen.
• Tragia involucrate Is botanical name.
• Hindi: बिछुआ पत्ती

Dr. P. D. Gokhale, MD, Jamshedpur:

• In Maharashtra, we used खाजकुयली (I don’t know English name) with excellent results. It caused intense itching.

Dr. N. K. Singh:

• I first consulted locals, not physicians.

Dr. P. D. Gokhale:

• Yes. About herbs, local people know best.

Dr. Murali Mohan, Pulmonologist, Bengaluru:

• Looks like Urtica or stinging nettle – from which we get the term urticaria.

Follow up:

After 24 hous, symptoms settled. I was comfortable. No medications used. Reassurance and watchfulness -Looks best approach.

CME INDIA Learning Points

• Stinging Nettle is a small plant that has fine hairs on the leaves and stems.
• The scientific name: Urtica dioica
• The genus name: Urtica comes from the Latin verb urere that means, “to burn” because of these stinging hairs.
• The species name dioica means “two houses” because the plant usually contains either male or female flowers.
• The species is divided into six subspecies, five of which have many hollow stinging hairs called trichomes on the leaves and stems, which act like hypodermic needles, injecting histamine, serotonin, and choline that produce a stinging sensation
• The stinging nettle plant – It is covered with multiple small spicule-type hairs noted on the stem and the underside of the leaves.
• Small exposures to nettles can cause local symptoms:
  • Burning
  • Itching
  • Redness,
  • Swelling (occasionally small blisters will form) and local numbness.
  • Symptoms are usually self-limiting and resolve within a few days.
  • In cases where a large area of the body has been exposed to the nettles, or exposed to the nettles for a longer period of time it is possible further symptoms such as inco-ordination, tremor, muscle weakness and faintness may occur.
  • The urticaria is accompanied by a stinging sensation
    • Usually lasting longer than 12 h.
    • Little is known of the cellular and molecular mechanism of stinging-nettle urticaria. Only mast cell numbers have been significantly increased at 12 h. Ultra-structurally, some mast cells show evidence of degranulation at 5 min and 12 h.
    • At 12 h mast cells are closely associated with dermal dendritic cells and lymphocytes suggesting a functional unit.
    • The mean histamine and serotonin contents of a nettle hair has been found to be 6.1 ng and 33.25 pg, respectively.
    • The persistence of the stinging sensation might suggest the presence of substances in nettle fluid directly toxic to nerves or capable of secondary release of other mediators.

Extended exposure can lead to this.

What happens when you get Stung?

• The mechanism of action of stinging nettles may be both biochemical and mechanical. Impalement of spicules into the skin may add additional mechanical irritation to the known adverse chemical effects of stinging nettles.

Self-care for nettle stings

Surprised to know, people eat its various part as documented benefit exist

• The leaf extract of nettle was one of the herbal remedies which the experimental, clinical and trials have complemented each other. It is a very well-known plant with a wide historical background use of stems, leaves and roots. It has a long history of use as power sources such as soup or curry, and also used as fiber and a medicinal plant.
• Medicinal uses for the plant derive from its anti-inflammatory properties
• It has been used to treat arthritis as well as other ailments
• The plant has been used for hundreds of years as a diuretic and to treat painful muscles and joints, eczema, and arthritis.
• Many people use Stinging Nettle to treat benign prostatic hyperplasia.
• The Use of Urtica dioica (Stinging Nettle) as a Blood Sugar Lowering Herb.
• Several studies suggest that the Stinging nettle works as a PPAR gamma agonistic and alpha-glucosidase inhibitory agent.
• Stinging nettle extracts have shown in preserving the epithelial integrity and enhancing intestinal steady-state defense.
• Traditionally been used in the control of cardiovascular disorders especially hypertension.  
• Urtica dioica extract significantly increased the sensitivity of breast cancer cells to paclitaxel.

CME INDIA Tail Piece

Nettles have a long and colourful history of use as food, cordage, and medicine.

• The young boiled shoots have been reported as being a food for Europeans and Persians as well as being used in the Himalayas.
• The stems were once widely used in Europe as cordage for weaving, sailcloth, and fishing line. With proper processing, the fiber was said to be as fine as silk

Nepal Connection

• The plant has a long history of use as a medicine and as a food source. Sisnu, sishnu, Lekali sishnu, Thulo sishnu, Ghario sishnu, Bhangre sishnu or Patle sishnu is the Nepali name for edible stinging nettles.  
• It is not common to see nettle greens sold like this since one has to go to the wild to collect it.
• When nettle greens are picked or gathered, only uppermost tender shoots and top green leaves are picked. The older and mature leaves from the lower part of the plants are tasteless.
• The Netttle are picked up by using Nepali metal tongs called chimta (चिम्टा). If you trying to explore and collect nettles from the wild, use rubber gloves, tongs or scissors.  Make sure not to touch the shoots, leaves and plants with your bare hands.  The stings of this plant is not a pleasant one.arcity of vegetables.
• Haat kaa maila sun kaa thailaa, ke garnu dhanle? – (हातका मैला सुनका थैला, के गर्नु धनले )
  Saag ra sisnu khaaeko besa aanandi manle! – (साग र सिस्नु खाएको बेस आनन्दी मनले)

I express my sincere gratitude to all my friends and CME INDIA group members who became very concerned about this episode. Many phoned me from abroad as well. I must admit that I got real time help and assurance. I was totally ignorant about such plants, which can make life so tragic – even if for 24 hours only. I trusted the LOCAL people and physicians who were like boon to unlock the mystery. I did not consult and super speciality and clinical medicine echoed not to go for investigations. If you do not agree, please do comment in the COMMENTS Section.

References:

1.https://www.health.govt.nz/your-health/conditions-and-treatments/accidents-and-injuries/bites-and-stings/stinging-nettles

2. Phytomedicine. 2013 Jan 15;20(2):143-7. doi: 10.1016/j.phymed.2012.09.016. Epub 2012 Oct 23.

3. Chemical Composition and Immuno-Modulatory Effects of Urtica dioica L. (Stinging Nettle) Extracts.protective effect against tissue damage caused by inflammation processes

4. Phytother Res. 2017 Aug;31(8):1183-1191. doi: 10.et al.,Screening of pharmacological uses of Urtica dioica and others benefits,Progress in Biophysics and Molecular Biology,Volume 150,2020,Pages 67-77,ISSN 0079-6107,https://doi.org/10.1016/j.pbiomolbio.2019.05.008.(https://www.sciencedirect.com/science/article/pii/S0079610719300987)

5. Contact urticaria due to the common stinging nettle (Urtica dioica)—histological, ultrastructural and pharmacological studies F. OLIVER,E. U. AMON,A. BREATHNACH,et al. 1991.https://doi.org/10.1111/j.1365-2230.1991.tb00282.x

6. Randall C.Randall H.Dobbs F.Hutton C.Sanders H.Randomized controlled trial of nettle sting for treatment of base-of-thumb pain.J Roy Soc Med. 2000; 93: 305-309

7. Oliver F.Amon E.U.Breathnach A.Francis D.M.Contact urticaria due to the common stinging nettle (Urtica dioica)—histological, ultrastructure and pharmacological studies.Clin Exp Dermatol. 1991; 16: 1-7

8. http://tasteofnepal.blogspot.com/2014/06/nettle-greens-sishnu-ko-saag.html?m=1

9. Chrubasik JE, Roufogalis BD, Wagner H, et al. A comprehensive review on the stinging nettle effect and efficacy profiles. Part II: urticae radix. Phytomedicine. 2007; 14: 568-579. doi: 10.1016/j.phymed.2007.03.014

10. Hailemeskel B, Fullas F. The use of Urtica dioica (stinging nettle) as a blood sugar lowering herb: a case report and a review of the literature. Diabetes Res Open J. 2015; 1(5): 123- 127. doi: 10.17140/DROJ-1-119

11. https://www.medicalnewstoday.com/articles/stinging-nettle-rash./

12. https://www.botany.one/2018/08/stinging-plants-share-needle-designs/

13. https://bsapubs.onlinelibrary.wiley.com/doi/10.1002/ajb2.1136 First published: 06 August 2018.https://doi.org/10.1002/ajb2.1136

14. https://www.health.govt.nz/your-health/conditions-and-treatments/accidents-and-injuries/bites-and-stings/stinging-nettles

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