Question: The manchineel (Hippomane mancinella) tree produces an extremely potent toxic sap containing diterpene esters of the tigliane phorbol and daphnane types. What is the usual manner in which humans become exposed to this sap and what are the clinical manifestations associated with this exposure?
Answer: The cited reference notes that “Exposure most commonly takes place when individuals take refuge from the rain under a Manchineel tree. Ingestion of the Manchineel fruit (Beach Apple or ‘‘Manzanilla de la muerte’’) can cause severe swelling, ulceration, and hemorrhage of the oral and gastrointestinal mucosa which has been reported to be fatal in extreme cases. Systemic manifestations can be significant and persistent bradycardia requiring permanent pacemaker insertion has been ascribed to Manchineel toxicity.
The toxin has been used in bellicosities by aboriginals from Florida to the southern Caribbean by treating arrow tips or poisoning water. Ponce De Leone is said to have died subsequent to a poisoned arrow wound containing Manchineel toxin in West Florida following an encounter with the hostile Calusa indians. The Manchineel is found in Florida, the West Indies, and Central and South America.” (Blue L et al. Manchineel dermatitis in North American students in the Caribbean. 2011 J Travel Med 1896):422-424)