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About this resource
This page closely follows the systematic review published by Sacco and colleagues in 2025. The paper centers on the association between kambô and sudden death while also including people who survived serious poisoning after medical intervention. It examines the clinical courses, histories, tests, and toxicologic confirmation that were reported.
“Association” in the title does not mean that kambô was confirmed as the sole cause of every death. At the same time, inability to establish causality completely is not a reason to disregard reported deaths or life-threatening complications. This resource distinguishes observed cases, the authors’ interpretations, and unresolved causation.
Study design
Following PRISMA, the authors searched PubMed and Scopus. “Kambo” was the principal search term, no location or date restriction was imposed, and English- or Spanish-language papers were eligible. They also followed references from selected articles and studies citing them. Searching continued from July through September 2024, with a final access date of September 30, 2024.
The search returned 123 records. After duplicates and irrelevant literature were removed, 18 full texts were assessed. Eligibility was broadened beyond deaths to include survivors after appropriate medical intervention, and the Results text reports that 9 publications ultimately met the criteria. Quality was assessed with Joanna Briggs Institute critical-appraisal tools, and every included report was said to meet the minimum threshold.
Because study designs and cases differed substantially, no meta-analysis or statistical estimate of mortality risk was performed. The review descriptively integrated author, year, region, purpose, outcome, toxicologic testing, symptoms, and medical intervention. It therefore did not calculate a mortality rate, relative risk, or safe amount.
Content
Fatal cases included a 42-year-old man who died approximately 30 minutes after application to burn wounds, a woman who died during a ritual in another region, and a report involving a 52-year-old man. In the 42-year-old man, deltorphin A was detected in blood, and deltorphin A, phyllocaerulein, and phyllokinin were identified on the stick used. This is important toxicologic evidence of exposure, but equivalent analysis was not available for every case.
Surviving cases included esophageal rupture, tension pneumothorax, and septic shock after intense vomiting; Boerhaave syndrome; hyponatremia and SIADH; seizures; rhabdomyolysis; kidney injury; dermatomyositis; toxic hepatitis; psychotic states; and prolonged vomiting, facial swelling, or altered consciousness. Confirmation of the secretion, co-used substances, medical history, treatment, and recovery time varied by case.
The review explains the pharmacology of phyllocaerulein, phyllomedusin, phyllokinin, sauvagine, dermorphin, deltorphin, and other constituents as background. Known effects of an individual peptide, however, are difficult to link 1-to-1 with the direct cause of a death or organ injury. Standardized methods for analyzing peptides in forensic samples are not widely available, and peptide degradation and timing of collection also affect detection.
Results
The integrated cases showed outcomes ranging from recovery within a short time to intensive care, surgery, weeks of treatment, and death. Reports of sudden death were not numerous, but the authors assessed that overlapping changes in heart rate or blood pressure, intense gastrointestinal symptoms, electrolyte abnormalities, and pre-existing cardiovascular or systemic disease could progress along a fatal pathway.
Cases surviving after medical intervention suggest that early recognition of the condition and supportive care may be important, but without a comparison group the effect size of a particular intervention cannot be calculated. Fatal cases also differed in the amount of available information on autopsy, toxicology, medical history, and co-used substances, so cause of death cannot be judged with equal certainty in every case.
The authors called for public-health surveillance, clinician awareness, identification of pre-existing risks, improved forensic analysis, and responses to unregulated online distribution. These are proposals in response to hazard reports, not conclusions confirming therapeutic efficacy of kambô.
Limitations
Because the search term was primarily “Kambo” and eligibility was limited to English and Spanish, reports using other names, Portuguese-language sources, and unindexed material may have been missed. The literature mixes case reports and narrative material and is affected by publication bias, duplicate reporting, and incomplete information. The total number of users is unknown, so mortality and risk by medical history cannot be calculated.
Although the main text describes 9 final publications, the presented table refers to a larger number of cited cases, requiring readers to inspect the boundary between included units and supplemental cases. JBI appraisal cannot supply amounts, constituents, or autopsy information absent from the original case records. Without meta-analysis, the independent contribution of each risk factor remains unknown.
Safety
Reported events include sudden death, esophageal rupture, pneumothorax, septic shock, seizures, SIADH, hyponatremia, rhabdomyolysis, and kidney, liver, or muscle injury. Intense vomiting, circulatory changes from secretion, heavy water intake, pre-existing disease, co-used substances, and delayed medical intervention may combine. Some cases begin within a short time, while others worsen later.
Research activity in isolated peptides does not guarantee the safety or benefit of whole secretion. This review did not establish a safe practitioner, number of points, amount, or screening method and does not recommend self-administration or treatment of disease.
Source and rights
Original source: Sacco MA, et al. Kambo Administration and Its Association With Sudden Death: Clinical and Forensic Perspectives From a Systematic Review. Cureus. 2025;17(1):e77646. DOI: 10.7759/cureus.77646. PMID 39968447; PMCID PMC11833272.
The original article is published under Creative Commons Attribution 4.0 (CC BY 4.0). This page follows the source’s search design, included cases, forensic issues, and limitations without reproducing its tables, figures, case descriptions, or reference list verbatim.