Lessons to be learned: a case study approach. Unseasonal severe poisoning of two adults by deadly nightside (Atropa belladonna)

A Poisoning Outbreak Caused by Anisodus tanguticus - Maqin County, Qinghai Province, China, July 2021

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?

Anisodus tanguticus belongs to the Solanaceae family. The plant is toxic due to the tropane alkaloids it contains and can cause poisoning when it is ingested or used inappropriately.

WHAT IS ADDED BY THIS REPORT?

A poisoning outbreak involved 10 patients, and one death was caused by Anisodus tanguticus. The etiological association of plant exposure and poisoning was confirmed with evidence from an epidemiological investigation, clinical manifestations, plant identification and a toxin analysis.

WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?

The risk of poisoning caused by mistakenly collecting and ingesting tropane alkaloid-containing plants should be highlighted, and public health practitioners should be on alert.

Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March-April 2019

Background

Jimsonweed (Datura stramonium) contains toxic alkaloids that cause gastrointestinal and central nervous system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous crops, mixing with them during harvesting. On 13 March 2019, more than 200 case-patients were admitted to multiple health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and magnitude of the outbreak and recommended evidence-based control and prevention measures.

Methods

We defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea, or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1 March—30 April 2019. We reviewed medical records and canvassed all villages of the eight affected subcounties to identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed 211 residents about dietary history during 11–15 March. We used modified Poisson regression to assess suspected food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic, DNA, and microbiological testing in one national and three international laboratories.

Results

We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2–12 h after Batch X of fortified corn-soy blend (CSB +) was distributed. In the retrospective cohort study, 66% of 134 persons who ate CSB + , compared with 2.2% of 75 who did not developed illness (RR_adj = 22, 95% CI = 6.0–81). Samples of Batch X distributed 11–15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and scopolamine (1-10 ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant laboratory findings were observed.

Conclusion

This was the largest documented outbreak caused by food contamination with tropane alkaloids. Implicated food was immediately withdrawn. Routine food safety and quality checks could prevent future outbreaks.

Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children

Deadly nightshade (Atropa belladonna) intoxication has been infrequently reported in both children and adults in the literature. In this article, the clinical and laboratory findings of 49 children with acute deadly nightshade intoxication are reviewed. Our purpose was to enlighten the findings of deadly nightshade intoxication in childhood. The most common observed symptoms and signs were meaningless speech, tachycardia, mydriasis, and flushing. None of the children required mechanical ventilation or died in our series. The patients were categorized into two groups, mild/moderate and severe intoxication. Children with and without encephalopathy were accepted as severe and mild/moderate intoxication, respectively. While 43 children were placed in the group of mild/moderate intoxication, six were in severe intoxication group. We found that meaningless speech, lethargy, and coma were more common, but tachycardia was less common in the severe intoxication group (children with encephalopathy) (P B-0.05). In the treatment, neostigmine was used in all children because of no available physostigmine in our country. In conclusion, our findings showed that the initial signs and symptoms of acute deadly nightshade intoxication might be severe in some children, but no permanent sequel and death were seen in children. We also showed that meaningless speech, lethargy, coma, and absence of tachycardia were ominous signs in deadly nightshade intoxication in childhood. Lastly, we suggest that neostigmine may be used in cases of deadly nightshade intoxication if physostigmine cannot be available.

Anticholinergic Toxic Syndrome Caused by Atropa Belladonna Fruit (Deadly Nightshade): A Case Report

Atropa Belladonna poisoning may lead to anticholinergic syndrome. Ingestion of high amounts of the plant may cause lethargy, coma, and even a serious clinical picture leading to death. In this case report, we aimed to present a case with anticholinergic syndrome that developed after ingestion of the fruit called "Deadly Nightshade" in our country.

Ethnobotanical study in the Madonie Regional Park (Central Sicily, Italy)--medicinal use of wild shrub and herbaceous plant species

ETHNOPHARMACOLOGICAL RELEVANCE

This paper illustrates the results of an ethnobotanical study carried out in the Madonie Regional Park (Central Sicily, Italy). It specifies the medicinal uses of plants in the study area and contains the results of a quantitative analysis carried out for the first time in an area noted for its high degree of biodiversity. It also introduces 28 species not previously accounted for in the area of study for their medicinal uses, highlighting Silene flos-cuculi L. Greuter & Burdet, little known as medicinal in the Mediterranean area.

AIM OF THE STUDY

To understand to what extent current knowledge on medicinal-use plants is still an element of the culture within the elderly population of the Madonie Regional Park.

METHODOLOGY

The information was obtained using a semi-structured interview format performed on 150 informants over the age of 60 who were considered experts in plants and rural traditions. The taxa were identified and the results were analysed also using a range of quantitative ethnobotanical indices.

RESULTS

A census was made of 174 wild plant species, 100 of which with medicinal and veterinary uses, belonging to 49 botanical families. Of the 170 endemic species found in the Madonie Regional Park, only 2 species were cited in this study for medicinal purposes. Most of the species were used against dermatological diseases, general health and metabolic disorders. The leaves were the most-used parts of the plant and the most common preparation methods were decoction and infusion. The level of knowledge on medicinal uses of the plants was not found to be high within the elderly population, demonstrating an ongoing process of cultural erosion.

CONCLUSIONS

Only very few medicinal uses are widely known by all the informants and, on many occasions, a specific medicinal use was cited by only very few people. Further study is required in order to find out to what extent knowledge on the medicinal use of plants is still present in the younger generations in this area of Sicily, and what methods might be adopted in order to halt this gradual loss in knowledge.

Toxicology in the ICU: part 3: natural toxins

This is the third article of a three-part series that reviews the care of poisoned patients in the ICU. This article focuses on natural toxins, such as heavy metals and those produced by plants, mushrooms, arthropods, and snakes. The first article discussed the general approach to the patient, including laboratory testing; the second article focused on specific toxic agents, grouped into categories.

An Atropa belladonna L. poisoning with acute subdural hematoma

Atropa belladonna L. is a plant long known to cause poisoning. But no cases of acute subdural hematoma resulting from such poisoning have been reported so far. Care must also be taken in terms of acute pancreatitis and rhabdomyolysis in cases of such poisoning. The plant may sometimes be mistaken for the Caucasian blueberry, V. arctostaphylos L. At least one anti-cholinesterase toxidrome finding was determined in all the nine cases of belladonna poisoning in this series. No elevated creatine kinase was reported in one case with acute subdural hematoma and hyperamylasemia.

Frontier medicine: the future and integrative medicine

Vigorous and prolonged effort is required to gain true mastery of the healing arts. Conventional and complementary medicine have complementary strengths and weaknesses. Like the yin and yang of traditional Chinese medicine, they naturally flow into one another by a process of induction, creating balance. Integrative medicine is the frontier; it is the future. If we are to progress beyond our current understanding and ability to heal, we must work with theoretic models that allow us and our perception to operate "outside the box." For some, this understanding is intuitive. It is through cooperative and collaborative efforts of intuitively adept and technologically adept minds that we can integrate and advance our understanding; increase our ability to predict, prevent, and diagnose disease; and expand our therapeutic options.

Plant exposures: wilderness medicine

This article discusses poisonous plants, the symptoms that might arise if they are ingested, and the treatments that should be administered to patients.