Deliberate Self-Poisoning with Plants in Southeastern France, a Poison Center 20-Year Report

INTRODUCTION

In a few regions of the globe, deliberate botanical intoxication may induce significant rates of toxicity and fatality. The objective of this report was to describe plant self-intoxication using the experiences of the southeastern France poison control center (PCC) between 2002 and 2021.

RESULTS

During those 20 years, 262 deliberate plants poisonings were reported involving 35 various plants. In most of the cases, poisoning was caused by Nerium oleander (n = 186, 71%), followed by the Datura genus (4.2%), Ricinus communis (3.8%), Taxus baccata (1.9%), Digitalis purpurea (1.2%), Aconitum nape (1.9%), Myristica fragans (1.5%), and Pyracantha coccine (1.2%). Through the 262 plants poisonings, 19 patients among the 186 Nerium oleander poisonings received Digifab as an antidote and 1 patient received physostigmine among the 11 Datura poisonings. Only four deaths were reported for this review, each involving Nerium oleander.

DISCUSSION

The first involved species was Nerium oleander (71% of all plants poisonings), then Datura sp and Ricinus communis. It is explained by this native local species' important repartition. Most patients must be admitted to an emergency department for adapted medical care; however, only 41 of them described severe poisonings symptoms. Even fewer needed an antidote, only 20 patients. There is no protocol for the use of a specific treatment, and it might be interesting to develop one for this purpose.

MATERIAL AND METHODS

This retrospective review was realized with files managed by the southeastern France PCC based in Marseille from 2002 to 2021. Our department covers the complete French Mediterranean coast, Corsica, and tropical islands (Reunion Island, Mayotte). For every patient, toxicity was evaluated using the Poison Severity Score (PSS).

Button Battery Ingestion in Children (PilBouTox®): A Prospective Study Describing the Clinical Course and Identifying Factors Related to Esophageal Impaction or Severe Cases

In this study, we aimed to identify the factors related to esophageal impaction following button battery (BB) ingestion in children. PilBouTox, a prospective multicentric observational cohort study, was conducted from French Poison Control Centers between June 1, 2016 and May 31, 2018. Children (0-12 years old) with BB ingestion were included. After ingestion, patients were monitored for 21 days or more if they remained symptomatic (maximum 1 year). Causes of ingestion, clinical manifestations, medical management, and the outcomes were recorded. In total, 415 patients were included; among them, 35 had esophageal impaction and 14 had severe complications or died. Seven symptoms were closely related (relative risk (RR) > 30) to esophageal impaction: anorexia, drooling, dyspnea, fever, hemodynamic instability, pallor, and pain. Furthermore, BBs > 15 mm were related to esophageal impaction (RR = 19, CI_95% [4.1; 88]). The absence of initial symptoms was a protective factor for esophageal impaction (RR = 0.013, CI_95% [0.002; 0.1]). Nine symptoms were closely related (RR > 30) to major effects and death: dyspnea, cough, dysphagia, drooling, fever, hemodynamic instability, pain, pallor, and vomiting. Seven symptoms were related to esophageal impaction and their rapid recognition could help to ensure that the patient is taken to a health care facility. Nine factors were related to the major effects of BB ingestion. We recommended an X-ray as soon as possible to determine the position of the BB.Trial Registry: Clinical Trial ID: NCT03708250, https://clinicaltrials.gov/ct2/show/NCT03708250.

Analyse rétrospective des expositions enregistrée par les centres antipoison français pendant la première vague de COVID-19

Objectifs

Le contexte inédit de la pandémie de COVID-19,des mesures barrières et du confinement a entraîné des bouleversements dans la population. L’objectif était d’évaluer l’impact de la pandémie COVID-19 sur les caractéristiques des appels aux centres antipoison français (CAP) entre les années 2018–2019 et 2020.

Méthode

Les cas d’exposition enregistrés du 1^er mars au 1er mai en 2018, 2019 et 2020 ont été extraits de la base de données nationale française des intoxications. Les données recueillies comprenaient les caractéristiques des appels, des patients et des expositions à certaines catégories de produits considérées a priori comme sentinelles et qui auraient pu être utilisées plus fréquemment pendant la pandémie COVID-19 : désinfectants, détergents, dont l’eau de javel, solutions hydroalcooliques, huiles essentielles et médicaments psychotropes. Les cas de 2020 ont été comparés aux expositions de 2018–2019 en utilisant des modèles logistiques simples et une évaluation de la taille d’effet significative (défini sur un p < 0,0001 et un odds ratio > 1,3).

Résultats

De mars à avril 2020, 32 182 expositions ont été rapportées aux CAP français, soit une augmentation globale de 5,6 % par rapport aux expositions de la même période en 2018–2019. Une augmentation similaire des appels a été observée dans les zones COVID-19 moins fortement épidémiques et plus fortement épidémiques et était liée à une augmentation des appels du public (+13,6 %) et une diminution des appels des professionnels de la santé (−7,5 %). Malgré l’augmentation des cas d’exposition, l’incidence des intoxications symptomatiques est restée stable (−0,4 %) avec une diminution de la gravité « modérée/grave » (−17,2 %). Une augmentation significative des expositions aux produits d’entretien ménager contenant des biocides (+74,9 %) et de la javel (+91,5 %), des huiles essentielles (+66,5 %) et des solutions hydroalcooliques (+239,5 %) a été observée (p < 0,0001).

Conclusion

La première vague de pandémie de COVID-19 a modifié le nombre et la typologie des appels aux CAP français avec une légère augmentation des appels pendant la période d’étude. Ces changements reflètent peut-être les conséquences indirectes de la pandémie de COVID-19, à savoir un accès limité aux soins primaires, la peur de contracter la COVID-19, le respect des mesures barrières et l’anxiété liée à l’isolement à domicile.