Common plant toxicology: A comparison of national and Southwest Ohio data trends on plant poisonings in the 21st century

Plant poisonings in Australia: a retrospective series of calls to the Queensland Poisons Information Centre

INTRODUCTION

There is little research to characterise plant poisoning in Australia. The aim of this project is to investigate plant exposures reported to a state poisons information centre.

METHODS

This is a retrospective review of plant exposures reported to the Queensland Poison Information Centre (QPIC) between January 2019 and December 2021. Main outcome measures included patient demographics, plant exposure details, symptomatology, and management advice.

RESULTS

QPIC received calls regarding 2766 plant exposures over the study period. Children aged 1-4 years were the commonest group exposed, accounting for 1295 (46.8%) exposures. The caller was usually a family member/caregiver (2036 [73.6%]) calling from home (2257 [81.6%]). Exposures were unintentional in 2722 (98.4%) cases, with the oral route being most common, occurring in 2264 (81.9%) cases.Plant groups most responsible for exposures included gastrointestinal irritants (536 [19.4%]), oxalates (522 [18.9%]), and non-toxic plants (442 [16.0%]). The plant involved was known in 2366 (85.5%) exposures, most commonly Euphorbiaceae (257 [9.3%]). Patients were asymptomatic (1644 [59.4%]) or had mild toxicity (1033 [37.3%]) in most exposures. Only 18 (0.6%) cases had moderate/severe toxicity, and this was most often due to recreational exposures by adults (9[0.3%]). Referral for medical review was advised in 407 (14.7%) cases, most commonly following exposures to Euphorbiaceae (140/407 [34.4%]), gastrointestinal irritants (52/407 [12.7%]), and oxalates (38/407 [9.3%]).

CONCLUSIONS

The majority of plant exposures reported to QPIC are unintentional paediatric exposures. Most are asymptomatic or have mild toxicity. More severe toxicity is seen in adults with recreational plant exposures.

Avoiding a crisis at Christmas: a systematic review of adverse health effects or 'Chrishaps' caused by traditional hazard sources and COVID-19

OBJECTIVE

To complement the 2020 ANZJPH editorial "How COVID-safe Santa can save Christmas". In addition to a concise update regarding SARS-CoV-2/COVID-19, we aimed to explore some risks of Christmas in terms of adverse health effects, which we call 'Chrishaps'. Our overall study question was "which hazards have been scientifically associated with old Christmas essentials such as decoration, gifts, menus, and Santa himself, as well as new challenges associated with COVID-19?"

METHOD

We searched the PubMed, Web of Science, and Open Grey databases systematically and Google unsystematically.

RESULTS

Thirty-six pertinent articles - most of them case reports or retrospective analyses - documented Chrishaps.

CONCLUSION

Overall results suggested that Chrishaps come in different shapes and guises. Implications for public health: Chrishaps pose a potential minor public health threat that should be borne in mind every festive season. Assessing and discussing specific public health implications of Chrishaps requires systematic risk research to be conducted.

Rapid Identification of Common Poisonous Plants in China Using DNA Barcodes

Toxic plants have been a major threat to public health in China. However, identification and tracing of poisoned species with traditional methods are unreliable due to the destruction of plant morphology by cooking and chewing. DNA barcoding is independent of environmental factors and morphological limitations, making it a powerful tool to accurately identify species. In our study, a total of 83 materials from 26 genera and 31 species of 13 families were collected and 13 plant materials were subjected to simulated gastric fluid digestion. Four markers (rbcL, trnH-psbA, matK, and ITS) were amplified and sequenced for all untreated and mock-digested samples. The effectiveness of DNA barcoding for the identification of toxic plants was assessed using Basic Local Alignment Search Tool (BLAST) method, PWG-Distance method, and Tree-Building (NJ) method. Except for the matK region, the amplification success rate of the remaining three regions was high, but the sequencing of trnH-psbA and ITS was less satisfactory. Meanwhile, matK was prone to be more difficult to amplify and sequence because of simulated gastric fluid. Among the three methods applied, BLAST method showed lower recognition rates, while PWG-Distance and Tree-Building methods showed little difference in recognition rates. Overall, ITS had the highest recognition rate among individual loci. Among the combined loci, rbcL + ITS had the highest species recognition rate. However, the ITS region may not be suitable for DNA analysis of gastric contents and the combination of loci does not significantly improve species resolution. In addition, identification of species to the genus level is sufficient to aid in the clinical management of most poisoning events. Considering primer versatility, DNA sequence quality, species identification ability, experimental cost and speed of analysis, we recommend rbcL as the best single marker for clinical identification and also suggest the BLAST method for analysis. Our current results suggest that DNA barcoding can rapidly identify and trace toxic species and has great potential for clinical applications. In addition, we suggest the creation of a proprietary database containing morphological, toxicological and molecular information to better apply DNA barcoding technology in clinical diagnostics.

Integrating non-targeted metabolomics and toxicology networks to study the mechanism of Esculentoside A-induced hepatotoxicity in rats

Esculentoside A (EsA) is a kind of triterpenoid saponins from the root tuber of Phytolacca acinosa Roxb. It has extensive medicinal activity, such as antibacterial, anti-inflammatory, immune regulation, and cell proliferation inhibition. However, some researches suggested that EsA can cause hepatotoxicity, whose mechanism is not precise. To ensure the safety and reliability in the clinical use of Phytolacca acinosa Roxb., it is necessary to establish a rapid and accurate method to evaluate the toxicity, analyze and verify the toxicity mechanism of EsA. Therefore, this research explored the mechanism of hepatotoxicity induced by EsA in rats and analyzed endogenous metabolites' changes in rat plasma by combining network toxicology with non-targeted metabolomics. We obtained 58 critical targets of EsA induced hepatotoxicity in rats based on the strategy of network toxicology, including albumin, mitogen-activated protein kinase 1, Caspase-3, etc. Many important pathways were obtained by Kyoto Encyclopedia of Genes and Genomes enrichment analysis, such as HIF-1 signaling pathway, TNF signaling pathway, IL-17 signaling pathway, and other concerning pathways. Sixteen biomarkers, including 5-hydroxykynurenamine, N-acetylserotonin, palmitic acid, etc., were screened from rat plasma using Ultra-performance liquid chromatography coupled with quadrupole time of flight mass spectrometry (UPLC-Q-TOF/MS), mainly involve Glycerophospholipid metabolism, Tryptophan metabolism, and other metabolic pathways. Further analysis showed that EsA may induce liver injury by activating oxidative stress and energy metabolism disorders, triggering inflammation and apoptosis.

Forensic application of DNA barcoding in the identification of commonly occurring poisonous plants

Exposure to poisonous plants is hazardous to health; thus, reliable species identification is required to decide the most appropriate treatment. Since ingested plants are too much degraded for visual observation, DNA barcoding can be used as a molecular tool for species identification. Considering the universal primers, PCR and sequencing success rate, and diversity of the poisonous plants, the rbcL DNA marker was selected for molecular identification. A reference DNA barcode library for 100 poisonous plant species was created using rbcL DNA barcodes. For the poisonous plants represented in the library, 100% and 89% species differentiation was observed at the genus and species level, respectively. All the undifferentiated species were congeneric species. Mapping the metabolites of the poisonous plants to the DNA based phylogenetic tree indicated that the phylogenetically related species also had related toxic compounds. Therefore, genus-level identification may be sufficient in the practical application of DNA barcoding in poisoning cases. We conclude that rbcL can be used as a primary marker, and if required, ITS2 or trnH-psbA may be used as a secondary marker to identify the poisonous plants. The present study provides the foundation to develop a reliable molecular method to identify the poisonous species from the vomit samples of poisoning cases.

Plants and mushrooms associated with animal poisoning incidents in South Africa

Background

There is extensive literature on animal poisoning from plants and mushrooms worldwide; however, there is limited account of poisoning from South Africa.

Methods

This study sought to describe and provide an overview of animal poison exposures in South Africa. Poisoning episodes reported to the Poisons Information Helpline of the Western Cape, jointly run by the Poisons Information Centres at the Red Cross War Memorial Children’s Hospital and Tygerberg Hospital over a period of approximately 2.5 years, from June 2015 to November 2017, were analysed to identify exposure patterns, severity and clinical outcomes.

Results

Alien plant species accounted for most cases (n=10) of reported poison exposures. Among the 26 recorded animal poisoning episodes, the dog was the most commonly implicated species (n=24), whereas just two enquiries were related to other animals (one rabbit and one cow). There were 20 plant cases and 6 mushroom cases (all dogs). There was only one fatal case involving cycad in a dog.

Conclusion

Features of animal poisoning in South Africa were similar to those in other countries. The reported cases of animals exposed to poisonous plants and mushrooms could represent only a fraction of the actual exposures. Since most reported cases involved taxa that could not be identified to species level, more attention should be paid in case reporting and in animal poisoning prevention, engaging the public to enable people to recognise potentially hazardous plants and reduce the risk of poisoning in animals.

Epipremnum aureum Keratopathy: Case Report and Review of the Literature

OBJECTIVES

To report a novel case of Epipremnum aureum toxicity masquerading as bilateral infectious keratitis and review the literature on ocular manifestations of Epipremnum exposure.

METHODS

Case report and literature review.

RESULTS

A 70-year-old man with a history of photorefractive keratectomy presented with a 3-day history of bilateral eye pain. The patient reported exposure to plant debris while performing yard work and also water exposure while cleaning his coral fish tanks. Clinical examination revealed bilateral epitheliopathy progressing to frank epithelial defects with underlying stromal necrosis 6 days after exposure. Empiric topical antibiotic drops were initiated, but multiple cultures, corneal biopsy, and confocal microscopy were all negative for an infectious agent. Over a 2-week period, the epithelial defects worsened and a suspicion for a toxic etiology was raised. The patient later recalled rubbing his eyes after exposure to Epipremnum aureum (Golden Pothos/Devils Ivy) sap. He was thus treated conservatively with artificial tears, topical corticosteroids, and amniotic membrane. After 3 months, the epithelial defects resolved, but with corneal scarring, prominently in the left eye and underwent penetrating keratoplasty. Five years after presentation, best-corrected visual acuity with hard contact lenses was 20/25 in the right eye and 20/20 in the left eye.

CONCLUSION

Epipremnum aureum toxicity is a rare cause of keratitis. It can mimic acanthamoeba keratitis or anesthetic abuse and should be considered in cases of culture negative nonhealing corneal ulcerations. Eliciting a history of plant sap exposure can facilitate appropriate supportive care for this toxic keratitis.

Mutagenic activity and chemical composition of phenolic-rich extracts of leaves from two species of Ficus medicinal plants

Plant species from the Ficus genus are widely used as food, and in folk medicine as anti-inflammatory, antioxidant and anticancer agents, although some of these species are known to produce adverse effects. The aim of this study was to determine and compare the chemical composition as well as in vitro antioxidant and mutagenic activity of the aqueous extracts of leaves from F. adhatodifolia and F. obtusiuscula. Phytochemical screening using thin-layer chromatography identified 6 classes of secondary metabolites in the extracts. Total phenolic content was estimated by the Folin-Ciocalteau method and the phenolic profile was determined by UPLC-DAD-ESI/MS/MS. Antioxidant activities were evaluated by the DPPH radical assay and by the β-carotene/linoleic acid system. Mutagenic activity was measured by the Salmonella typhimurium reverse mutation test with 4 strains, in both the presence and absence of metabolic activation. Flavonoids, coumarins, and tannins were detected in both extracts, and 6 major derivatives were identified as flavone compounds. Antioxidant activities were demonstrated for both extracts, while F. obtusiuscula contained higher concentrations of phenolic compounds. Mutagenic activity of the TA97 strain without metabolic activation was observed for both tested extracts, as well as the TA102 strain with metabolic activation. In addition, the extract of F. adhatodifolia was shown to be mutagenic to the TA102 strain without metabolic activation. Evidence indicates that the use of teas obtained from these two plant extracts in folk medicine may raise concerns and needs further investigation as a result of potential pro-oxidant mutagenic effects in the absence or presence of metabolic activation.

Human Plant Exposures Reported to a Regional (Southwestern) Poison Control Center Over 8 Years

BACKGROUND

There is little published data about human plant exposures reported to US poison control centers (PCCs).

METHODS

A retrospective chart review of all reported plant exposures to a single regional PCC between January 1, 2003 and December 31, 2010 was done to understand better the characteristics of plant exposure cases. Specific generic plant codes were used to identify cases. Recorded variables included patient demographics, plant involved, exposure variables, symptoms, management site, treatments, and outcome. Univariate and multivariate regression was used to identify outcome predictors.

RESULTS

A total of 6492 charts met inclusion criteria. The average age was 16.6 years (2 months-94 years); 52.4% were male. The most common exposure reason was unintentional (98%), and the majority (92.4%) occurred at the patient's home. Ingestions (58.3%) and dermal exposures (34.3%) accounted for most cases. Cactus (27.5%), oleander (12.5%), Lantana (5.7%), and Bougainvillea (3.8%) were most commonly involved. Symptoms developed in 47.1% of patients, and were more likely to occur following Datura (66.7%), and Morning Glory or Milkweed (25% each) exposures. Almost 94% of patients were managed onsite (home) and only 5.2% involved evaluation in a health care facility (HCF). Only 37 (0.6%) patients required hospital admission, and 2.9% of cases resulted in more than minimal effects. Exposures resulting in more than minimal clinical effects were predicted by several variables: abnormal vital signs (OR = 35.62), abnormal labs (OR = 14.87), and management at a HCF (OR = 7.37). Hospital admissions were increased for patients already at a HCF (OR = 54.01), abnormal vital signs (OR = 23.28), and intentional exposures (OR = 14.7).

CONCLUSION

Plant exposures reported to our poison control center were typically unintentional ingestions occurring at home. Most patients were managed onsite and few developed significant symptoms.

Bioinformatics analysis to assess potential risks of allergenicity and toxicity of HRAP and PFLP proteins in genetically modified bananas resistant to Xanthomonas wilt disease

Banana Xanthomonas wilt (BXW) disease threatens banana production and food security throughout East Africa. Natural resistance is lacking among common cultivars. Genetically modified (GM) bananas resistant to BXW disease were developed by inserting the hypersensitive response-assisting protein (Hrap) or/and the plant ferredoxin-like protein (Pflp) gene(s) from sweet pepper (Capsicum annuum). Several of these GM banana events showed 100% resistance to BXW disease under field conditions in Uganda. The current study evaluated the potential allergenicity and toxicity of the expressed proteins HRAP and PFLP based on evaluation of published information on the history of safe use of the natural source of the proteins as well as established bioinformatics sequence comparison methods to known allergens (www.AllergenOnline.org and NCBI Protein) and toxins (NCBI Protein). The results did not identify potential risks of allergy and toxicity to either HRAP or PFLP proteins expressed in the GM bananas that might suggest potential health risks to humans. We recognize that additional tests including stability of these proteins in pepsin assay, nutrient analysis and possibly an acute rodent toxicity assay may be required by national regulatory authorities.

Medicinal plants used to treat snakebite in Central America: Review and assessment of scientific evidence

ETHNOPHARMACOLOGICAL RELEVANCE

Every year between 1.2 and 5.5 million people worldwide are victims of snakebites, with about 400,000 left permanently injured. In Central America an estimated 5500 snakebite cases are reported by health centres, but this is likely to be an underestimate due to unreported cases in rural regions. The aim of this study is to review the medicinal plants used traditionally to treat snakebites in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.

MATERIALS AND METHODS

A literature search was performed on published primary data on medicinal plants of Central America and those specifically pertaining to use against snakebites. Plant use reports for traditional snakebite remedies identified in primary sources were extracted and entered in a database, with data analysed in terms of the most frequent numbers of use reports. The scientific evidence that might support the local uses of the most frequently reported species was also examined.

RESULTS

A total of 260 independent plant use reports were recorded in the 34 sources included in this review, encompassing 208 species used to treat snakebite in Central America. Only nine species were reported in at least three studies: Cissampelos pareira L., Piper amalago L., Aristolochia trilobata L., Sansevieria hyacinthoides (L.) Druce, Strychnos panamensis Seem., Dorstenia contrajerva L., Scoparia dulcis L., Hamelia patens Jacq., and Simaba cedron Planch. Genera with the highest number of species used to treat snakebite were Piper, Aristolochia, Hamelia, Ipomoea, Passiflora and Peperomia. The extent of the scientific evidence available to understand any pharmacological basis for their use against snakebites varied between different plant species.

CONCLUSION

At least 208 plant species are traditionally used to treat snakebite in Central America but there is a lack of clinical research to evaluate their efficacy and safety. Available pharmacological data suggest different plant species may target different symptoms of snakebites, such as pain or anxiety, although more studies are needed to further evaluate the scientific basis for their use.

Plant poisoning in domestic animals: epidemiological data from an Italian survey (2000-2011)

An Italian epidemiological study based on the human Poison Control Centre of Milan (Centro Antiveleni di Milano (CAV)) data related to domestic animal poisoning by exposure to plants, was carried out in collaboration with the Veterinary Toxicology Section of the University of Milan. It encompasses a 12-year period, from the beginning of 2000 to the end of 2011. Calls related to toxic plants accounted for 5.7 per cent of total inquiries (2150) received by CAV. The dog was the most commonly poisoned species (61.8 per cent of calls) followed by the cat (26 per cent). Little information was recorded for other species. Most exposures (73.8 per cent) resulted in mild to moderate clinical signs. The outcome was reported in only 53.7 per cent of cases, and fatal poisoning accounted for 10.6 per cent of these cases. Glycoside, alkaloid, oxalate, toxalbumin, saponin, terpene and terpenoid-containing plants were recorded and found to be responsible for intoxication. Cycas revoluta, Euphorbia pulcherrima, Hydrangea macrophylla, Nerium oleander, Rhododendron species and Prunus species were the plants most frequently involved. Epidemiological data from this Italian survey provide useful information on animal exposure to plants and confirm the importance of plants as causative agents of animal poisoning.