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Guo X, He Q, Qi B, Sun C, Lyu D, Zhang H. A Poisoning Outbreak Caused by Anisodus tanguticus - Maqin County, Qinghai Province, China, July 2021. China CDC Wkly 2022; 4:920-923. [PMID: 36426290 PMCID: PMC9681605 DOI: 10.46234/ccdcw2022.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/13/2022] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Xuebin Guo
- QingHai Center for Disease Control and Prevention, Xi’ning City, Qinghai Province, China
| | - Qian He
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bangguo Qi
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chenye Sun
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - DongJin Lyu
- QingHai Center for Disease Control and Prevention, Xi’ning City, Qinghai Province, China,Dongjin Lyu,
| | - Hongshun Zhang
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China,Hongshun Zhang,
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Mutebi RR, Ario AR, Nabatanzi M, Kyamwine IB, Wibabara Y, Muwereza P, Eurien D, Kwesiga B, Bulage L, Kabwama SN, Kadobera D, Henderson A, Callahan JH, Croley TR, Knolhoff AM, Mangrum JB, Handy SM, McFarland MA, Sam JLF, Harris JR, Zhu BP. Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March-April 2019. BMC Public Health 2022; 22:623. [PMID: 35354446 PMCID: PMC8969350 DOI: 10.1186/s12889-022-12854-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
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 (RRadj = 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.
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Affiliation(s)
- Ronald R Mutebi
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.,Ministry of Health, Kampala, Uganda
| | - Maureen Nabatanzi
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Irene B Kyamwine
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Yvette Wibabara
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Peter Muwereza
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Eurien
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Steven N Kabwama
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Alden Henderson
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John H Callahan
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - Timothy R Croley
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - Ann M Knolhoff
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - John B Mangrum
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - Sara M Handy
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - Melinda A McFarland
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - Jennifer L Fong Sam
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA
| | - Julie R Harris
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Bao-Ping Zhu
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Centers for Disease Control and Prevention, Kampala, Uganda
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HASGÜL B, ÇATAK M, ÇATAK Aİ, KARAMAN S. CASE SERİES WITH ATROPA BELLADONNA (DEADLY NIGHTSHADE) INTOXICATION AND EXPERIENCE OF PHYSOSTIGMIN. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2021. [DOI: 10.33706/jemcr.998002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fatur K, Kreft S. Common anticholinergic solanaceaous plants of temperate Europe - A review of intoxications from the literature (1966–2018). Toxicon 2020; 177:52-88. [DOI: 10.1016/j.toxicon.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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Caksen H, Odabaş D, Akbayram S, Cesur Y, Arslan S, Uner A, Oner AF. Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 2016; 22:665-8. [PMID: 14992329 DOI: 10.1191/0960327103ht404oa] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Hüseyin Caksen
- Yüzüncü Yil University, Faculty of Medicine, Department of Pediatrics, 65200, Van, Turkey.
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Demirhan A, Tekelioğlu ÜY, Yıldız İ, Korkmaz T, Bilgi M, Akkaya A, Koçoğlu H. Anticholinergic Toxic Syndrome Caused by Atropa Belladonna Fruit (Deadly Nightshade): A Case Report. Turk J Anaesthesiol Reanim 2013; 41:226-8. [PMID: 27366377 DOI: 10.5152/tjar.2013.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/20/2012] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Abdullah Demirhan
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Ümit Yaşar Tekelioğlu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - İsa Yıldız
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Tanzer Korkmaz
- Department of Emergency Medicine, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Murat Bilgi
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Akcan Akkaya
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Hasan Koçoğlu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
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Leto C, Tuttolomondo T, La Bella S, Licata M. Ethnobotanical study in the Madonie Regional Park (Central Sicily, Italy)--medicinal use of wild shrub and herbaceous plant species. JOURNAL OF ETHNOPHARMACOLOGY 2013; 146:90-112. [PMID: 23276781 DOI: 10.1016/j.jep.2012.11.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/02/2012] [Accepted: 11/18/2012] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- Claudio Leto
- Department of Agri-Environmental Systems, University of Palermo, Viale delle Scienze 13, 90128 Palermo, Italy.
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Levine M, Ruha AM, Graeme K, Brooks DE, Canning J, Curry SC. Toxicology in the ICU: part 3: natural toxins. Chest 2011; 140:1357-1370. [PMID: 22045882 DOI: 10.1378/chest.11-0295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
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.
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Affiliation(s)
- Michael Levine
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ.
| | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
| | - Kim Graeme
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ; Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, CA
| | - Daniel E Brooks
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
| | - Joshua Canning
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
| | - Steven C Curry
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
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Cikla U, Turkmen S, Karaca Y, Ayaz FA, Ayaz AF, Turedi S, Gunduz A. An Atropa belladonna L. poisoning with acute subdural hematoma. Hum Exp Toxicol 2011; 30:1998-2001. [PMID: 21540312 DOI: 10.1177/0960327111407225] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Ulas Cikla
- Department of Neurosurgery, Gümüşhane State Hospital, Gümüşhane, Turkey
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Ross C, Haussler KK, Kenney JD, Marks D, Bertone JJ, Henneman K, May KJ. Frontier medicine: the future and integrative medicine. Vet Clin North Am Equine Pract 2005; 17:351-77. [PMID: 15658181 DOI: 10.1016/s0749-0739(17)30067-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
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.
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Affiliation(s)
- C Ross
- El Cajon Valley Veterinary Hospital, El Cajon California, USA.
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Abstract
This article discusses poisonous plants, the symptoms that might arise if they are ingested, and the treatments that should be administered to patients.
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Affiliation(s)
- Sophia Dyer
- Department of Emergency Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA.
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