Death in Children After Atractylis gummifera L. Poisoning in Morocco-Report of Three Cases and Review of Literature

BACKGROUND

Atractylis gummifera L. is a poisonous thistle plant that grows in the Mediterranean regions especially in northern Africa like Morocco and southern Europe. It has been used frequently to treat some diseases in traditional medicine, and its ingestion is a common cause of fatal poisoning. Here, we report 3 death cases in children after accidental ingestion of the Atractylis gummifer L.

CASES REPORTS

We report 3 cases of death in children after accidental ingestion of the poisonous plant Atractylis gummifer L. The poisoned children were admitted to hospital in deteriorated general state with clinical symptoms, such as nausea, vomiting, epigastric, and abdominal pain, diarrhea, followed by coma. However, they died a few hours later. The postmortem investigations were performed, and the diagnosis of Atractylis gummifer L. poisoning was confirmed by toxicological examination (chromatography), the latter showed the presence of atractyloside (potassium atractylate), a toxic compound of the plant Atractylis gummifera L.Atractylis gummifer L. poisoning was discussed with review through the literature.

CONCLUSIONS

Through the presented cases, we show that Atractylis gummifera L. poisoning remains a health problem that involves children in Morocco, where the plant grows spontaneously. Thus, teaching children to recognize dangerous plants will be helpful to prevent accidental ingestion.

Prognostic factors of Atractylis gummifera L. poisoning, Morocco

In Morocco, acute Atractylis gummifera L. poisoning represents the leading cause of death by plant poisoning especially for children. All cases received in the Moroccan poison control centre from January 1981 to December 2009 (n = 467) were included in a retrospective study of the characteristics and risk factors of A. gummifera L. poisoning. The most vulnerable age group was children (63.4% of cases). Most cases were due to accidental exposure (75.5%), but some were from therapeutic use (18.1%) or attempted abortion (7.4%). Patients presented with moderate poison severity signs (grade 2) in 22.3% of cases or severe signs (grade 3) in 21.0%. The mortality rate was 39.2%. The majority of deaths (81.1%) occurred in children aged < 15 years following accidental exposure. Multivariate logistic regression analysis revealed that risk factors for mortality were coma (OR = 20.5); hepatitis (OR = 52.7) and rural residence (OR = 7.26), while gastric decontamination was a protector factor (OR = 0.26).

Atractylis gummifera and Centaurea ornata in the Province of Badajoz (Extremadura, Spain)-Ethnopharmacological importance and toxicological risk

ETHNOPHARMACOLOGICAL RELEVANCE

Atractylis gummifera L. and Centaurea ornata Willd. are locally marketed herbal remedies, even though in Spain it is forbidden to sell toxic plants like Atractylis gummifera. Intoxications in Spain are mainly due to accidental substitution of Centaurea ornata with Atractylis gummifera which may be fatal.

AIM OF STUDY

The aim of this article is to analyse the current use and marketing of Atractylis gummifera and Centaurea ornata in Badajoz and analyse the ethnopharmacological relevance of two recent cases of Atractylis gummifera poisoning.

BACKGROUND AND METHODS

An ethnopharmacological survey was conducted in the area where one of the poisoned patients lives and in Guadiana del Caudillo. The use, knowledge and naming of the species involved in the poisoning was assessed. This information was complemented with an exhaustive search in Spanish ethnobotanical works on the ethnopharmacological uses of both species.

RESULTS

Intoxications are due to species' substitutions. The two species are similar in name and use in the area, and both are locally marketed. AG is mainly used to heal wounds and calcaneal spurs, and CO to treat gastric ulcers and wounds.

CONCLUSIONS

New intoxications are likely since consumers often have limited knowledge of the plants they consume. Also, it is common to think that all medicinal plants are harmless. As the use of Atractylis gummifera seems to increase in the area, preventive measures need to be taken.

Intoxication par le chardon à glu chez une femme enceinte

BACKGROUND

Atractylis gummifera is poisonous and its ingestion causes illness, characterized principally by hepatorenal injury, often fatal. The toxicity of this plant to the fetus is not known. We report a case of poisoning during pregnancy.

CASE REPORT

A 28 year-old woman was admitted to our intensive care unit for Atractylis gummifera poisoning during her 24th week of pregnancy. She showed gastrointestinal symptoms, impaired consciousness, hypoglycemia, hepatic cytolysis and decreased factor V blood levels. The mother recovered after symptomatic treatment. A healthy boy was delivered vaginally at 39 weeks and his clinical findings and laboratory results were normal at birth and a week later.

DISCUSSION

Poisoning by Atractylis gummifera has not previously been reported during pregnancy. The favorable course of our patient and her infant do not rule out possible fetal damage from which he recovered, as his mother did.

Atractylis gummifera L. poisoning: an ethnopharmacological review

Atractylis gummifera L. (Asteraceae) is a thistle located in the Mediterranean regions. Despite the plant's well-known toxicity, its ingestion continues to be a common cause of poisoning. The toxicity of Atractylis gummifera resides in atractyloside and carboxyatractyloside, two diterpenoid glucosides capable of inhibiting mitochondrial oxidative phosphorylation. Both constituents interact with a mitochondrial protein, the adenine nucleotide translocator, responsible for the ATP/ADP antiport and involved in mitochondrial membrane permeabilization. Poisoned patients manifest characteristic symptoms such as nausea, vomiting, epigastric and abdominal pain, diarrhoea, anxiety, headache and convulsions, often followed by coma. No specific pharmacological treatment for Atractylis gummifera intoxication is yet available and all the current therapeutic approaches are only symptomatic. In vitro experiments showed that some compounds such as verapamil, or dithiothreitol could protect against the toxic effects of atractyloside, but only if administered before atractyloside exposure. New therapeutic approaches could come from immunotherapy research: some studies have already tried to produce polyclonal Fab fragments against the toxic components of Atractylis gummifera.

A review of acute poisoning from Atractylis gummifera L

Atractylis gummifera is a poisonous plant widely found in North Africa. The thistle grows commonly in dry areas, and the juice of the rhizome is poisonous. It provokes frequent poisoning, especially of children. Toxic glucosides have been isolated and their identified as atractyloside and carboxyatractyloside. Tissues of high metabolic activity are the main target organs. Atractylis gummifera glucosides cause a severe hepatitis with fatal liver failure common. The plant's poisonous compounds interact with detoxication and/or transformation systems in the liver even at doses not likely to induce cytolysis by blocking ADP-ATP conversion through inhibition of P450 cytochrome. Clinical manifestations are related to an induced hypoglycemia and neurovegetative disorders or subsequent renal failure. Liver transplantation or immunotherapy may improve the often fatal prognosis.

[Atractylis gummifera L. poisoning: a case report]

Intoxication by Atractylis gummifera L. frequently happens in Morocco. It's often accidental and mortal if no precocious and effective treatment. In order to take stock of this intoxication of which diagnosis is clinical and treatment symptomatic, we suggest to analyze one clinical case of the intoxication by Atractylis gummifera L. on a 12 year old child who accidentally ingested this plant.