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Mohamedi N, Mirault T, Durivage A, Di Primio M, Khider L, Detriche G, El Batti S, Sapoval M, Messas E, Goudot G. Ergotism with acute limb ischemia, provoked by HIV protease inhibitors interaction with ergotamine, rescued by multisite transluminal balloon angioplasty. J Med Vasc 2021; 46:13-21. [PMID: 33546816 DOI: 10.1016/j.jdmv.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022]
Abstract
Acute limb ischemia induced by arterial vasospasm remains an exceptional situation, favoured by the use of arterial vasoconstrictors. The risk of these substances is largely underestimated in the general population, especially with the co-administration of strong cytochrome inhibitors like human immunodeficiency virus (HIV) protease inhibitors. A 33-year-old woman, who used to take dihydroergotamine for orthostatic hypotension, was prescribed a post-exposure HIV prophylaxis including lopinavir and ritonavir. One day later, she presented an acute bilateral limb ischemia with a sudden pain in both calves, initially while walking and then at rest with bilateral ischemic toes. Angiography confirmed diffuse arterial vasospasm of the lower limb arteries. A first-line therapy with isosorbide dinitrate and amlodipine was ineffective, with rapid clinical worsening. A combination of intra-arterial injections and intra-venous infusions of vasodilators, transluminal balloon angioplasty and bilateral 4-Compartment fasciotomies permitted rapid improvement and finally resulted in both lower limbs rescue. This case and literature review illustrate ergotism due to ergotamine overdose after taking HIV protease inhibitors. It also demonstrates the benefit of an interventional procedure besides medical therapy with vasodilators in severe arterial vasospasm. All along the lower limb arterial tree, transluminal balloon angioplasty restored the blood flow, without vasospasm recurrence. CONCLUSION: In case of ergotism with acute lower limbs ischemia, combining medical vasodilator therapy with interventional procedure can restore the arterial blood flow, thus allowing to save lower limbs.
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Affiliation(s)
- N Mohamedi
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - T Mirault
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - A Durivage
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - M Di Primio
- Interventional radiology department, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - L Khider
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - G Detriche
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - S El Batti
- Vascular surgery department, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - M Sapoval
- Interventional radiology department, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - E Messas
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - G Goudot
- Vascular medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France.
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Michael Besser G, Pfeiffer RF, Thorner MO. ANNIVERSARY REVIEW: 50 years since the discovery of bromocriptine. Eur J Endocrinol 2018; 179:R69-R75. [PMID: 29752299 DOI: 10.1530/eje-18-0378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/11/2018] [Indexed: 11/08/2022]
Abstract
Ergotism is the long-term ergot poisoning by ingestion of rye or other grains infected with the fungus Claviceps purpurea and more recently by excessive intake of ergot drugs. It has either neuropsychiatric or vascular manifestations. In the Middle Ages, the gangrenous poisoning was known as St. Anthony's fire, after the order of the Monks of St. Anthony who were particularly skilled at treating the condition. In 1917, Prof. Arthur Stoll returned home to Switzerland from Germany, to lead the development of a new pharmaceutical department at Sandoz Chemical Company. Stoll, using the special methods of extraction learned from his work with his mentor Willstetter, started his industrial research work with ergot. He succeeded in isolating, from the ergot of rye, ergotamine as an active principle of an old popular remedy for excessive post-partum bleeding. The success of this discovery occurred in 1918 and was translated into a pharmaceutical product in 1921 under the trade name Gynergen. In subsequent work, Stoll and his team were leaders in identifying the structure of the many other alkaloids and amines produced by Claviceps purpurea This was the cultural background and scientific foundation on which bromocriptine was discovered.
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Affiliation(s)
| | - Ronald F Pfeiffer
- Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Abstract
Consumption of feedstuffs contaminated with ergot alkaloids has a broad impact on many different physiological mechanisms that alters the homeostasis of livestock. This change in homeostasis causes an increased sensitivity in livestock to perturbations in the ambient environment, resulting in an increased sensitivity to such stressors. This ultimately results in large financial losses in the form of production losses to livestock producers around the world. This review will focus on the underlying physiological mechanisms that are affected by ergot alkaloids that lead to decreases in livestock production.
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Affiliation(s)
- James L Klotz
- Forage-Animal Production Research Unit, Agricultural Research Service, United States Department of Agriculture, Lexington, KY 40546, USA.
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Finn BC, Vadalá S, Meraldi A, Bruetman JE, Martínez JV, Young P. [Ergotism and HIV]. Medicina (B Aires) 2013; 73:346-348. [PMID: 23924536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Ergotism is a complication of acute intoxication and/or chronic abuse of ergot derivatives. It expresses itself through a vasomotor syndrome with peripheral vascular disease which frequently involves extremities. We report four cases of HIV-1 infected patients treated with antiretroviral drugs including boosted-protease inhibitors who had self-treated themselves with ergotamine. They developed peripheral vascular disease symptoms and their pulses where diminished or absent in the physical examination. Arterial Doppler confirmed diffused arterial spasm in two of them. Ergotism following ergotamine-protease inhibitors association was diagnosed. Patients were treated through the discontinuity of involved drugs (protease inhibitors and ergotamine), calcium blockers; antithrombotic prophylaxis with enoxaparine, antiaggregant therapy with acetylsalicylic acid, and one of them received pentoxifylline and vasodilator prostaglandins infusion, with amelioration of the symptoms. We discuss the clinical presentation of this drug interaction, difficult to diagnose properly without a strong suspicion of its existence.
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Affiliation(s)
- Bárbara C Finn
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Dal Verme A, López E, Grinspon S, Fernández Pardal R, Mengia M, Mazzocchi O. [Splenic infarction. Ergotism induced by ritonavir?]. Medicina (B Aires) 2012; 72:475-477. [PMID: 23241290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Ergotism is a clinical condition known since old times and whose main characteristics are ischemia and even limb gangrene. Some drugs have the capacity of interacting with small amounts of ergotamine or its derivatives producing ergotism as a side effect. This is the case of ritonavir, a widely used anti-HIV drug. Here we present a case of ergotism that developed in an HIV positive 39 year old male under treatment with ritonavir, after taking 1 mg of ergotamine tartrate. His clinical picture, apart from showing the basic manifestations of the disease, was associated with splenic infarction. For this reason, we consider important to advise patients about the potential pharmacological interaction between ergotamines and others common drugs and, in particular, ritonavir in HIV positive patients.
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Affiliation(s)
- Agustín Dal Verme
- Va Cátedra de Medicina, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina.
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6
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Acle S, Roca F, Vacarezza M, Álvarez Rocha A. [Ergotism secondary to ergotamine-ritonavir association. Report of three cases]. Rev Med Chil 2011; 139:1597-1600. [PMID: 22446707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.
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Affiliation(s)
- Santiago Acle
- Centro de trabajo Clínica Médica A, Departamento Clínico de Medicina, Hospital de Clínicas Dr. Manuel Quíntela, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Rodríguez de Cossío A, Rodríguez Sánchez R, Alonso Moreno FJ. [Peripheral ischaemia after chronic ergot poisoning]. Neurologia 2010; 25:518-519. [PMID: 20965006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Wollina U, Hansel G, Gruner M, Schönlebe J, Heinig B, Köstler E. Painful ANA-positive scleroderma-like disease with acral ulcerations: a case of chronic gangrenous ergotism. INT J LOW EXTR WOUND 2007; 6:148-52. [PMID: 17909173 DOI: 10.1177/1534734607305308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic ergotism is a rare cause of limb ischemia. In this case report, the authors present a 62-year-old woman with history of long-term use of ergotamine alkaloids for the treatment of menstrual pain, who developed a severe painful disease initially misdiagnosed as systemic sclerosis (scleroderma) for 3 decades. She presented with a combination of acral gangrene, foot ulcer, renal obstruction, mild pulmonary fibrosis, and reduced esophageal motility. Right-sided renal obstruction was evident. The condition was extremely painful and had led to muscular contractions and immobility, drug abuse, and anemia. After establishing the diagnosis of chronic gangrenous ergotism, changing drug therapy, mobilization, and treatment of chronic wounds, she showed a remarkable recovery. Eventually the foot ulcer was closed successfully using a mesh graft transplantation, and the patient was able to walk alone. Chronic ergotism is rare but has to be taken into account when presented with painful chronic digital and foot ulcers.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hosputal of the Technical University of Dresden, Dresden, Germany.
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Favretto D, Frison G, Vogliardi S, Ferrara SD. Highly Specific Quantification of Ergotamine in Urine, Blood, and Hair Samples by Liquid Chromatography-Tandem Mass Spectrometry. Ther Drug Monit 2007; 29:325-32. [PMID: 17529890 DOI: 10.1097/ftd.0b013e318067dfe7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ergotamine has been used for therapeutic purposes since the 1950s, usually to treat vascular headache. It is highly toxic and in large, repeated doses can produce all the symptoms of ergot poisoning. A selective and sensitive method, based on liquid chromatography-tandem mass spectrometry (LC-MS2), has been developed for quantifying ergotamine in biological fluids with use of a quick and easy sample preparation. Ergotamine and the internal standard, trideuterated lysergic acid diethylamide, were extracted from human urine, blood, and hair by means of liquid-liquid extraction at alkaline pH. Gradient elution on a cyanopropyl column was used for chromatographic separation. Positive ion electrospray ionization and tandem mass spectrometry determination by collision-induced dissociation were performed in an ion trap mass spectrometer. The method was validated and successfully applied to a case of iatrogenic ergotism resulting from the intake of ergotamine tartrate for treating headache. For the first time, ergotamine was identified and quantified in hair. The ergotamine concentrations measured were 320 pg/mL in blood, 100 pg/mL in urine, 24 pg/mg in proximal hair, and 15 pg/mg in distal hair.
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Affiliation(s)
- Donata Favretto
- Forensic Toxicology and Antidoping, University Hospital of Padova, Padova, Italy.
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Matossian MK. Why the Quakers quaked: the influence of climatic change on Quaker health, 1647-1659. ACTA ACUST UNITED AC 2007; 96:36-51. [PMID: 17508460 DOI: 10.1353/qkh.2007.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE To assess the impact of feeding different amounts of sorghum ergot to sows before farrowing. DESIGN Fifty-one pregnant sows from a continually farrowing piggery were sequentially inducted into the experiment each week in groups of four to seven, as they approached within 14 days of farrowing. Diets containing sorghum ergot sclerotia within the range of 0 (control) up to 1.5% w/w (1.5% ergot provided 7 mg alkaloids/kg, including 6 mg dihydroergosine/kg) were randomly allocated and individually fed to sows. Ergot concentrations were varied with each subsequent group until an acceptable level of tolerance was achieved. Diets with ergot were replaced with control diets after farrowing. Post-farrowing milk production was assessed by direct palpation and observation of udders, and by piglet responses and growth. Blood samples were taken from sows on three days each week, for prolactin estimation. RESULTS Three sows fed 1.5% ergot for 6 to 10 days preceding farrowing produced no milk, and 87% of their piglets died despite supplementary feeding of natural and artificial colostrums, milk replacer, and attempts to foster them onto normally lactating sows. Ergot inclusions of 0.6% to 1.2% caused lesser problems in milk release and neo-natal piglet mortality. Of 23 sows fed either 0.3% or 0.6% ergot, lactation of only two first-litter sows were affected. Ergot caused pronounced reductions in blood prolactin, and first-litter sows had lower plasma prolactin than multiparous sows, increasing their susceptibility to ergot. CONCLUSION Sorghum ergot should not exceed 0.3% (1 mg alkaloid/kg) in diets of multiparous sows fed before farrowing, and should be limited to 0.1% for primiparous sows, or avoided completely.
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Affiliation(s)
- J S Kopinski
- Department of Primary Industries and Fisheries, Moorooka, QLD, Australia.
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Molkara AM, Abou-Zamzam AM, Teruya TH, Bianchi C, Killeen JD. Chronic Ergot Toxicity Presenting with Bilateral External Iliac Artery Dissection and Lower Extremity Rest Pain. Ann Vasc Surg 2006; 20:803-8. [PMID: 17096087 DOI: 10.1007/s10016-006-9133-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic use of ergot alkaloids has been recognized as a rare cause of lower extremity ischemia. Most patients with ergot toxicity present with symptoms of lower extremity claudication. Herein we present a woman with bilateral lower extremity rest pain and a history of chronic ergot use for migraine headaches. Arteriography demonstrated extensive pruning of the distal arterial tree along with bilateral external iliac artery dissections - a finding that is not often associated with young, normotensive patients with chronic ergot toxicity. This patient was treated with endovascular stenting of the dissections along with cessation of ergot. Her symptoms improved markedly, and follow-up arteriography 6 weeks later demonstrated resolution of the iliac dissections along with restoration of nearly normal lower extremity runoff vessels. Discontinuation of ergot-containing products and cessation of tobacco and caffeine use is the cornerstone of therapy in chronic ergot toxicity. The association of ergot toxicity and iliac dissection has not been previously described. Endovascular or surgical interventions may be considered in patients with ergot toxicity for specific indications or those whose symptoms progress despite conservative management.
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Affiliation(s)
- Afshin M Molkara
- Division of Vascular Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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Affiliation(s)
- John C Morgan
- Movement Disorders Program, Department of Neurology, Medical College of Georgia, 1429 Harper Street, HF-1121, Augusta, GA 30912, USA.
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Naudè TW, Botha CJ, Vorster JH, Roux C, Van der Linde EJ, Van der Walt SI, Rottinghaus GE, Van Jaarsveld L, Lawrence AN. Claviceps cyperi, a new cause of severe ergotism in dairy cattle consuming maize silage and teff hay contaminated with ergotised Cyperus esculentus (nut sedge) on the Highveld of South Africa. ACTA ACUST UNITED AC 2005; 72:23-37. [PMID: 15991703 DOI: 10.4102/ojvr.v72i1.221] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
During December/January 1996/97 typical summer syndrome (hyperthermia and a 30% drop in milk yield) occurred in succession in two Holstein dairy herds (n=240 and n=150 milking cows, respectively) on the South African Highveld. These farms are situated in the midst of the prime maize and dairy farming areas of South Africa where this condition had never been diagnosed before. The individual components of the concentrate on both farms were negative for ergot alkaloids. Endophytic fungi and/or ergot infestation of teff and other grasses fed to the cows were then suspected of being involved, but neither endophytes nor ergot alkaloids could be implicated from these sources. By measuring the serum prolactin levels of groups of sheep (n=5) fed the first farm's total mixed ration (TMR) or its three individual fibre components for a period of 11 days, the source of the ergot alkaloids was identified. A statistically significant decrease in the level of this hormone occurred only in the group on maize silage (which constituted 28% on dry matter base of the TMR). The involvement of the maize silage was further chemically confirmed by the high levels of total ergot alkaloids, predominantly ergocryptine, found by LC-MS in the silage as well as in the TMR (115-975 ppb and 65-300 ppb, respectively). The ergot alkaloid content (mainly ergocryptine) of the maize silage on the second affected farm was 875 ppb. Withdrawal of contaminated silage resulted in gradual recovery of stock on both farms. Nut sedge (Cyperus esculentus and Cyperus rotundus of the family Cyperaceae) has a world-wide distribution and is a common weed in annual crops, and can be parasitized by Claviceps cyperi. Careful examination of the maize silage from both farms revealed that it was heavily contaminated with nut sedge and that it contained minute sclerotia, identified as those of Claviceps cyperi, originating from the latter. Nut sedge was abundant on both farms and it is believed that late seasonal rain had resulted in mature, heavily ergotised nut sedge being cut with the silage. Claviceps cyperi sclerotia, collected on the affected fields in the following autumn contained 3600-4000 ppm ergocryptine. That the dominant alkaloid produced by this particular fungus was indeed ergocryptine, was confirmed by negative ion chemical ionization MS/MS. In one further outbreak in another Holstein herd, teff hay contaminated with ergotised nut sedge and containing 1200 ppb alkaloids, was incriminated as the cause of the condition. This is the first report of bovine ergotism not associated with the Poaceae infected with Claviceps purpureum or endophytes but with the family Cyperaceae and this particular fungal phytopathogen.
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Affiliation(s)
- T W Naudè
- Division of Toxicology, ARC-Onderstepoort Veterinary Institute, Private Bag X05, Onderstepoort, 0110, South Africa.
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Abstract
The 1st outbreak of fescue toxicosis in South Africa was recently confirmed in a Brahman herd at Perdekop, near Standerton, in Mpumalanga province, South Africa. Within 3 weeks of being placed on a fescue pasture in mid-winter, 50 of 385 cattle developed lameness and/or necrosis of the tail. The farmer had established Festuca elatior L. (tall fescue, Iewag variety) on c. 140 ha for winter grazing. Fescue may be infected by an endophyte, Neotyphodium coenophialum, which produces ergot alkaloids, in particular ergovaline. Ergovaline concentrations in basal leaf sheaths and grass stems collected during the outbreak ranged from 1720-8170 ppb on a dry-matter basis.
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Affiliation(s)
- C J Botha
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa.
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Kraus-Zatecky A. [The shadow sides of the bio-boom. Where do fungi overall leave their poison behind]. MMW Fortschr Med 2004; 146:12. [PMID: 18441572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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17
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Arnheim K. [Digitalis -- poisoning, myopathy, ergotism.... When antibiotic and associated therapy become dangerous mixture]. MMW Fortschr Med 2003; 145:12-3. [PMID: 14649064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
Between 1085 and 1927, epidemics of "convulsive ergotism" were widespread east of the Rhine in Europe due to consumption of grain contaminated with ergot, which is produced by the fungus Claviceps purpurea. West of the Rhine, consumption of ergot-contaminated food caused epidemics of gangrenous ergotism. The clinical features of convulsive ergotism--muscle twitching and spasms, changes in mental state, hallucinations, sweating, and fever lasting for several weeks--suggest serotonergic overstimulation of the CNS (ie, the serotonin syndrome). The ergot alkaloids are serotonin agonists. Dihydroergotamine binds to serotonin receptors in the dorsal horn of the spinal cord, which is the site of neuropathological changes in convulsive ergotism. Dihydroergotamine given to human beings can cause the serotonin syndrome. Ergots produced by different strains of Claviceps purpurea, and those growing in different soils, may have different ergot alkaloid compositions. An alkaloid, present in high concentrations in ergots from east of the Rhine, may have caused convulsive ergotism at a circulating concentration insufficient to produce peripheral ischaemia. The serotonin syndrome may, therefore, have been a public-health problem long before it was recognised as a complication of modern psychopharmacology.
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Affiliation(s)
- Mervyn J Eadie
- Department of Medicine, University of Queensland, and the Royal Brisbane Hospital, Brisbane, Australia.
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Ilha MRS, Loretti AP, Barros CSL. Hyperthermic syndrome in dairy cattle associated with consumption of ergots of Claviceps purpurea in southern Brazil. Vet Hum Toxicol 2003; 45:140-5. [PMID: 12776790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A hyperthermic syndrome (HS) associated with consumption of ration contaminated with Claviceps purpurea is described in 4 dairy cattle herds from different counties in the state of Rio Grande do Sul, southern Brazil. Outbreaks of this mycotoxicosis occurred during the summer of 1999-2000 and autumn of 2002 when 25% to 70% of cattle from those herds were affected. The disease occurred after the introduction of a new batch of feed contaminated with sclerotia of C. purpurea. First clinical signs were observed up to 3 mo after the ration was introduced and consisted of pyrexia, intense salivation and drooling, open-mouth, difficult breathing, in some cases with the tongue protruded, decrease in milk yield, decrease in food intake and weight loss. Affected cattle compulsively sought shade or water ponds. Signs were more pronounced during daytime. The severity of the clinical picture varied according to changes in environmental temperature during the day. There was complete recovery approximately 60 d after feeding with the contaminated ration was discontinued. Abortions occurred during the outbreak and soon after the remission of the clinical signs associated with HS. In one of the herds, reproductive performance and fertility were seriously impaired even after clinical signs of HS completely disappeared. Diagnosis was based on epidemiology, clinical signs and pathology. The pathogenetic mechanisms involved in the occurrence of HS are briefly discussed.
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Affiliation(s)
- Marcia R S Ilha
- Department of Preventive Veterinary Medicine, State University of Londrina, 86051-990 Londrina, PR, Brazil
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Abstract
Ergotism is a rare condition of acute vasospasm found classically in young and middle-aged women taking ergot alkaloid agents to treat migraine headache. We report the case of a young man with human immunodeficiency virus (HIV) positivity and describe the drug interaction between protease inhibitors and ergot alkaloid agents, which most likely predisposed to development of ergot toxicity. The HIV-positive population receiving antiviral therapy may be an under-recognized group at risk for ergotism through decreased hepatic metabolism of ergot preparations.
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Affiliation(s)
- Zachary K Baldwin
- Department of Surgery, Kaiser Permanente-Oakland, 280 W MacArthur Boulevard, Oakland, CA 94611, USA
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Abstract
Ritonavir strongly inhibits cytochrome P450, thus altering the metabolism of other drugs. We report on an HIV-positive man who, on his 13th day of ritonavir therapy, developed severe ergotism after self-administration of low doses of ergotamine. Drug interactions, the degree of responsibility of the patient and the availability of over-the-counter medications must be considered when prescribing antiretroviral therapy.
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Affiliation(s)
- A Vila
- Department of Internal Medicine, CEMIC, Norberto Quirno, Buenos Aires, Argentina
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Abstract
A 41-year-old woman presented to the Emergency Department complaining of a 4-day history of worsening lower leg pain, pallor, and a sensation of coolness aggravated by exertion. Evaluation revealed severe lower extremity vasospasm. She recently had been prescribed clarithromycin for "flu-like" symptoms, and for many years had been taking a caffeine-ergotamine preparation for migraine headaches. Clarithromycin is known to interfere with ergotamine metabolism. This drug interaction is often not recognized. Ergot alkaloids are commonly used for migraine headaches and have vasoconstrictive properties. In a patient with ergotamine toxicity, these vasoconstrictive properties can lead to frank ischemia. We reviewed the literature for reports of ergotamine-associated ischemia and for reports of ergotamine toxicity caused by drug-drug interaction.
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Affiliation(s)
- S C Ausband
- Department of Emergency Medicine, East Carolina University, Greenville, North Carolina, USA
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Enríquez E, Rangel A, Velasco CE, Basave MN, López-Rodríguez R. [Ergotism caused by automedication]. Arch Inst Cardiol Mex 2000; 70:603-8. [PMID: 11255720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The authors report 7 cases of gangrenous ergotism (six women and one man) secondary to an overdose of ergotamine ingested in order to relieve migraine crisis. In all cases, patients presented symptoms and signs of severe arterial constriction confirmed by echography and angiography. Hallucinations were absent. Ergotamine ingestion was discontinued and treatment was based on vasodilators and sympathectomy. After treatment, all seven patients showed clinical improvement with disappearance of the vasospastic symptoms and signs, and an increase in the plethysmographic index of blood perfusion, measured by Doppler echography. These changes were observed even in a patient who lost two toes of the right foot. Although, none of the patients presented hallucinations, the authors made reference to the historical first use of the ergot in magic and religious rites that took place in Eleusis, at the time of classic Greece, as well as the more recent mystic use of ergot in Salem, New England, in 1692. Migraine is indeed a serious disease, frequently causing despair to the patient, who attempts to alleviate the migraneous crisis with an overdose of ergotamine. Accordingly, physicians must be aware of prophylactic vasodilating drugs, reducing the risk of ergotism.
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Affiliation(s)
- E Enríquez
- Servicio de Angiología, Hospital de Especialidades, Centro Médico La Raza, IMSS, Calles de Seris y Zaachila, 02990 México, D.F
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26
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Bourke CA, Bailey GD, Kemp JB. The case for solar light radiation being more significant than ambient temperature in producing lethal hyperthermic ergotism in cattle. Aust Vet J 2000; 78:618-21. [PMID: 11022289 DOI: 10.1111/j.1751-0813.2000.tb11936.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Bourke
- NSW Agriculture, Orange Agricultural Institute
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Payne B, Sasse B, Franzen D, Hailemariam S, Gemsenjäger E. Manifold manifestations of ergotism. Schweiz Med Wochenschr 2000; 130:1152-6. [PMID: 11005105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Vasospastic side effects leading to organic manifestations are rare in ergotamine therapy. To our knowledge, combinations of more than two signs of ergotism have rarely been described in the literature so far. We present a 65-year-old male patient who as a consequence of severe migraine had developed ergotamine abuse. He was admitted to our hospital after one week of increasing abdominal pain. During laparotomy, necrotic areas of the small intestine and the sigmoid colon were resected, which on histopathologic examination revealed severe hypertrophy of the smooth musculature of mesenteric arteries, resulting from chronic vasospasms. Postoperatively, the patient developed ischaemia of the limbs which was confirmed by angiography. Before death, the patient also showed ischaemic signs in the acrae and necrosis of the tongue.
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Affiliation(s)
- B Payne
- Division of Surgery, Spital Zollikerberg, Zurich
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Affiliation(s)
- B Karam
- Departments of Cardiovascular Surgery and Internal Medicine, Hôtel-Dieu de France, Beirut, Lebanon
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Blanche P, Rigolet A, Gombert B, Ginsburg C, Salmon D, Sicard D. Ergotism related to a single dose of ergotamine tartrate in an AIDS patient treated with ritonavir. Postgrad Med J 1999; 75:546-7. [PMID: 10616689 PMCID: PMC1741351 DOI: 10.1136/pgmj.75.887.546] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report a rare case of ergotism related to a single dose of ergotamine tartrate in a man with AIDS being treated with ritonavir. He was treated with a prostacyclin analogue and made a complete recovery.
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Affiliation(s)
- P Blanche
- Service de Médecine Interne 2, Hôpital Cochin, Université René Descartes, Paris, France
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31
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Nordskar M, Johansen TE. [A case of migraine attack followed by abdominal pain]. Tidsskr Nor Laegeforen 1999; 119:2363-6. [PMID: 10414203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Affiliation(s)
- M Nordskar
- Kirurgisk avdeling Telemark sentralsjukchus, Porsgrunn
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Abstract
HISTORY AND CLINICAL FINDINGS For 6 months a 42-year-old farmer without cardiovascular risk factors had been suffering from increasing pain in both feet and calves. Angiography two months apart had demonstrated progressive narrowing of all lower-leg arteries. Pain-free walking had become restricted to 50 m, there were no palpable pulses in the right foot and those in the left foot were markedly reduced. INVESTIGATIONS Occlusion pressure of the right foot was 55 mm Hg. Repeat angiography showed proximal occlusion of all three lower-leg arteries. Biopsy and biochemical tests excluded degenerative and inflammatory causes of the vascular disease. DIAGNOSIS, TREATMENT AND COURSE Enquiry of the patient discovered that he had been exposed to ergotamine-containing milling dust in the preparation of rye flour. Inhalational intake of ergotamine was proven by a high plasma ergotamine level. Attempted treatment with prostaglandin E1 (intraarterially for 16 days), doxazosin (2 mg/d) and acetylsalicylic acid 300 mg/d) had only little effect on symptoms. But complete avoidance of exposure to flour dust slowly decreased the plasma level of ergotamine within 4 months, after which all lower-leg arteries had almost completely re-opened. CONCLUSIONS This is the first reported case proving that chronic ergotamine inhalation can cause ergotism affecting peripheral arteries. As the plasma ergotamine level fell only slowly it must be assumed that ergotamine had accumulated in a, so far unknown, body depot with slow release into the blood.
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Affiliation(s)
- K Stange
- Medizinische Klinik, Clemenshospital, Münster
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34
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Campbell GD. Studies on mycotoxins in the Kruger National Park region, Eastern Transvaal--with special respect to the abolition of recurrent myco-oestrogen abortion and vulvo-vaginitis in the large Piggery. Nutr Health 1998; 12:135-40. [PMID: 9502239 DOI: 10.1177/026010609801200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- G D Campbell
- Clinical Mycotoxicosis Research Unit, Themba Hospital, Kabokweni, Eastern Transvaal
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Tay JC, Chee YC. Ergotism and vascular insufficiency: a case report and review of literature. Ann Acad Med Singap 1998; 27:285-8. [PMID: 9663328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report a case of ergot-induced peripheral vascular insufficiency of the lower limbs and review the vascular complications, angiographic findings and the different modalities of treatment. The following case report highlights the clinical features and course of ergot toxicity, and the difficulty in early diagnosis.
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Affiliation(s)
- J C Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
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Caballero-Granado FJ, Viciana P, Cordero E, Gómez-Vera MJ, del Nozal M, López-Cortés LF. Ergotism related to concurrent administration of ergotamine tartrate and ritonavir in an AIDS patient. Antimicrob Agents Chemother 1997; 41:1207. [PMID: 9145904 PMCID: PMC163885 DOI: 10.1128/aac.41.5.1207] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Abstract
'Mal seco' is an almost invariably fatal disease of horses in Argentina and Chile, which resembles grass sickness, a dysautonomia of horses in Europe. The aetiology of mal seco remains unknown. An attempt to reproduce the disease was made by feeding horses with Festuca argentina, a plant considered to be toxic to animals and which was consistently found in the diet of nine horses suffering from mal seco. Three horses were fed with F argentina ad libitum for 28 days. The plant was infected with an endophytic fungus, whose morphological characteristics were in agreement with descriptions of Acremonium chlamydosporioides. No clinical abnormalities were observed in two of the horses, but one died on the fifth day of the trial after becoming incoordinated, unsteady and ataxic in the fore- and hindlimbs. No gross changes were observed post mortem in any of the horses, with the exception of a small number of Fasciola hepatica in the liver of the horse which died, and a moderate number of Gasterophilus species in the stomach of all three horses. No histopathological changes were observed in any of the organs examined, including several autonomic ganglia, brain including most brain stem nuclei, spinal cord, liver, kidney, stomach and small and large intestine. The results of this study suggest that F argentina is either not implicated in the aetiology of mal seco or produces its effects only when they are triggered by other unknown factors.
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Affiliation(s)
- F A Uzal
- Animal Health Unit National Institute of Agricultural Technology (INTA), Bariloche, Argentina
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38
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Strickland JR, Bailey EM, Abney LK, Oliver JW. Assessment of the mitogenic potential of the alkaloids produced by endophyte (Acremonium coenophialum)-infected tall fescue (Festuca arundinacea) on bovine vascular smooth muscle in vitro. J Anim Sci 1996; 74:1664-71. [PMID: 8818813 DOI: 10.2527/1996.7471664x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The objective of these experiments was to test the hypothesis that the major alkaloid classes found in endophyte-infected tall fescue could act as growth promoters for vascular smooth muscle. Bovine vascular smooth muscle cells (VSMC) from the dorsal metatarsal artery were grown in vitro and exposed to five concentrations (10(-6), 10(-8), 10(-9), 10(-11) and 0 M) of ergonovine, alpha-ergocryptine, ergovaline, and N-acetyl loline for 48 h. The mitogenic potential of the alkaloids was tested on both actively growing cells (serum fed, 10% fetal bovine serum) and quiescent cells (serum starved, 0.1% serum) to assess the need for serum constituents for alkaloid induced growth or toxicity. Ergonovine stimulated (P < .07) VSMC growth at 10(-6) M concentration in growing and quiescent culturs and at 10(-8) M concentration in quiescent cultures. alpha-Ergocryptine stimulated (P < .01) growth at 10(-6) M concentration in growing cultures and at 10(-8) and 10(-9) M concentrations in quiescent cultures. Ergovaline exhibited a dual activity on the growth of VSMC in culture, stimulating (P = .06) growth of quiescent cells at 10(-9) M concentration but inhibiting (P < .05) growth of growing cultures at concentrations of 10(-6) and 10(-9) M. This duality of activity was also noted for N-acetyl loline: N-acetyl loline stimulated (P < .05) growth of quiescent cultures at concentrations of 10(-8), 10(-9), and 10(-11) M but inhibited (P < .05) growth of growing cultures at concentrations of 10(-8) and 10(-9) M. The growth effects of the alkaloids in vitro on VSMC support in part the hypothesis that the alkaloids may contribute to the vascular complications noted in cattle grazing endophyte-infected tall fescue through hyperplasia of the intima. This would result in a decreased luminal diameter of the blood vessels and a resultant decrease in blood flow to the afflicted tissues. The diminished blood flow to tissues would result in tissue death and reduced ability to dissipate heat.
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Affiliation(s)
- J R Strickland
- Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA
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39
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Schneider DJ, Miles CO, Garthwaite I, Van Halderen A, Wessels JC, Lategan HJ. First report of field outbreaks of ergot-alkaloid toxicity in South Africa. Onderstepoort J Vet Res 1996; 63:97-108. [PMID: 8966013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Outbreaks of clinical disease caused by the ingestion of ergotized Lolium rigidum (annual ryegrass), which resulted in a substantial loss in production, have been reported. A number of outbreaks of a hyperthermia syndrome in cattle, characterized by severe loss in milk production, loss of body mass and reduced fertility, are described. In one major outbreak in March to April 1994, a milling company reported that 2,646 dairy cows on 29 farms had developed clinical signs. In this outbreak, significant levels of ergotamine, ergosine, ergocornine and ergocryptine were found in the milled dairy rations fed to the affected cows. Barley screenings containing ergotized annual-ryegrass seed was identified as the toxic component and probable source of the ergot alkaloids in the ration. The clinical syndrome was reproduced experimentally by feeding suspected feed to a group of nine high-producing Ayrshire cows. An outbreak of gangrenous necrosis of the extremities in young cattle in the winter of 1987 was also suspected of having been caused by ergot alkaloids in grain screenings.
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Affiliation(s)
- D J Schneider
- Regional Veterinary Laboratory, Stellenbosch, South Africa
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40
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Horowitz RS, Dart RC, Gomez HF. Clinical ergotism with lingual ischemia induced by clarithromycin-ergotamine interaction. Arch Intern Med 1996; 156:456-8. [PMID: 8607732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The macrolide class of antibiotics, including erythromycin and troleandomycin, is associated with clinically significant adverse drug interactions. This results from macrolide inhibition of cytochrome P-450 metabolism of numerous xenobiotics, resulting in elevated serum drug levels and clinical intoxication. Animal studies, however, suggest that clarithromycin, the newest approved macrolide antibiotic, has has less potential for adverse drug reactions. We describe a patient who, on her fifth day of clarithromycin therapy, developed clinical ergotism (i.e., hypertension, lingual ischemia, and peripheral cyanosis) several hours after administration of her usual 2-mg dose of ergotamine tartrate. To our knowledge, this is the first report of clinical ergotism precipitated by clarithromycin-ergotamine interaction and suggests that, like other macrolide antibiotics, ergot preparations should be avoided in patients who are taking clarithromycin.
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Affiliation(s)
- R S Horowitz
- Rocky Mountain Poison Center, Denver, Colo., USA
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41
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Abstract
Ergotamine has been used for many years in the treatment of migraine, although there is little formal clinical evidence that it is significantly more efficacious than placebo. A number of side effects associated with ergotamine have been reported in the literature, including myocardial infarction, ischaemia of limb extremities, and fibrotic changes. Long-term use has led to reported cases of ergotamine-induced headache, vascular reactivity, and subclinical ergotism. When the safety profile of this drug is considered, coupled with its debatable efficacy from a clinical review previously published, the resulting poor risk:benefit ratio brings into question the continued use of ergotamine as a migraine treatment and calls for better controlled trials of its efficacy, or lack of, in the acute treatment of migraine.
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Affiliation(s)
- W J Meyler
- Department of Anaesthesiology, University Hospital, Groningen, Netherlands
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42
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Abstract
Generalized vasoconstriction in chronic ergot poisoning is attributed both to the ergotamine activity on alpha-adrenergic receptors and to its direct action on vascular smooth muscle cells. The authors propose that endothelial wall, chronically damaged by ergot alkaloids, releases platelet-derived growth factor (PDGF), which contributes to vasoconstriction and promotes further arterial obstruction. Their hypothesis is supported by the increased PDGF activity found in plasma of a patient suffering from chronic ergotism.
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Affiliation(s)
- F Pietrogrande
- Second Chair of Medicine, Institute of Medical Semeiotics, University of Padua, Italy
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43
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Paraskevopoulos JA, Teasdale DE, Cuschieri RJ. Severe reversible arterial spasm with ergotamine. Br J Clin Pract 1995; 49:214. [PMID: 7547165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient is described with marked unilateral arterial spasm of the proximal vessels and severe ischaemia of the left foot as a result of excessive use of ergotamine tartrate. Treatment with intravenous heparin infusion followed by chemical sympathectomy was successful.
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Haglind E, Brevinge H, Svanberg E. [Ergotamine poisoning in unclear ischemia. Do not overlook unusual effects in "acute abdomen"!]. Lakartidningen 1995; 92:1701-2. [PMID: 7723486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
A historic profile of endophyte-induced tall fescue toxicosis is presented. A chronology of events is presented, beginning with the importance of finding Balansia-infected grasses in a tall fescue pasture in north central Georgia. This initial finding was followed by the discovery that another related endophyte was present in tall fescue and other major forage grasses. This species of endophyte was identified as Acremonium coenophialum. After this report was the important discovery that cattle performance was poor on Acremonium-infected tall fescue. Thus, this endophyte and its presence in tall fescue was implicated as the cause of tall fescue toxicosis and fescue foot. It was later established that this endophyte also produced ergot alkaloids. The related endophyte of perennial ryegrass, A. lolii, was subsequently shown to be responsible for the ryegrass staggers syndrome. Several other species of Acremonium have been associated with other important forage and turf grasses. Finally, important papers leading to the revelations that endophytic fungi and their grass hosts are ecologically significant and that most should be considered mutualistic symbioses are reviewed. Symbiotic grasses have enhanced physiological and morphological characteristics that offer biotechnological exploitations on one hand, but on the other solutions to the toxicity of tall fescue are difficult because grasses free of their fungal partner are generally ecological failures.
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Affiliation(s)
- C W Bacon
- Toxicology and Mycotoxin Research Unit, Russell Research Center, ARS, USDA, Athens, GA 30613, USA
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Abstract
Research on livestock toxicoses caused by Acremonium (endophyte)-infected grasses strongly implicate the ergopeptine alkaloids with A. coenophialum-infected fescue and paxilline and the lolitrem alkaloids with A. lolii-infected perennial ryegrass as the causative agents. Isolation, identification, and detection of these toxins involves extraction with appropriate solvents, clean-up procedures, and chromatographic methods with known standards. Thin-layer, high-performance liquid and gas chromatography along with ultraviolet and mass spectrometric (i.e., electron impact, chemical ionization, tandem mass) characterizations have been reported. These methods have varying degrees of success depending on the matrix from which the alkaloids have been extracted. Ergovaline is the primary ergopeptine alkaloid isolated from cultures of A. coenophialum and also from infected fescue grass and seeds toxic to livestock. Other compounds isolated from the endophyte-infected fescue include: lysergic acid amide (ergine), the clavine class of ergot alkaloids (chanoclavine I, agroclavine, elymoclavine, penniclavine), the pyrrolizidine alkaloids (N-formylloline, N-acetylloline, N-methyloline, N-acetylnorloline), and the unique pyrrolopyrazine alkaloid peramine. The loline alkaloids and peramine have been more associated with the insect-deterrent properties of the endophyte-infected fescue than with livestock toxicoses. Also, both peramine and the ergopeptine alkaloids (ergovaline, ergotamine) have been isolated from A. lolii-infected perennial ryegrass. More recently, paxilline and lolitrem B have been detected in laboratory cultures of A. coenophialum isolated from tall fescue. The ergot alkaloids in endophyte-infected perennial ryegrass may be more related to decreased animal productivity (weight gains, reproduction problems), whereas the lolitrems cause the staggers syndrome. The detection, isolation, identification, and analyses of these compounds from Acremonium-infected grasses is presented.
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Affiliation(s)
- J K Porter
- Toxicology and Mycotoxin Research Unit, Richard B. Russell Agricultural Research Center, ARS, USDA, Athens, GA 30613, USA
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Abstract
A 27-year-old woman developed acute pain, pallor and feeling of cold in her left arm. She had been a smoker of 15-20 cigarettes daily since the age of 15 years, but had not previously had any serious illness. In addition to contraceptives she had had been taking one to several suppositories containing caffeine and ergotamine tartrate (2 mg) daily against migraine. Angiological examination 5 days after onset of symptoms discovered a weak brachial pulse low in the left upper arm, while ulnar and radial pulses were absent. All other pulses were normally palpable. Colour duplex sonography demonstrated occlusion of the brachial artery which angiographically was due to a 5 cm severe narrowing without thrombus, blood flowing distally via collaterals. No improvement was achieved by local injection of 100,000 IU urokinase, 0.5 mg nitroglycerin, 20 mg tolazoline and a 3-hour infusion of alprostadil. On infusion of 560 ml hydroxyethylstarch over 8 hours, 400 mg naftidrofuryl, therapeutic doses of heparin and abstinence from ergotamine (since admission) the vessel diameter increased by 50% within 23 hours and after a further 24 hours to almost 100% of the comparable arterial segment of the right arm while merely on heparin infusion.
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Affiliation(s)
- M Heinz
- I. Medizinische Klinik, Technische Universität München
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48
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Aleĭnikova NV. [The chemical-toxicological analysis of ergot alkaloids]. Sud Med Ekspert 1994; 37:20-23. [PMID: 7974606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Russian and foreign literature dealing with this topic is reviewed. Brief descriptions of methods of examinations starting from color tests and up to high-pressure liquid chromatography and mass spectrometry are presented in a chronological order. Clinical and toxicological characteristics of some ergot alkaloids are described.
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Antón Aranda E, Martí Cabane J, Utrilla Mínguez R. [Doppler ultrasound in the diagnosis of ergotism]. Neurologia 1994; 9:204-5. [PMID: 7912943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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50
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Bocchia M, Baldini GG, Bertola G, Zorzoli C. [Risks related to the use of ergotamine in the therapy of hemicrania. Description of a case]. Recenti Prog Med 1991; 82:390-3. [PMID: 1947404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The ergotamine tartrate used for the migraine headache therapy can induce to a condition of chronic intoxication (ergotism) similar to what occurs after the ingestion of Claviceps purpurea contaminated rye. The case of an Italian woman affected by chronic migraine rectally treated with ergotamine showed cerebral and legs ischaemic indications--angiographically documented--vasospasm in the carotid and femoral arterial area. The withdrawal of the drug produced complete remission. It is therefore important to consider ergotism as a cause of the non-atherosclerotic vascular ischaemic disease; the authors also underline the serious risks linked to the ergotamine self prescription should the maximum dose of the 10 mg be exceeded via rectum over the period of one week (see the above illustrated case). No other evidence of intoxication due to ergotamine with angiography documentation with femoral and carotid involvement is described in literature.
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Affiliation(s)
- M Bocchia
- Medicina generale II, Presidio ospedaliero S. Corona, USSL 67, Garbagnate Milanese
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