Ricin poisoning: A review on contamination source, diagnosis, treatment, prevention and reporting of ricin poisoning.

INTRODUCTION: Ricin, a toxic glycoprotein derived from the castor bean plant, is one of the most potent poisons known in the world. Ricin intoxication is a fatal and uncommon medical condition and recently its use as a potential bioterrorism agent has also been reported. This study aims to identify the main characteristics of diagnosed ricin poisoning cases worldwide in order to raise awareness of this toxin among the population and clinicians. METHODS: A collection of human case studies of ricin intoxication in the world was produced. The databases Pubmed, Sciencedirect and Google Scholar were used to extract articles from January 1980 to June 2020. RESULTS: Fifty ricin-intoxicated patients worldwide described in the literature have been identified. Most cases were found in Asia (19 cases), Europe (12 cases) and America (15 cases). Intoxication was mostly accidental (37 cases). Intoxication by castor bean is characterized by acute gastroenteritis-like disease as primary manifestations leading to severe fluid and electrolyte imbalance. The mechanism of death was peripheral vascular collapse and progressing multiple organ failure occurring 10h-72h after intoxication. The questioning of patients and family made it possible to retrieve an history of castor seeds or castor oil ingestion Patients received symptomatic treatment consisting mostly to rehydration with intravenous fluids and digestive decontamination performed with activated charcoal and/or gastric lavage within one day after the ingestion, to reduce gastrointestinal absorption of ricin. This decontamination treatment administered early has been very effective. Only six deaths were observed. DISCUSSION: Currently, no antidote, vaccine, or other specific effective treatment is available for ricin poisoning or prevention. Prompt treatment with supportive care was necessary to limit morbidity and mortality. To date, patient education is essential to prevent this accidental poisoning. CONCLUSION: Clinicians and health care professionals should have a high level of suspicion when faced with an outbreak of serious respiratory or gastrointestinal illness.

Toxin Degradation by Rumen Microorganisms: A Review.

Animal feeds may contain exogenous compounds that can induce toxicity when ruminants ingest them. These toxins are secondary metabolites originating from various sources including plants, bacteria, algae and fungi. Animal feed toxins are responsible for various animal poisonings which negatively impact the livestock industry. Poisoning is more frequently reported in newly exposed, naïve ruminants while 'experienced' ruminants are observed to better tolerate toxin-contaminated feed. Ruminants can possess detoxification ability through rumen microorganisms with the rumen microbiome able to adapt to utilise toxic secondary metabolites. The ability of rumen microorganisms to metabolise these toxins has been used as a basis for the development of preventative probiotics to confer resistance against the poisoning to naïve ruminants. In this review, detoxification of various toxins, which include plant toxins, cyanobacteria toxins and plant-associated fungal mycotoxins, by rumen microorganisms is discussed. The review will include clinical studies of the animal poisoning caused by these toxins, the toxin mechanism of action, toxin degradation by rumen microorganisms, reported and hypothesised detoxification mechanisms and identified toxin metabolites with their toxicity compared to their parent toxin. This review highlights the commercial potential of rumen inoculum derived probiotics as viable means of improving ruminant health and production.

Techniques for prevention and control of poisoning by sodium monofluoroacetate (MFA)-containing plants in ruminants / Técnicas para prevenção e controle da intoxicação em ruminantes por plantas que contém monofluoroacetato de sódio

Monofluoroacetate (MFA)-containing plants cause sudden death associated with exercise in ruminants, and are responsible for significant losses in Brazilian livestock, estimated at 500,000 bovine deaths annually. Most of the times, the control and treatment of this type of poisoning are not efficient, because disease evolution is superacute, usually causing the death of the animal. Due to the difficulty in controlling this intoxication, several studies have suggested alternatives to prevent it, mainly by making animals resistant to the MFA present in these plants or by avoiding their consumption. This literature review addresses the techniques used experimentally to control the poisoning of ruminants by plants containing MFA. The first studies carried out in Brazil demonstrated that goats and sheep that continuously receive non-toxic doses of plant containing MFA show greater resistance to poisoning than untreated animals, and that this resistance can be transmitted by ruminal fluid transfaunation, suggesting that poisoning occurs due to the presence of bacteria that hydrolyze MFA in the rumen. Based on this hypothesis, several MFA-hydrolyzing bacteria were isolated (Enterococcus faecalis, Bacillus sp., Paenibacillus sp., Burkholderia sp., Cupriavidus sp., Staphylococcus sp., Ancylobacter sp., Ralstonia sp., Stenotrophomonas sp., Pigmentiphaga kullae, and Ancylobacter dichloromethanicus). When some of these bacteria were administered intraruminally, they provided the animal with a different level of protection against poisoning. However, it was observed that protection is gradually lost when the bacterium administration is interrupted. Consequently, to obtain more efficient protection, these bacteria should be administered continuously, probably in the form of probiotics. In another assay, MFA was administered to sheep at non-toxic doses to test the hypothesis that this substance could induce the multiplication of bacteria that hydrolyze it in the rumen. There was no increase in resistance to poisoning after administration of MFA; however, no signs of poisoning were observed when animals received trifluoroacetate and no clinical signs were verified when they were challenged with toxic doses of MFA; in contrast, all control animals presented clinical signs. These results suggest that trifluoroacetate induces the proliferation of MFA-degrading bacteria, and can be used in intoxication prophylaxis. The conditioned food aversion technique, using lithium chloride, has been successfully used experimentally to prevent ruminants from ingesting plants that contain MFA. Another alternative tested was the spraying of Amorimia septentrionalis with the endophytic bacterium Herbaspirillum seropedicae, which degrades MFA, resulting in decreased concentration of this compound in the plants. In conclusion, several experimental techniques have been proved efficient in the control and prophylaxis of MFA-containing plant poisoning; however, none of these techniques are available commercially. Further experiments, mainly in the field, should be carried out to adapt some of these techniques to the conditions of extensive breeding in the numerous areas where MFA-containing plants occur.(AU)

As plantas que contém monofluoroacetato (MFA) causam morte súbita associada ao exercício em ruminantes, e são responsáveis por grandes perdas na pecuária brasileira, estimadas em 500.000 mortes de bovinos anualmente. O controle e tratamento desse tipo de intoxicação, na maioria das vezes, não apresenta eficiência, visto que a evolução da doença é superaguda, e geralmente ocasiona a morte do animal. Devido à dificuldade no controle dessa intoxicação, diversos estudos sugerem alternativas para preveni-la, principalmente tornando os animais resistentes ao MFA presente nessas plantas ou evitando seu consumo. O objetivo do presente trabalho é fazer uma revisão bibliográfica das técnicas utilizadas experimentalmente para controlar a intoxicação de ruminantes por plantas que contém MFA. Nos primeiros trabalhos realizados no Brasil, foi determinado que caprinos e ovinos que recebem continuadamente doses não tóxicas de planta que contém MFA apresentam maior resistência a intoxicação que animais não tratados e que essa resistência pode ser transmitida por transfaunação de fluído ruminal, sugerindo que a mesma ocorre devido a presença de bactérias que hidrolisam MFA no rúmen. Com base nessa hipótese foram isoladas diversas bactérias que hidrolisam MFA (Enterococcus faecalis, Bacillus sp., Paenibacillus sp., Burkholderia sp., Cupriavidus sp., Staphylococcus sp., Ancylobactersp., Ralstoniasp., Stenotrophomonas sp., Pigmentiphaga kullae e Ancylobacter dichloromethanicus). Quando algumas dessas bactérias foram administradas intraruminalmente conferiram diferentes graus de proteção contra a intoxicação. No entanto foi observado que a proteção se perde gradualmente quando se deixa de administrar a(s) bactéria(s). Em consequência, para obter uma proteção mais eficiente essas bactérias deveriam ser administradas continuadamente, provavelmente na forma de probiótico. Em outro ensaio administrou-se MFA a ovinos em doses não tóxicas para testar a hipótese de que esta substância poderia induzir a multiplicação de bactérias que hidrolisam o mesmo no rúmen. Não houve um aumento da resistência a intoxicação após a administração de MFA; no entanto quando foi administrado trifluoroacetato, os animais não desenvolveram nenhum sinal de intoxicação e quando desafiados com doses tóxicas de MFA não apresentaram sinais clínicos, pelo contrário todos os animais controles apresentaram sinais clínicos. Esses resultados sugerem que o trifluoroacetato induz a proliferação de bactérias que degradam MFA e pode ser utilizado para a profilaxia da intoxicação. A técnica da aversão alimentar condicionada, utilizando cloreto de lítio, tem sido empregada experimentalmente, com sucesso, para evitar que ruminantes ingiram plantas que contém MFA. Outra alternativa testada foi a pulverização de Amorimia septentrionalis com a bactéria endofítica Herbaspirullum seropedicae, que degrada MFA, resultando na diminuição da concentração deste composto na planta. Conclui-se que há diversas técnicas que experimentalmente tem demonstrado eficiência no controle e profilaxia das intoxicações por plantas que contém MFA; no entanto, nenhuma dessas técnicas está disponível comercialmente. Futuros experimentos, principalmente, a campo, deverão ser realizados para adaptar alguma(s) dessas técnicas as condições de criação extensiva nas numerosas áreas onde ocorrem plantas que contém MFA.(AU)

Effects of endophyte-infected tall fescue seed and protein supplementation on stocker steers: I. Growth performance and hemodynamic responses.

Fescue toxicosis is a multifaceted syndrome common in cattle grazing endophyte-infected tall fescue and is detrimental to growth and performance. Recent research has shown that supplementing protein has the potential to enhance growth performance in weaned steers. Therefore, the objective of this study was to evaluate the effect of supplemental CP on physiological parameters in stocker steers experiencing fescue toxicosis. Thirty-six weaned Angus steers (6 mo of age) stratified by weight (196.1 ± 3.6 kg) were assigned to a 2 × 2 factorial arrangement for 56 d: endophyte-free (EF) seed and 14% CP (EF-14; n = 9), EF seed and 18% CP (EF-18; n = 9), endophyte-infected (EI) seed and 14% CP (EI-14; n = 9), and EI seed and 18% CP (EI-18; n = 9). Steer growth and hemodynamic responses were collected weekly during ergot alkaloid exposure. On day 14 of the trial, iButton temperature data loggers were subcutaneously inserted in the lateral neck region to record hourly body temperature for 42 d. Data were analyzed using PROC MIXED of SAS with repeated measures. No differences were observed in DMI, BW, ADG, F:G, or BCS during the treatment period (P > 0.05). Hair shedding scores, rectal temperatures, surface temperatures, and respiration rates were greater in EI steers compared to EF steers regardless of supplemental CP (P < 0.05). However, subcutaneous body temperature was greater in EI-14 steers (37.94 °C) compared to other steer groups (37.60, 37.68, 37.72 ± 0.04 °C for EF-14, EF-18, and EI-18, respectively; P < 0.05). Prolactin concentrations tended to be greater in EF steers when compared to EI steers (P = 0.07). Heart rate and hematocrit were reduced for EI-18 steers compared to other steer groups (P < 0.05). Caudal artery diameter was reduced in EI-18 steers compared to EI-14 steers (2.60 vs. 2.75 ± 0.05 mm, respectively; P < 0.05) and caudal vein diameter was reduced in EI-18 steers (3.20 mm) compared to all other steer groups (3.36, 3.39, 3.50 mm for EF-14, EF-18, and EI-14, respectively; P < 0.05). However, there was no difference observed in systolic or diastolic blood pressure during the treatment period (P > 0.05). Based on the data, exposure to low to moderate levels of ergot alkaloids during the stocker phase had a negative impact on hemodynamic responses and supplemental CP had minimal impact to alleviate symptoms. Therefore, feeding additional protein above established requirements is not expected to help alleviate fescue toxicosis.

Poison Ivy, Oak, and Sumac Dermatitis: What Is Known and What Is New?

Poison ivy, poison oak, and poison sumac are the most common causes of clinically diagnosed allergic contact dermatitis in North America. Approximately 50% to 75% of the US adult population is clinically sensitive to poison ivy, oak, and sumac. We reviewed the botany and history of these plants; urushiol chemistry and pathophysiology, clinical features, and the prevalence of allergic contact dermatitis caused by these plants; and current postexposure treatment and preventive methods, including ongoing investigations in the development of a vaccine (immunotherapy). Although extensive efforts have been made to develop therapies that prevent and treat contact dermatitis to these plants, there lacks an entirely effective method, besides complete avoidance. There is a need for a better therapy to definitively prevent allergic contact dermatitis to these plants.

Sequential administrations of trifluoroacetate induce tolerance to Palicourea maccgravii, a monofluoroacetate-containing plant, in calves.

Monofluoroacetate (MFA) is considered one of the most toxic substances known. It is found naturally in plants, and causes sudden death syndrome in ruminants. Due to hyperacute evolution of poisoning and the absence of effective treatment, induction of resistance in animals might be the best tool to control MFA poisoning in ruminants. The objective of this study was to promote resistance in cattle against the toxic effects of MFA through its degradation by the ruminal microbiota after the administration of sodium trifluoroacetate (TFA). Ten calves were distributed into two groups: control group (n = 3) and treated group (n = 7). The calves in the treated group received 0.1 mg/kg live weight of TFA, whereas, those in the control group received water; both for 28 consecutive days. The calves were subjected to daily clinical evaluation and weekly blood biochemical determination to identify any signs of poisoning. After 28 d of administration of TFA or water, 2.0 g/kg body weight of Palicourea marcgravii leaves (containing 0.15% MFA) were administered using a stomach tube to determine the occurrence of resistance. The administration of TFA did not induce any clinical or biochemical changes in blood. The administration of P. marcgravii induced clinical changes in the calves of control group, but there was no change in the calves of the treated group. In conclusion, the administration of TFA to cattle can induce effective resistance against MFA poisoning.

Effect of grinding and long-term storage on the toxicity of white snakeroot (Ageratina altissima) in goats.

White snakeroot (Ageratina altissima) contains the putative toxin tremetone and can produce a disease called "trembles" or "milk sickness". However the toxicity of tremetone has not been demonstrated in vivo. It has been reported that the plant is less toxic after drying and grinding. The objectives of these studies were to determine: 1) the toxic effect of grinding white snakeroot 4 months prior to dosing and, 2) the toxic effect of storing white snakeroot at ambient temperature for 5 years. Dried white snakeroot, ground 1 day, 1 month, and 4 months prior to dosing, was orally gavaged to goats at 2% of their body weight for up to 28 days or until they were minimally poisoned (minimal muscular weakness and increased serum creatine kinase (CK) activities). All four goats dosed with white snakeroot that had been ground 4 months previously and stored at room temperature were poisoned, became exercise intolerant, and had increased serum CK activities (>5600 U/ L). White snakeroot stored for 5 years was toxic as 3 of 5 dosed goats developed clinical disease within only 6 days of dosing even though approximately 80% of the tremetone in the plant had disappeared during the 5-year storage period. The results from this study demonstrate that previous grinding and extended storage did not significantly alter white snakeroot toxicity. The results also indicate that tremetone concentration is not the singular indicator of toxicity and that other white snakeroot toxins or toxic tremetone degradation products remain in dried, stored white snakeroot.

An agent-based model of cattle grazing toxic Geyer's larkspur.

By killing cattle and otherwise complicating management, the many species of larkspur (Delphinium spp.) present a serious, intractable, and complex challenge to livestock grazing management in the western United States. Among the many obstacles to improving our understanding of cattle-larkspur dynamics has been the difficulty of testing different grazing management strategies in the field, as the risk of dead animals is too great. Agent-based models (ABMs) provide an effective method of testing alternate management strategies without risk to livestock. ABMs are especially useful for modeling complex systems such as livestock grazing management, and allow for realistic bottom-up encoding of cattle behavior. Here, we introduce a spatially-explicit, behavior-based ABM of cattle grazing in a pasture with a dangerous amount of Geyer's larkspur (D. geyeri). This model tests the role of herd cohesion and stocking density in larkspur intake, finds that both are key drivers of larkspur-induced toxicosis, and indicates that alteration of these factors within realistic bounds can mitigate risk. Crucially, the model points to herd cohesion, which has received little attention in the discipline, as playing an important role in lethal acute toxicosis. As the first ABM to model grazing behavior at realistic scales, this study also demonstrates the tremendous potential of ABMs to illuminate grazing management dynamics, including fundamental aspects of livestock behavior amidst ecological heterogeneity.

Yellow Oleander Seed, or "Codo de Fraile" (Thevetia spp.): A Review of Its Potential Toxicity as a Purported Weight-Loss Supplement.

The Dietary Supplements and Health Education Act (DSHEA), passed by the United States Congress in October of 1994, defines herbal products as nutritional supplements, not medications. This opened the market for diverse products made from plants, including teas, extracts, essential oils, and syrups. Mexico and the United States share an extensive border, where diverse herbal products are available to the public without a medical prescription. Research undertaken in the neighboring cities of Ciudad Juarez, Mexico, and El Paso, Texas, USA, shows the use of herbs is higher in this border area compared to the rest of the United States. A portion of the population is still under the erroneous impression that "natural" products are completely safe to use and therefore lack side effects. We review the dangers of ingesting the toxic seed of Thevetia spp. (family Apocynaceae), commonly known as "yellow oleander" or "codo de fraile," misleadingly advertised on the Internet as an effective and safe dietary supplement for weight loss. Lack of proper quality control regarding herbs generates a great variability in the quantity and quality of the products' content. Herb-drug interactions occur between some herbal products and certain prescription pharmaceuticals. Certain herbs recently introduced into the U.S. market may not have been previously tested adequately for purity, safety, and efficacy. Due to the lack of reliable clinical data regarding the safe use of various herbal products currently available, the public should be made aware regarding the possible health hazards of using certain herbs for therapeutic purposes. The potentially fatal toxicity of yellow oleander seed is confirmed by cases reported from various countries, while the purported benefits of using it for weight loss have not been evaluated by any known clinical trials. For this reason, the use of yellow oleander seed as a dietary supplement should be avoided.

A chimeric protein of abrin and Abrus precatorius agglutinin that neutralizes abrin mediated lethality in mice.

Abrin, a type II ribosome inactivating protein from the Abrus precatorius plant, is extremely toxic. It has been shown to be 75 times more potent than its infamous sister toxin, ricin and their potential use in bio-warfare is a cause of major concern. Although several vaccine candidates are under clinical trials for ricin, none are available against abrin. The present study proposes a chimeric protein, comprising of 1-123 amino acids taken from the A chain of abrin and 124-175 amino acids from Abrus precatorius agglutinin A chain, as a vaccine candidate against abrin intoxication. The design was based on the inclusion of the immunogenic region of the full length protein and the minimal essential folding domains required for inducing neutralizing antibody response. The chimera also contains the epitope for the only two neutralizing antibodies; D6F10 and A7C4, reported against abrin till now. Active immunization with the chimera protected all the mice challenged with 45 X LD50 of abrin. Also, passive transfer of antibodies raised against the chimera rescued all mice challenged with 50 X LD50 of toxin. Hence the chimeric protein appears to be a promising vaccine candidate against abrin induced lethality.

Protection against Amorimia septentrionalis poisoning in goats by the continuous administration of sodium monofluoroacetate-degrading bacteria.

The intraruminal inoculation of sodium monofluoroacetate (MFA)-degrading bacteria has been proposed as a method to prevent poisoning by MFA-containing plants. In previous experiments, MFA-degrading bacteria were inoculated intraruminally before or concurrent with plant challenge, with both strategies conferring partial protection to poisoning. To evaluate the protection to Amorimia septentrionalis poisoning provided by the continuous inoculation of MFA-degrading bacteria isolated from plants and soils, 18 goats were divided into three experimental groups of six animals each: Group 1 goats received daily doses of a mixture of Paenibacillus sp. and Cupriavidus sp., and Group 2 goats received a mixture of Ralstonia sp. and Burkholderia sp., for 40 days, while Group 3 goats were not inoculated. Ten days after initiation of bacterial inoculation in Groups 1 and 2, all goats were challenged daily with 5 g/kg body weight of green leaves from A. septentrionalis. Four goats from Group 1 consumed the leaves throughout the 30-day consumption period and showed clinical signs such as transient tachycardia and engorgement of the jugular. The two remaining animals from Group 1 showed obvious signs of intoxication, and plant administration was suspended on days 17 and 19. The goats in Group 2 consumed the leaves throughout the 30-day study without showing signs of poisoning. The goats from Group 3 (control) manifested severe clinical signs of poisoning between the 3rd and 10th days following the start of the A. septentrionalis challenge. Under the conditions of this experiment continuous intraruminal administration of Ralstonia sp. and Burkholderia sp. provided complete protection to poisoning by A. septentrionalis in goats, while continuous intraruminal administration of Paenibacillus sp. and Cupriavidus sp. provided partial protection.

Estudo sobre a sensibilidade dos caprinos à toxidez de crotalárias tóxicas para bovinos visando a sua utilização na profilaxia / Study about the sensitivity of goats to the toxicity of crotalarias poisonous for cattle aiming their use for prophylactic measures

A intoxicação por plantas é sabidamente uma das principais causas de morte de bovinos adultos no Brasil. Uma vez que pouco pode ser feito no que diz respeito ao tratamento destas intoxicações, os esforços devem se concentrar na adoção de medidas profiláticas alternativas, como a utilização de uma espécie menos sensível no local de ocorrência de determinadas plantas. Objetivou-se com esse trabalho verificar a sensibilidade de caprinos às crotalárias (Crotalaria spectabilis e Crotalaria juncea) para que estes possam ser utilizados na profilaxia da intoxicação por essas plantas em bovinos. Sementes de C. spectabilis e C. juncea foram fornecidas em doses únicas ou diárias a oito caprinos adultos jovens, de ambos os sexos, divididos aleatoriamente em dois grupos de quatro animais (um grupo para cada planta)...

Plant poisoning is known to be one of the most important causes of death of adult cattle in Brazil. As there are not many possibilities for treatment, all efforts must focus on application of alternative prophylactic measures, among them the use of a less sensitive animal species in areas of the occurrence of certain plants...

Monofluoroacetate-containing plants that are potentially toxic to livestock.

Many plants worldwide contain monofluoroacetate and cause sudden death in livestock. These plants are primarily found in the southern continents of Africa, Australia, and South America, where they negatively affect livestock production. This review highlights past and current research investigating (1) the plants reported to contain monofluoroacetate and cause sudden death; (2) the mode of action, clinical signs, and pathology associated with poisoning by monofluoroacetate-containing plants; (3) chemical methods for the analysis of monofluoroacetate in plants; (4) the coevolution of native flora and fauna in Western Australia with respect to monofluoroacetate-containing plants; and (5) methods to mitigate livestock losses caused by monofluoroacetate-containing plants.

Induction and transfer of resistance to poisoning by Amorimia (Mascagnia) septentrionalis in goats.

Amorimia septentrionalis contains sodium monofluoroactetate (MFA) and can cause acute heart failure in ruminants when ingested in toxic doses. In this study, we demonstrate that resistance to poisoning by A. septentrionalis can be improved in goats by the repeated administration of non-toxic doses of A. septentrionalis. We also show that increased resistance to poisoning by A. septentrionalis can also be achieved by the transfaunation of ruminal content from goats previously conditioned to be resistant to naïve goats. These methods of improving resistance require further study, but appear to provide potential management solutions to mitigate toxicity problems from A. septentrionalis, and perhaps other plant species containing MFA.

Poisonous plants: effects on embryo and fetal development.

Poisonous plant research in the United States began over 100 years ago as a result of livestock losses from toxic plants as settlers migrated westward with their flocks, herds, and families. Major losses were soon associated with poisonous plants, such as locoweeds, selenium accumulating plants, poison-hemlock, larkspurs, Veratrum, lupines, death camas, water hemlock, and others. Identification of plants associated with poisoning, chemistry of the plants, physiological effects, pathology, diagnosis, and prognosis, why animals eat the plants, and grazing management to mitigate losses became the overarching mission of the current Poisonous Plant Research Laboratory. Additionally, spin-off benefits resulting from the animal research have provided novel compounds, new techniques, and animal models to study human health conditions (biomedical research). The Poisonous Plant Research Laboratory has become an international leader of poisonous plant research as evidenced by the recent completion of the ninth International Symposium on Poisonous Plant Research held July 2013 in Hohhot, Inner Mongolia, China. In this article, we review plants that negatively impact embryo/fetal and neonatal growth and development, with emphasis on those plants that cause birth defects. Although this article focuses on the general aspects of selected groups of plants and their effects on the developing offspring, a companion paper in this volume reviews current understanding of the physiological, biochemical, and molecular mechanisms of toxicoses and teratogenesis.

Prophylactic and therapeutic effects of garlic extract on Nerium oleander-induced arrhythmia: a new approach to antiarrhythmic therapy in an ovine model.

CONTEXT: Oleander is a potent cardiotoxic plant and is a common cause of poisoning in human and animals. There is no affordable and cost-effective treatment for oleander poisoning. Objective. To evaluate the prophylactic and therapeutic effects of garlic extract (Allium sativum) on Nerium oleander (a potent cardiotoxic plant) intoxication in sheep. MATERIALS AND METHODS: Eight sheep were intravenously infused with an unsterilized hydro-ethanol extract of garlic (50 mg/kg) before or after receiving a lethal dose of dried leaves (as a powder) of oleander (100 mg/kg, orally). The cardiac rhythm was continuously monitored using biopotential wireless transmitters and telemetry system. For evaluation of therapeutic effects, six sheep received the lethal dose of oleander and were administered with garlic extract after development of cardiac arrhythmias. Subsequently, the survived animals from the therapeutic study (four sheep) were administered with oleander without receiving any medication. Some blood constituents, including total antioxidant capacity, malondialdehyde, and troponin I, were compared between treated and untreated animals. RESULTS: Pretreatment with garlic extract reversed the arrhythmia caused by oleander to its previous normal rhythm in seven sheep, but, one sheep died of ventricular fibrillation. On therapeutic treatment, four sheep survived while two died of ventricular fibrillation. Dosing with oleander without receiving garlic extract resulted in death of all sheep due to ventricular fibrillation. Blood constituents did not show any significant changes between treated and untreated sheep, and before and after intoxication. CONCLUSIONS: Garlic extract reduced the case fatality from 100% to 12.5% and 33.3% as a prophylactic or therapeutic agent, respectively. Additionally, garlic extract delayed the time of onset of arrhythmias and prolonged the interval between intoxication and death of the animals. Garlic extract could be considered to be a potential and affordable antidote in oleander poisoning. However additional studies with a larger sample size and in other species need to be performed to confirm the results in this study.