Poisoning by toxic plants in Hong Kong: a 15-year review.

INTRODUCTION: Hong Kong has a great diversity of plants, many of which are toxic to humans. The aim of this study was to identify the plant species most commonly involved in cases of plant poisoning in Hong Kong and to provide clinicians with a reference tool for the diagnosis and management of plant poisoning. METHODS: We retrospectively reviewed all plant poisoning cases referred to the Hospital Authority Toxicology Reference Laboratory from 1 January 2003 to 31 December 2017. Demographics, clinical presentation, laboratory findings, treatment and outcomes of patients, as well as morphological identification and analytical testing of the plant specimens, were investigated. RESULTS: A total of 62 cases involving 26 poisonous plant species were identified, among which Alocasia macrorrhizos (Giant Alocasia), Gelsemium elegans (Graceful Jessamine), and Rhododendron (Azalea) species were the three most commonly encountered. Gastrointestinal toxicity (n=30, 48%), neurological toxicity (n=22, 35%), and hepatotoxicity (n=6, 10%) were the three most common clinical problems. Forty-nine (79%) and eight (13%) patients had mild and moderate toxicity, respectively; they all recovered shortly with supportive treatment. The remaining five (8%) patients experienced severe toxicity requiring intensive care support. Most patients (n=61, 98%) used the plants intentionally: as a medicinal herb (n=31), as food (n=29), and for attempting suicide (n=1). Reasons for using the poisonous plants included misidentification (n=34, 55%), unawareness of the toxicity (n=20, 32%), and contamination (n=6, 10%). CONCLUSIONS: Although most plant exposure resulted in a self-limiting disease, severe poisonings were encountered. Epidemiology of plant poisonings is geographically specific. Clinicians should be aware of local poisonous plants and their toxicities.

Poisoning of cattle by Senecio spp. in Brazil: a review / Intoxicação por Senecio spp. em bovinos no Brasil: revisão de literatura

Poisoning of cattle by plants of the Senecio genus represents an important cause of death in cattle and has important economic repercussions in southern Brazil. This review is intended to provide a detailed review of Senecio spp. intoxication in cattle and addresses issues regarding the toxic principle and pathogenesis of the disease caused by these plants and the epidemiology, clinical signs, diagnosis, control and prophylaxis of the disease. Senecio brasiliensis is the main species associated with natural intoxication of livestock in Brazil, and the number of cases associated with the ingestion of S. madagascariensis is increasing. The toxic principle of Senecio spp. comprises the hepatotoxic alkaloids of the pyrrolizidine group (pyrrolizidine alkaloids, PAs). The resulting liver lesions are chronic and irreversible and result from the inhibition of hepatocellular mitosis. Deaths of adult cattle may occur both sporadically and in larger outbreaks over an extended period of time. In cattle raising, Senecio spp. are consumed mainly during the winter, when there is a dearth of forage; at this time the poisonous Senecio species are budding and contain high concentrations of PAs. Spontaneous Senecio spp. intoxication in cattle is a chronic condition that frequently involves acute clinical manifestations. Affected cattle may present ascites, emaciation, intermittent dark diarrhea, tenesmus, rectal prolapse, and neurological signs resulting from hepatic encephalopathy. Hepatogenous photosensitization may be observed but is uncommon. Necropsy findings include dependent subcutaneous edema, ascites, and edema of the mesentery, abomasal folds, and gallbladder. The liver is firm, normal or reduced in size with a white, thick capsule. Microscopically, the hallmarks of Senecio-associated disease are varying degrees of hepatocellular megalocytosis, bile duct hyperplasia and fibrosis. Sheep are significantly more resistant to Senecio intoxication than are cattle and avidly ingest Senecio plants; therefore, the use of sheep for grazing infested pasture is recommended for preventing the associated disease in cattle.(AU)

Intoxicação por plantas do gênero Senecio representa uma importante causa de morte em bovinos com grande repercussão econômica na região sul do Brasil. O objetivo dessa revisão é fornecer uma abordagem detalhada da intoxicação por Senecio spp. em bovinos, com enfoque nos seguintes aspectos da intoxicação: princípio tóxico e patogenia, epidemiologia, sinais clínicos, diagnóstico e controle e profilaxia. Senecio brasiliensis constitui a principal espécie associada a intoxicações espontâneas em animais de produção e há uma crescente incidência de casos relacionados à intoxicação por S. madagascariensis. A toxicidade das espécies de Senecio deve-se à presença de alcaloides hepatotóxicos pertencentes ao grupo das pirrolizidinas (APs), que produzem lesão hepática crônica e irreversível, caracterizada pela inibição da mitose de hepatócitos. As mortes dos bovinos adultos acontecem de forma esporádica ou em surtos durante um período prolongado de tempo, e podem ocorrer durante o ano todo. As espécies do gênero Senecio são pouco palatáveis e consumidas pelos bovinos somente em determinadas circunstâncias, principalmente, no inverno, período em que as diferentes espécies estão em brotação, com maior concentração de alcaloides, e a disponibilidade de forragem é escassa. A intoxicação geralmente cursa com um quadro crônico, embora as manifestações clínicas sejam agudas. Os bovinos afetados podem apresentar ascite, emagrecimento, diarreia escura intermitente, tenesmo, prolapso retal e sinais neurológicos (encefalopatia hepática). Ocasionalmente ocorre fotossensibilização hepatógena. Na necropsia, os principais achados incluem edema subcutâneo ventral, ascite, edema de mesentério e das pregas do abomaso, distensão e edema da vesícula biliar e fígado firme, diminuído de tamanho e com a cápsula brancacenta. Microscopicamente, as principais alterações hepáticas consistem de graus variados de hepatomegalocitose, hiperplasia de ductos biliares e fibrose. A profilaxia inclui o uso de ovinos para pastorear os campos infestados pela planta, visto que essa espécie é mais resistente à ação dos APs e apresenta avidez no consumo da brotação da planta.(AU)

Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis.

The American Association of Poison Control Centers has continued to report approximately 50,000 telephone calls or 8% of incoming calls annually related to plant exposures, mostly in children. Although the frequency of plant ingestions in children is related to the presence of popular species in households, adolescents may experiment with hallucinogenic plants; and trekkers and foragers may misidentify poisonous plants as edible. Since plant exposures have continued at a constant rate, the objectives of this review were (1) to review the epidemiology of plant poisonings; and (2) to propose a rapid toxidromic classification system for highly toxic plant ingestions for field use by first responders in comparison to current classification systems. Internet search engines were queried to identify and select peer-reviewed articles on plant poisonings using the key words in order to classify plant poisonings into four specific toxidromes: cardiotoxic, neurotoxic, cytotoxic, and gastrointestinal-hepatotoxic. A simple toxidromic classification system of plant poisonings may permit rapid diagnoses of highly toxic versus less toxic and nontoxic plant ingestions both in households and outdoors; direct earlier management of potentially serious poisonings; and reduce costly inpatient evaluations for inconsequential plant ingestions. The current textbook classification schemes for plant poisonings were complex in comparison to the rapid classification system; and were based on chemical nomenclatures and pharmacological effects, and not on clearly presenting toxidromes. Validation of the rapid toxidromic classification system as compared to existing chemical classification systems for plant poisonings will require future adoption and implementation of the toxidromic system by its intended users.

Intoxicaciones por plantas en menores de 15 años, ôHospital Materno Infantil Fernando Vélez Paizö, enero de 2002 a diciembre de 2003 / Intoxications for plants in smaller than 15 years, ôInfantile Maternal Hospital Fernando Vélez Paizö, January of 2002 to December of 2003

Se realizó un estudio descriptivo de corte transversal en todos los niños menores de 15 años Intoxicados por Plantas que ingresaron a los servicios de Pediatría del Hospital Fernando Vélez Paiz en el período comprendido de Enero 2002 a Diciembre 2003. El Universo estuvo conformado por 592 pacientes con Intoxicación por cualquier sustancia y que se obtuvieron mediante búsqueda activa de casos, la Muestra estuvo representada por 178 pacientes con Intoxicación por Plantas y que cumplieron con los criterios de inclusión. La fuente de información fueron los expedientes clínicos y la información fue integrada mediante un instrumento destinado para la recolección de datos (ficha de recolección de datos). El objetivo de éste estudio era conocer la incidencia, factores predisponentes, características clínicas, manejo y evolución de pacientes con Intoxicación por Plantas. Se encontraron los siguientes resultados: Se obtuvo una frecuencia del 30 porciento de casos en relación al total de intoxicados, con una mortalidad del 6.7 porciento que corresponde a una tasa de mortalidad de 2 por 100,000 habitantes y al realizar análisis de forma comparativa entre el 2002 y el 2003 observamos que se triplicó el número de casos en el 2003. La edad materna de pacientes intoxicados que predominó fue entre 20 ù 29 años con el 38.7 porciento. El grupo etáreo con mayor número de intoxicados correspondió a los menores de 1 año con el 66.8 porciento y el sexo predominante fue el Masculino con 57.8 porciento. La mayor cantidad de intoxicados procedían del área Urbana con el 65.7 porciento. El tipo de intoxicación más frecuente fue el Intencional (Autoadministración: Purga) con el 91 porciento de casos. El tipo de planta más utilizada fue el Ricino (Aceite vegetal) en un 83.7 porciento. El cuadro clínico ó síndrome más frecuente fue el Digestivo en el 98.3 porciento. De acuerdo a la severidad de la intoxicación el mayor número se caracterizó por ser severo en su evolución...

Envenenamiento mortal causado por el aceite de epazote: chenopodium graveolens / Fatal poisoning caused by epazote oil: chenopodium graveolens

Se presenta el caso de una niña de 2 años y 9 meses de edad, a quien una curandera indica la administración de aceite de epazote (aceite de quenopodio) como vermífugo, en dos tomas de 20 ml cada una. Después de la segunda manifiesta coma profundo, convulciones, midriasis, apnea, acidosis metabólica, choque neurogénico y muerte. ElEEG mostró un trazo sugestivo de encefalopatía, la TAC con imagen de edema cerebral y colapso ventricular. El estudio postmortem ratificó el edema cerebral y microscópicamente evidenció necrosis neuronal difusa; otros hallazgos fueron neumonía, enteritis, peicolangitis, pancreatitis incipiente y necrosisi tubular, el análisis fitoquímico del aceite identificó ascaridol, principio activo de las quenopodáceas, en cantidad 39 mg/ml (1,560 mg en los 40 ml ingeridos) y a chenopodium graveolens como la planta de la que se obtuvo el aceite, conforme al método como históricamente se adminstraba el aceite, la paciente debió haber ingerido una dosis total de ascaridol de 60 mg, por lo que la cantidad administrada fue 26 veces superior, además que excedía 56 por ciento la dosis de 1,000 mg, informada como letal en humanos.