Ergotism is a rare condition caused by ingestion of alkaloids produced by Claviceps purpurea fungi, most commonly through the use of drugs for migraine headaches (methylergometrine, ergotamine or ergotoxine) and concomitant administration of cytochrome P450 3A4 inhibitors, including antiretrovirals and macrolide antibiotics. Marked vasoconstriction and arterial insufficiency are the principal causes of symptoms.
Presentation
Symptoms stem from profound vasoconstrictive effects through blockade of alpha-adrenergic receptors, smooth muscle stimulation, and central sympatholytic activity, causing arterial insufficiency and development of both vascular and central nervous system complaints [1] [2]. Vasospasm can affect virtually any vessel in the body, but most commonly involves the femoral artery, which is why lower extremities are the principal site of symptom occurrence [3]. Initial reports showed that manifestations of ergotism may be seen as early as one hour after introduction of the harmful substance into the body [4], while other studies show that several days usually pass before the onset of symptoms [1]. Limb ischemia, burning pain, impaired sensation followed by numbness, appearance of cold and pale skin of the affected extremities, eventually leading to claudication and gangrene is the typical clinical course if the condition is not recognized on time, and loss of the affected extremity has been reported [1] [3] [4] [5] [6]. In addition, central nervous systems symptoms are encountered as well, having in mind the fact that ergot alkaloids are derivatives of lysergic acid (LSD), one of the most potent psychoactive substances [4]. Headaches, vertigo, hallucinations, mania, psychosis, convulsions (ranging from simple seizures to painful muscular contractions and tetanus-like cramps) and coma are constitutive features of ergotism [1] [4]. Gastrointestinal irritation can also occur. It presents as nausea, vomiting, diarrhea and cramping abdominal pain [2].
Entire Body System
- Gangrene
[…] by necrosis of the extremities (gangrene) due to contraction of the peripheral vascular bed. [medical-dictionary.thefreedictionary.com]
A fungus growing on the rye Convulsive and gangrenous Capiliaries contract, blood can't reach the body part Dry gangrene of the extremeties Lysurgic Acid Diethylamide Ignis Sacer, the Holy Fire Middle Age name for gangrenous ergotism Hallucination, epileptic [quizlet.com]
′ gə tiz′əm), USA pronunciation n. [ Pathol. ] Pathology a condition caused by eating rye or some other grain that is infected with ergot fungus or by taking an overdose of a medicine containing ergot, characterized by cramps, spasms, and a form of gangrene [wordreference.com]
Gangrenous [ edit ] The dry gangrene is a result of vasoconstriction induced by the ergotamine - ergocristine alkaloids of the fungus. It affects the more poorly vascularized distal structures, such as the fingers and toes. [en.wikipedia.org]
- Pallor
Loss of sensation, pallor and decrease in skin temperature of feet were observed. The patient denied taking any drug. An arterial Doppler test revealed the absence of flow in both tibioperoneal arteries. [pmj.bmj.com]
[…] idiosyncratic hypersensitivity reaction with therapeutic doses, 3 and during concomitant use of other kinds of medication. 4 The sustained arterial spasm observed in ergotism causes vascular insufficiency in the extremities, which is characterized by pallor [synapse.koreamed.org]
- Limb Pain
Humans suffer from two varieties of ergotism and here are the associated symptoms, according to this 2007 Medicina article: Gangrenous ergotism (AKA ignis sacer or holy fire): nausea, limb pain. [tor.com]
Gastrointestinal
- Vomiting
Consumption of foods contaminated with ergot and ergot derivatives may cause vomiting, diarrhea, hallucinations, and may lead to gangrene in serious cases. [botit.botany.wisc.edu]
[…] the rye Convulsive and gangrenous Capiliaries contract, blood can't reach the body part Dry gangrene of the extremeties Lysurgic Acid Diethylamide Ignis Sacer, the Holy Fire Middle Age name for gangrenous ergotism Hallucination, epileptic convulsions, vomiting [quizlet.com]
Definition (noun) poisoning by ingestion of ergot-infected grain products; characterized by thirst and diarrhea and nausea and cramping and vomiting and abnormal cardiac rhythms; in severe cases it can cause seizures and gangrene of the limbs [mnemonicdictionary.com]
It presents as nausea, vomiting, diarrhea and cramping abdominal pain. The diagnosis of ergotism may be difficult to make, as approximately 0.001-0.002% of patients receiving ergot derivatives actually develop ergotism. [symptoma.com]
1 2 अर्गटिज़म Inflected forms ergotisms (noun plural) Definitions and Meaning of ergotism in English noun poisoning by ingestion of ergot-infected grain products; characterized by thirst and diarrhea and nausea and cramping and vomiting and abnormal cardiac [shabdkosh.com]
- Nausea
Definition (noun) poisoning by ingestion of ergot-infected grain products; characterized by thirst and diarrhea and nausea and cramping and vomiting and abnormal cardiac rhythms; in severe cases it can cause seizures and gangrene of the limbs [mnemonicdictionary.com]
It presents as nausea, vomiting, diarrhea and cramping abdominal pain. The diagnosis of ergotism may be difficult to make, as approximately 0.001-0.002% of patients receiving ergot derivatives actually develop ergotism. [symptoma.com]
1 2 अर्गटिज़म Inflected forms ergotisms (noun plural) Definitions and Meaning of ergotism in English noun poisoning by ingestion of ergot-infected grain products; characterized by thirst and diarrhea and nausea and cramping and vomiting and abnormal cardiac [shabdkosh.com]
Other symptoms include strong uterine contractions, nausea, seizures, and unconsciousness. 13. Wait…Benefits???... [slideshare.net]
Anthony’s Fire. 1 The symptoms of ergotism consist of headaches, nausea, vomiting and diarrhea, paresthesias and itching, painful seizures and spasms, hallucinations, mania or psychosis. [hekint.org]
- Abdominal Pain
He was admitted to our hospital after one week of increasing abdominal pain. [ncbi.nlm.nih.gov]
It presents as nausea, vomiting, diarrhea and cramping abdominal pain. The diagnosis of ergotism may be difficult to make, as approximately 0.001-0.002% of patients receiving ergot derivatives actually develop ergotism. [symptoma.com]
Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself [nejm.org]
Cardiovascular
- Hypertension
The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage. Neuroradiology. 2001 [visitado 2013 Feb 21];43:302-4. [revista.fecolsog.org]
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. [ncbi.nlm.nih.gov]
Google Scholar | Medline | ISI Gomez-Sanchez MA, De La Calzada CS, Gomez-Pajuelo C., et al : Different hemodynamic responses between acute and chronic infusion of Iloprost (prostacyclin-stable analogue) in severe pulmonary hypertension Am Rev Respir Dis [doi.org]
It was possible to identify a history of hypertension and/or preeclampsia only in nine cases, and a history of migraine in four. The vast majority of patients were otherwise healthy. [scielo.org.co]
He had no prior history of type 2 diabetes mellitus, hypertension, dyslipidemia, or trauma. He was a current smoker consuming one pack daily for 30 years. [synapse.koreamed.org]
Skin
- Skin Lesion
The trials began when several young girls in Salem, Massachusetts, fell ill and developed unexplained symptoms, including temporary blindness, skin lesions, convulsions, and hallucinations. [jamanetwork.com]
Psychiatrical
- Delusion
Toxicologists now know that eating ergot-contaminated food can lead to a convulsive disorder characterized by violent muscle spasms, vomiting, delusions, hallucinations, crawling sensations on the skin, and a host of other symptoms — all of which, Linnda [pbs.org]
Some of the more common symptoms include tremors, delusions, prickling sensations on skin, convulsing seizures, hallucinations, and violent muscle spasms. [cropwatch.unl.edu]
In some cases, this is accompanied by muscle spasms, confusions, delusions and hallucinations, as well as a number of other symptoms. [scottnevinssuicide.wordpress.com]
[…] there was a minister att theat meeting & he was a short man & she thought is name was Borroughs: she s’d they agreed that time to afflict folk: & to pull done the kingdom of Christ & to set up the devils kingdom …” In the book, Extraordinary Popular Delusions [ianchadwick.com]
Neurologic
- Headache
Rebound headache after withdrawal of ergot alkaloids may lead to self-medication and overdosage, with subsequent risk of ergotism. [ncbi.nlm.nih.gov]
All of the accused had similar symptoms: manic melancholia, psychosis, delirium, crawling sensations of the skin, vertigo, headaches, vomiting and diarrhea. [botit.botany.wisc.edu]
Keywords Clinical Picture Daily Intake Migraine Patient Headache Patient Chronic Daily Headache These keywords were added by machine and not by the authors. [link.springer.com]
Ergotism is a rare condition caused by ingestion of alkaloids produced by Claviceps purpurea fungi, most commonly through the use of drugs for migraine headaches (methylergometrine, ergotamine or ergotoxine) and concomitant administration of cytochrome [symptoma.com]
- Seizure
Definition (noun) poisoning by ingestion of ergot-infected grain products; characterized by thirst and diarrhea and nausea and cramping and vomiting and abnormal cardiac rhythms; in severe cases it can cause seizures and gangrene of the limbs [mnemonicdictionary.com]
Headaches, vertigo, hallucinations, mania, psychosis, convulsions (ranging from simple seizures to painful muscular contractions and tetanus-like cramps) and coma are constitutive features of ergotism. Gastrointestinal irritation can also occur. [symptoma.com]
[…] plural) Definitions and Meaning of ergotism in English noun poisoning by ingestion of ergot-infected grain products; characterized by thirst and diarrhea and nausea and cramping and vomiting and abnormal cardiac rhythms; in severe cases it can cause seizures [shabdkosh.com]
Anthony’s Fire. 1 The symptoms of ergotism consist of headaches, nausea, vomiting and diarrhea, paresthesias and itching, painful seizures and spasms, hallucinations, mania or psychosis. [hekint.org]
Convulsive symptoms Edit Convulsive symptoms include painful seizures and spasms, diarrhea, paresthesias, itching, headaches, nausea and vomiting. Usually the gastrointestinal effects precede central nervous system effects. [psychology.wikia.org]
- Paresthesia
Anthony’s Fire. 1 The symptoms of ergotism consist of headaches, nausea, vomiting and diarrhea, paresthesias and itching, painful seizures and spasms, hallucinations, mania or psychosis. [hekint.org]
One day after the initiation of therapy, both radial pulses were palpable, and 2 days later the pain in the upper extremities had subsided, with minimal paresthesia. [synapse.koreamed.org]
In both convulsive and gangrenous ergotism, the initial symptoms consist of gastrointestinal disturbances, vague flu-like symptoms, and distal extremity paresthesias. [visualdx.com]
- Vertigo
[…] gangrenous Capiliaries contract, blood can't reach the body part Dry gangrene of the extremeties Lysurgic Acid Diethylamide Ignis Sacer, the Holy Fire Middle Age name for gangrenous ergotism Hallucination, epileptic convulsions, vomiting, diarrhea, vertigo [quizlet.com]
Headaches, vertigo, hallucinations, mania, psychosis, convulsions (ranging from simple seizures to painful muscular contractions and tetanus-like cramps) and coma are constitutive features of ergotism. Gastrointestinal irritation can also occur. [symptoma.com]
All of the accused had similar symptoms: manic melancholia, psychosis, delirium, crawling sensations of the skin, vertigo, headaches, vomiting and diarrhea. [botit.botany.wisc.edu]
In her article, Caporael points out that the convulsive symptoms, such as crawling sensations in the skin, tingling in the fingers, vertigo, tinnitus aurium, headaches, disturbances in sensation, hallucination, painful muscular contractions, vomiting [psychology.wikia.org]
- Confusion
As a result of early imprecision in disease specificity and diagnosis, physicians confused ergotism with the plague and a variety of other diseases including leprosy, anthrax, typhus, smallpox, and scurvy. [cambridge.org]
However, a severe outbreak of something akin to ergot poisoning occurred in the French village of Pont-Saint-Esprit in 1951, resulting in five deaths. [6] The outbreak, and the diagnostic confusion surrounding it, are vividly described in John Grant Fuller [en.wikipedia.org]
Workup
The diagnosis of ergotism may be difficult to make, as approximately 0.001-0.002% of patients receiving ergot derivatives actually develop ergotism [3]. The workup, however, should be thorough and consist of several steps. Firstly, a thorough patient history to confirm the use of ergot-containing drugs and other agents that interfere with the cytochrome P450 3A4 system should be obtained, as ergot derivatives are metabolized through this cytochrome pathway in the liver [1]. Antiretrovirals, antidepressants, macrolide antibiotics (erythromycin, azithromycin), azole antifungals, but also grapefruit juice use the same pathway for metabolic degradation and virtually all patients who suffer from ergotism used some of the above-mentioned drugs [1]. Angiography is the cornerstone of evaluation of the vascular system in the setting of ergotism, and a generalized intense arterial spasm, the formation of collateral vessels (more commonly seen in prolonged toxicity) and thrombosis may be encountered [2]. Isolated spasms, multifocal stenoses, often described as "threadlike narrowing" of the vessel, is mentioned in various reports [2] [7], and a combination of medication history, clinical findings and results from angiography should be sufficient to make the diagnosis.
Treatment
The diagnosis may be made with the evidence of vascular ischemia in the presence of a history of migraines and its treatment with this drug. [ncbi.nlm.nih.gov]
: Use of the prostacyclin analogue iloprost in the treatment of patients with critical limb ischemia Therapie 46: 319 - 322, 1991. [doi.org]
Etiology
When there was no laboratory confirmation of the arteritis, an iatrogenic etiology (ergotism) was suspected. This was later confirmed by the patient. [ncbi.nlm.nih.gov]
The local doctor, unsure of the etiology of their sickness, diagnosed the girls as having “bewitchment,” 1 a clinical judgment that led to the persecution and subsequent prosecution of the accused individuals. [jamanetwork.com]
[…] simplex CMV infection Syphilis Pyoderma gangrenosum Sarcoidosis Amebiasis Deep mycosis Ulcerative neoplasm Ankle-brachial index (ABI) is a useful test for establishing whether the patient has ischemic disease, but it does not help pinpoint the underlying etiology [visualdx.com]
Ergotism: a possible etiology for puerperal psychosis. Obstet Gynecol. 1989 [visitado 2013 Feb 21];73(3 Pt 2):475-7. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/2915878 [revista.fecolsog.org]
The etiologic agent was once thought to be the ergot alkaloids produced by the fungus Claviceps purpurea, found in contaminated rye. ** The Medical Dictionary tells us: The blight…was identified and named by Denis Dodart who reported the relation between [ianchadwick.com]
Epidemiology
The similarities between the clinical manifestations of ergotism and puerperal psychosis, and some of the epidemiologic features of the latter condition, appear to implicate ergot alkaloids as potential causative agents. [ncbi.nlm.nih.gov]
The present study describes epidemiological data, clinical signs and lesions of a bovine cattle disease characterized by hyperthermia, tachycardia, tachypnea and injuries in the coronary band of the hooves. [scielo.br]
ISSN: 0950-2688 EISSN: 1469-4409 URL: /core/journals/epidemiology-and-infection Unfortunately you do not have access to this content, please use the Get access link below for information on how to access this content. × × Metrics Full text views Full [journals.cambridge.org]
Pathophysiology
In this paper, we review the history, pathophysiology, initial symptoms and signs, diagnosis and treatment of ergotamine poisoning. [neurologia.com]
In this paper, we review the history, pathophysiology, initial symptoms and signs, diagnosis and treatment of ergotamine poisoning [pesquisa.bvsalud.org]
Prevention
Abstract Ergot's derivatives are widely used to treat and prevent migraine and, associated with heparin, for the prevention of deep vein thrombosis. [ncbi.nlm.nih.gov]
When you close your browser window without clicking “sign out”, the site will automatically prevent you from signing in again until your session clears, usually after about 20 minutes. [oed.com]
Control/Prevention None. Avoid the use of wheat, oats, and rye grass in the feed formulation. Withdrawal of suspected feed. [pig333.com]
They have also been used for treating chronic pathological cognitive and neurosensorial impairment (problems with memory and sensation) and for preventing migraine headaches. [ema.europa.eu]
References
- Fröhlich G, Kaplan V, Amann-Vesti B. Holy fire in an HIV-positive man: a case of 21st-century ergotism. CMAJ. 2010;182(4):378-380.
- Garcia GD, Goff JM Jr, Hadro NC, O'donnell SD, Greatorex PS. Chronic ergot toxicity: A rare cause of lower extremity ischemia. J Vasc Surg. 2000;31(6):1245-1247.
- Brancaccio G, Celoria GM, Falco E. Ergotism. J Vasc Surg. 2008;48(3):754.
- Alm T, Elvevåg B. Ergotism in Norway. Part 1: The symptoms and their interpretation from the late Iron Age to the seventeenth century. Hist Psychiatry. 2013;24(1):15-33.
- Ayarragaray JE. Ergotism: a change of persepective. Ann Vasc Surg. 2014;28(1):265-268
- Molkara AM, Abou-Zamzam AM Jr, 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(6):803-808.
- Jeong SY, Lim ES, Shin BS, et al. Ergotism With Ischemia In All Four Extremities: A Case Report. J Clin Neurol. 2006;2(4):279-282.