On a recent episode of House, a young woman believed that she was assaulted by two dead people. In reality, she was actually hallucinating. When her coworker found her, she was having a seizure. She was taken to the hospital and when the emergency room doctors could not figure out what was wrong with her, she was sent to see Dr. House. Her symptoms continued to get worse. After several wrong diagnoses and digging up a corpse, Dr. House and his team figured out what was wrong with her: she was suffering from ergotism. So what exactly is ergotism?
Ergotism occurs as a result of long-term ergot poisoning. Ergot is the common name for the fungus Claviceps purpurea. Ergot commonly affects many cereal grains including rye, triticale, wheat, barley, and oats as well as certain grasses. The fungus has the ability to significantly reduce yield and quality of grains. However, it is primarily a concern because of its toxicity in animals and humans. Ergot contains high concentrations of ergotamine, ergoline, and many other alkaloids. The alkaloids have a wide range of effects on the human body. In small amounts, the alkaloids are relatively harmless. However, in large amounts or when small amounts are ingested over a period of time, the alkaloids can cause serious effects. Ergot poisoning refers to the condition that results from ingesting ergot. Long-term ergot poisoning is known as ergotism. It is interesting to note that because ergot alkaloids are often used in medicine, certain drugs have been implicated in ergotism. Ergotism used to be much more common in the past. However, it is almost nonexistent in today’s society.
Symptoms of ergotism are divided into two groups: convulsive symptoms and gangrenous symptoms. Convulsive symptoms are usually the result of ergoline alkaloids. A characteristic convulsive symptom is parethesias, the sensation of pain, tingling, or numbness of the skin. It is sometimes described as a burning sensation of the limbs, particularly the legs. Other convulsive symptoms include hallucinations, seizures, diarrhea, painful muscle spasms, itching, headaches, confusion, nausea, and vomiting. Gangrenous symptoms are the result of ergotamine which cause vasoconstriction. These symptoms include poor circulation, weak pulse, loss of sensation, edema, and desquamation (a condition where the outer layers of skin are shed). Eventually, the result is gangrene (a condition where tissues die and are inevitably lost). In general, symptoms vary from patient to patient, the severity of which depends on the extent and length of poisoning.
There is no test for ergotism. Therefore, diagnosis can be somewhat difficult. The diagnosis is made following a physical examination, review of the patient’s medical history, and review of the patient’s signs and symptoms. It is important to find the source of the poisoning. Once the source is found, it is necessary to eliminate it and follow steps to prevent further poisoning. Treatment of ergotism is highly individualized. It depends on the symptoms and severity of the poisoning. Vasodilators, anticoagulants, anticonvulsants, muscle relaxants, and low molecular weight dextrans are usually used. Temporary sedation may be necessary if hallucinations are severe. Prognosis depends on the severity of the poisoning. In general, it is relatively good. After treatment, patients usually have no more affects from the disease.
Ergotism is a type of poisoning caused by a fungus. In the past, ergotism was much more common. However, it is almost nonexistent in today’s society. Symptoms vary from patient to patient, the severity of which depends on the extent and length of poisoning. Treatment of ergotism is highly individualized. In general, prognosis of ergotism is relatively good.
Sources
Wikipedia
MedicineNet
