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Ergotism is the effect of long-term ergot poisoning. It is also called ergotoxicosis or ergot poisoning.
It can be caused by high ergot-based drug use (like methylergometrine, ergotamine or (previously) ergotoxine), consumption interacting with a potentiator (like azithromycin), or, classically, eating grains or grain-based products contaminated with the fungus claviceps purpurea. The alkaloids can also pass through lactation from mother to child, causing ergotism in the child.
The symptoms can be roughly divided into convulsive symptoms and gangreneous symptoms.
Convulsive symptoms include diarrhea, paresthesias, pruritus, seizures, headaches, nausea and vomiting. Usually the gastrointestinal effects preceed CNS effects. As well as seizures there can be hallucinations and mental effects including mania or psychosis. The convulsive symptoms are caused by clavine alkaloids.
The dry gangrene is a result of vasoconstriction induced by the ergotamine-ergocristine alkaloids of the fungus. It effects the more poorly vascularized distal structures, such as the fingers and toes. Symptoms include desquamation, weak peripheral pulse, loss of peripheral sensation, edema and ultimately the death and loss of affected tissues.
Epidemics of the disease were identified throughout history. The 12th century chronicler Geoffroy du Breuil of Vigeois recorded the mysterious outbreaks in the Limousin region of France. Notable epidemics of ergotism, at first seen as a punishment from God, occured from the late Middle Ages up into the 19th century. Outbreaks have occured since then and in developed countries rye is carefully monitored, in less wealthy countries ergotism still occurs (there was an outbreak in Ethiopia in mid-2001 from contaminated barley). Whenever there was a combination of moist weather, cool temperatures, delayed harvest in lowland crops and rye consumption an outbreak was possible, Russia was particularly afflicted. In the Middle Ages the poisoning was known as ignis sacer or Saint Antony's fire. When milled the ergot is reduced to a red powder, obvious in lighter grasses but easy to miss in dark rye flour.Causes
Symptoms
Convulsive symptoms
Gangreneous symptoms
History
