Ergotism: Causes, Symptoms & Treatment

Ergotism is poisoning by ergot alkaloids such as ergotamine or ergometrine, which are found in ergot fungi and are used as drugs nowadays. The symptomatology focuses on massive circulatory disturbances with death of arms or legs, which can lead to death.

What is ergotism?

Ergotism actually belongs to the category of “medical history“: as poisoning after accidental consumption of ergot alkaloids with the grain, this disease ravaged thousands of unsuspecting peasants in the Middle Ages. Today, however, ergotamine is still found in medications for migraines or Parkinson’s disease, so in rare cases of overdose, ergotism-like side effects can occur here as well.

Causes

Ergot alkaloids are produced by the fungus Claviceps purpurae, which primarily attacks rye. As small crumbs, the fungi sit on the plants and were accordingly often overlooked during harvest in the Middle Ages. Thus, epidemic poisonings occurred again and again, to which thousands of people fell victim. Since the Order of St. Anthony in particular made it its business in the Middle Ages to treat these epidemics, the disease was also called “St. Anthony’s fire”. Ergotamine exerts its effect in the human organism, once it has entered the bloodstream, primarily at alpha receptors in the blood vessels: here the ergotamine molecules cause massive constriction of the blood vessels, with the result that large areas of the downstream tissue can no longer be adequately supplied with blood. The problem is then the same as with a heart attack or arterial thrombosis in the leg: tissue is no longer supplied with oxygen and dies within a short time, causing enormous pain. Although ergot is avoided in the cultivation of rye today, the pharmacological effect of the alkaloids is still important today: the vasoconstrictive effect of ergotamine can be used for migraine prophylaxis, for example, if it is assumed that the pressure in the head also decreases somewhat with decreasing cranial blood flow. Although this therapy is no longer standard, it can be successful in individual cases. Ergot alkaloids also play a role in the therapy of Parkinson’s disease; theoretically, they can also be used to treat low blood pressure. Poisoning from nature also occurs from time to time. In all these cases, it can come to the clinical picture of ergotism.

Symptoms, complaints and signs

The complaints in an ergotism can be very diverse and thereby do not always directly indicate the disease. For this reason, the disease often comes to a relatively late diagnosis and treatment. Those affected generally suffer from a narrowing of the vessels, which is why less blood can be transported in the same amount of time. This results in a low pulse and circulatory disturbances. As a result, the affected persons also suffer from permanent fatigue and tiredness, and these complaints cannot be compensated with the help of sleep. Furthermore, ergotism can also lead to sensory disturbances or even paralysis. The paralyses themselves usually occur only temporarily and disappear again. Due to the disturbances in sensitivity, the patient’s everyday life is significantly negatively affected and made more difficult. Some affected persons are therefore also dependent on the help of other people in their everyday life. Furthermore, ergotism can also lead to vomiting or to diarrhea and is often associated with various complaints in the stomach or intestines. In some cases, the disease has a negative effect on the patient’s psyche and leads to delusions. If left untreated, this can lead to a heart attack, in which case the affected person may die.

Diagnosis and course

The clinical picture of ergotism is characterized primarily by functional vascular occlusion: circulatory disturbances occur throughout the body, which are most noticeable in the heart, kidneys, and limbs. Initially, tingling and numbness occur in the hands and feet, followed by possible paralysis. If the lack of oxygen progresses, toes or fingers die painfully and turn black; the physician then speaks of gangrene. General symptoms such as headaches, nausea, ringing in the ears, diarrhea and delusions are also present.In addition to the possible massive myocardial infarction, which can quickly end in cardiac death, and acute renal failure, death may also occur due to respiratory paralysis. Crucial for the diagnosis of ergot alkaloid poisoning is knowledge of the ingestion of appropriate drugs or the possibility of intoxication elsewhere. The clinical picture is often ambiguous, especially since ergotism is also an absolute rarity in today’s clinics. An ultrasound examination of the blood vessels in the arms and legs can be performed. Although this provides evidence of the circulatory disorder, it is equally unable to clarify its cause.

Complications

In ergotism, death occurs in the worst case. In most cases, however, symptoms include headache and nausea. These are accompanied by itching and vomiting. As a rule, the patient can no longer lead a normal everyday life due to ergotism and the quality of life is reduced. Hallucinations or seizures often occur as a result of the poisoning. These can be associated with severe pain and in the worst case lead to cardiac arrest. Without treatment, the patient’s pulse becomes slower and slower. Unfortunately, ergotism is difficult to identify because the symptoms of the first stage are very similar to those of flu or a cold. It is not until the second stage that the fingers and face swell. The extremities become numb and cold, and there is also severe twitching in the arms and legs. Due to ergotism, there are limitations in hearing and speaking. Treatment at the doctor’s office takes place in most cases by stopping the medication. Furthermore, charcoal and sodium sulfate are administered to relieve the symptoms. If necessary, gastric lavage is necessary to completely detoxify the body. No further symptoms occur if the ergotism is treated in time. In severe cases, surgery is necessary.

When should you go to the doctor?

A doctor should be consulted as soon as symptoms such as cramps or stabbing pain develop. The cramping condition may be felt all over the body, with the main area of focus being the stomach. The pain occurs more frequently in the chest area and, because of its intensity, arouses the feeling of shortness of breath. A doctor should be consulted if nausea or vomiting occurs repeatedly. Headaches, a general weakness or a drop in the usual level of performance, should be investigated and treated medically. If the symptoms occur immediately after a food intake, this is considered worrisome. A physician should be consulted as soon as possible. If the itching on the skin cannot be explained, it should be clarified medically. If open wounds appear, the risk of infection and blood poisoning increases. In case of pus formation, fever or general malaise, a doctor should be consulted. The disease ergotism occurs rarely in the present time, but should be comprehensively examined and treated at the first signs. If behavioral changes are noticed in the affected person, which occur suddenly and unexpectedly, a visit to the doctor is necessary. If the complaints occur after taking medication, these should be checked for their ingredients. Consultation with the attending physician is necessary.

Treatment and therapy

To counteract the onset of ergotism, it is crucial to discontinue the triggering medications. This alone should be enough to reverse the vasoconstrictor effect and restore adequate oxygen to the starving tissues. If this alone is not sufficient or if the case is already an emergency, infusion of calcium antagonists, nitrates, and prostaglandins can be used to cause active vasodilatation.

Outlook and prognosis

Patients of ergotism may suffer further deterioration of their medical condition without an immediate change in medication regimen. The supply of tissues and organs is impaired by taking preparations containing the active ingredient ergotamine. The patient is thus threatened with paralysis, the death of limbs and, in severe cases, an early demise due to a functional failure of various systems. Nowadays, ergotism is usually triggered by the administration of drugs to relieve migraine or Parkinson’s disease.All other causes have already been eliminated or are no longer vacant due to the evolutionary changes of the last centuries. The active ingredient ergotamine is still contained in some medical preparations today. Although in normal cases newer therapies are already used for migraine prophylaxis or in Parkinson’s disease, it is still possible in exceptional cases to take medicines containing ergotamine. For a good prognosis and a chance of cure, the active substance must be removed from the body as quickly as possible. Thus, the immediate discontinuation of the prescribed medication is indispensable. If the symptoms are not yet severe, the patient’s health will subsequently be restored. If the patient is already suffering from irreversible damage as a result of taking the preparations, discontinuation of the medication will prevent progress in the deterioration of health.

Prevention

To prevent ergotism, of course, it is important to always carefully weigh the benefits against the risks when taking appropriate medications. For this reason, ergotamine has also gone out of fashion medically as a migraine medication. Meanwhile, agriculture has developed various cultivation protocols and cleaning techniques to minimize ergot infestation of rye. There is no longer any danger of poisoning, as there was in the Middle Ages, when eating this grain.

Aftercare

In most cases of ergotism, the measures of aftercare are very limited. In this case, the affected person usually depends on the treatment of this poisoning first, so that there are no further complications or, in the worst case, the death of the affected person. The earlier the poisoning is recognized and treated, the better the further course of the disease usually is. Aftercare is based on avoiding the triggering substance so that ergotism does not recur. In any case, the triggering medication should be discontinued or replaced by other medication after consultation with a physician. In an emergency, however, ergotism should be treated in a hospital or by an emergency physician. In this case, the affected persons are dependent on taking supplements to alleviate the symptoms. Here, regular and correct intake is to be ensured, whereby consultation with a physician is also always to be held. Furthermore, the affected person should in any case rest and take care of the body. Unnecessary strain or other strenuous and stressful activities should be avoided in any case. With successful treatment of ergotism, the life expectancy of the affected person is usually not reduced.

What you can do yourself

In everyday life, pay attention to the contamination of food before eating it. Ingested foods should be sufficiently cleaned before they are fed raw to the organism. Before further processing for meals, they should also be cleaned thoroughly. This applies in particular to cereal products. Consumption of free-grown cereals should be avoided. If symptoms occur immediately after taking medication, contact the attending physician without delay. In consultation with the medical practitioner, the further course of action should be discussed. If the intolerance of the additive ergot alkaloids is already known, their ingredients should be carefully checked before taking a medical preparation. Subsequently, the medication should be discussed with the doctor or the medicine should be replaced. If the first symptoms occur, the instructions of a doctor should be followed. To improve one’s own well-being, the intake of sufficient fluids is recommended. In addition, the immune system should be supported by a diet rich in vitamins and fiber. Sufficient sleep and the avoidance of unnecessary stress are also beneficial. Food should be completely avoided in contaminated stalls or grain stores. If in doubt, the food stored there should be disposed of or tested for contaminants in the laboratory.