Poisoning Following Ingestion of Narcissus Tazetta Bulbs by Schoolchildren Amer Hussein MD Phd and Aurica Yassin MD
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IMAJ • VOL 16 • FebruAry 2014 CASE COMMUNICATIONS Poisoning following Ingestion of Narcissus Tazetta Bulbs by Schoolchildren Amer Hussein MD PhD and Aurica Yassin MD Department of Emergency Medicine, Ziv Medical Center, affiliated with Bar-Ilan University Faculty of Medicine in the Galilee, Safed, Israel in the Mediterranean region and thrives KEY WORDS: Narcissus tazetta, toxic plants, PATIENT DESCRIPTION in two habitats – valleys and mountains. poisoning, bulb A group of 10 children aged 10–11 years The mountain Narcissus grows in rocky IMAJ 2014; 16: 125–126 together with their guide presented at the mountainous areas and flourishes dur- emergency department in February 2010 ing November and December. The valley suffering from vomiting after ingestion of Narcissus grows in ponds and swamp mar- the Narcissus bulb, which had been mis- gins, flourishing from January to March. takenly identified as the bulb of a garden Materials derived from plants of the onion. All the children had been perfectly family Amaryllidaceae are known to have healthy prior to this incident. Eight of them healing properties. For example, oil pro- he American Association of Poison vomited within half an hour after eating duced from Narcissus poeticus was used in T Control Centers received more than the Narcissus bulb. Two children had no ancient Greece for the treatment of cancer. 47,000 reports of poisoning in 2011 due to complaints at all. Physical examination Components of these plants (such as nar- toxic plant exposure [1]. Of these, 13.2% was normal in all the children. Vital signs ciclasine) are presently being investigated were due to unknown plants and less than including temperature, blood pressure and for activity against cancer cells. These 1% to Narcissus. In most cases, the degree pulse were normal. No swelling of lips or components derived from the plants are of toxicity from plants is low because of mouth and no dyspnea or other respiratory also used in Alzheimer’s disease as inhibi- the small amounts of material consumed. manifestations were noted. One child had tors of the enzyme acetyl-choline esterase More severe poisoning occurs in adults slight diffuse tenderness in the upper abdo- [3]. They are being investigated for other who mistakenly believe the plant is edible men. Laboratory tests (electrolytes and kid- healing purposes as well. or holds medicinal properties [2]. There ney function) were normal. The eight chil- However, along with the healing abil- are a few antidotes for toxic plants, and in dren were treated with intravenous normal ity of Narcissus, there is also the danger of most cases the treatment is only support- saline and the whole group was kept for 4 poisoning. All parts of this plant are poi- ive. We describe an outbreak that occurred hours for observation in the emergency sonous especially if large amounts are con- in a group of children and their 22 year old department. The 22 year old guide vom- sumed. A review of the literature produced guide who suffered from vomiting after ited once and suffered abdominal pain. a few reports of poisoning from eating the ingesting the bulb of the Narcissus tazetta Her vital signs and laboratory tests were Narcissus bulb, but these referred to other plant, also known as the daffodil. normal. She was treated in the emergency species of Narcissus and not Narcissus department with intravenous normal saline tazetta [4]. In addition to vomiting, previ- Narcissus tazetta and metoclopramide hydrochloride. Once ously described reactions were respiratory their condition improved the whole group symptoms and contact dermatitis [5]. was discharged to their homes. Patients may be asymptomatic or pres- ent with nausea and severe vomiting, diar- rhea, nervous symptoms such as trembling, COMMENT and convulsions. Death can result from Narcissus tazetta [Figure] is a geophyte, a ingestion of the bulb. Irritant dermatitis can plant whose secondary parts on the ground also occur when the needle-sharp calcium die and only a storage organ lives under- oxalate crystals, distributed in the outer ground. The Narcissus tazetta belongs to layers of many Narcissus bulbs, pierce the Amaryllidaceae, a family with a brown hands of those handling them. The wheals bulb [2]. The flowers have a strong smell are characteristic of the disorder “bulb fin- that attracts insects. It is widely grown gers,” a symptom suggestive of histamine 125 CASE COMMUNICATIONS IMAJ • VOL 16 • FebruAry 2014 release. Pre-hospital treatment includes for adults is 1 g/kg (30–100 g) per os and References ceasing contact with the plant immediately 1–2 g/kg (15–30 g) per os for chidlren. This 1. Bronstein A, Spyker D, Cantilena L, Green J, and strict washing of hands, and eye irriga- treatment is a general recommendation Rumack B, Dart R. 2011 Annual Report of the American Association of Poison Control Centers’ tion in cases where patients rubbed their and is not specific to Narcissus poisoning. National Poison Data System (NPDS): 29th eyes with contaminated hands. Administration of activated charcoal is Annual Report. Clin Toxicol 2012; 50: 9111-164. In the emergency department the treat- contraindicated in vomiting patients [1,2]. 2. Froberg B, Ibrahim D, Furbee RB. Plant poisoning. ment for poisoning is primarily symp- In conclusion, it is necessary to recognize Emerg Med Clin North Am 2007; 25 (2): 375-433. 3. Lopez S, Bastida J, Viladomat F, Codina C. tomatic in nature. Airway, breathing and the symptoms of poisoning by Narcissus, a Acetylcholinesterase inhibitory activity of some circulation must be ensured, followed by common plant in our region, especially Amaryllidaceae alkaloids and Narcissus extracts. supportive therapy including removal of since the bulb of this plant strongly resem- Life Sci 2002; 71 (21): 2521-9. any remaining toxin by gastric decon- bles the garden onion. 4. Jaspersen-Schib R, Theus L, Guirguis-Oeschger M, Gossweiler B, Meier-Abt PJ. Serious plant tamination. Gastric lavage is unlikely to be Corresponding author: poisonings in Switzerland 1966-1994. Case analysis effective. GastrointestinaI decontamination Dr. A. Hussein from the Swiss Toxicology Information Center. by activated charcoal may be beneficial by Head, Dept. of Emergency Medicine, Ziv Medical Schweiz Med Wochenschr 1996; 126 (25): 1085-98. Center, P.O. Box 1008, Safed 13100, Israel 5. Goncalo S, Freitas JD, Sousa I. Contact dermatitis reducing the absorbed poison dose, only if Fax: (972-4) 692-8746 and respiratory symptoms from Narcissus pseudo- administered within the first hour. Dosing email: [email protected] narcissus. Contact Dermatitis 1987; 16 (2): 115-16. Capsule ‘Watch’ stops unnecessary heart attack deaths It looks like a watch but it’s a sophisticated blood-oxygen heart nothing helps if the user is not able to mobilize these devices rate monitor. About half the people at risk of death from cardiac in time. And many patients may not be able to read the signs or pulmonary arrest could gain the chance to live, once Israeli that cardiac arrest is imminent. That’s why Eisen developed a entrepreneur Leon Eisen’s new Oxitone device goes to market wearable watch-like mobile device – synched with Bluetooth, some time this year. 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Gene clustering highlights the cytosolic DNA sensor infection by inducing hundreds of interferon-stimulated cyclic GMP-AMP synthase (cGAS, also known as MB21D1) as genes (ISGs), some of which encode direct antiviral effectors. a gene whose expression also broadly inhibits several RNA Recent screening studies have begun to catalogue ISGs viruses. In vitro, lentiviral delivery of enzymatically active with antiviral activity against several RNA and DNA viruses. cGAS triggers a STING-dependent, IRF3-mediated antiviral However, antiviral ISG specificity across multiple distinct program that functions independently of canonical IFN/STAT1 classes of viruses remains largely unexplored. Schoggins et al. signaling. 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