ergotism


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Classification according to ICD-10
T62.2 Toxic effect: Other consumed plant (s) or part (s) thereof
ICD-10 online (WHO version 2019)
Rye ear with ergot (dark, elongated, grain- like structure), the permanent form ( sclerotium ) of the ergot fungus Claviceps purpurea

Ergotism or ergot poisoning (formerly also Antoniusfeuer and Latin Ignis sacer "holy fire"; from Latin sacer : 'holy', also 'cursed', 'abominable') is a mycotoxicosis and describes the symptoms of poisoning by ergot alkaloids such as ergotamine or ergometrine .

causes

In the Middle Ages , ergotism occurred as a result of the consumption of grain and the flour made from it, which  were contaminated with ergot  - an elongated, grain -like permanent form ( sclerotium ) of the ergot fungus Claviceps purpurea . Since the danger posed by ergot is now known, various measures are being taken to counteract the contamination of cereal products. Ergotism nowadays mostly arises from taking medication containing ergot alkaloids and their derivatives. These drugs are still used in the therapy of migraines (e.g. ergotamine ), in obstetrics ( methyl and ergometrine ), for weaning (bromocriptine) and in the treatment of Parkinson's disease (e.g. bromocriptine , pergolide , cabergoline or dihydroergocryptine ) application. An uncontrolled increase in dose can lead to ergotism.

Symptoms

Detail of the Isenheim Altarpiece : A man suffering from the Antonius fire on the innermost wall painting (Temptations of Saint Anthony)

A poisoning with ergotamine leads to a massive narrowing of the blood vessels and consequently to a circulatory disorder of the heart muscle , kidneys and limbs . The limbs are cold and pale, the pulse is usually barely detectable. There are also tingling sensations in the skin ( paresthesia ), sensory disorders ( hypesthesia ) and possibly symptoms of paralysis ( paresis ). A frequent consequence is the secondary (induced) Raynaud's syndrome or the increase in the form of painful dying of fingers and toes ( gangrene and necrosis in ergotism gangrenosus , the "ergot burn", also known as Ignis sacer ("holy fire"), Antonius fire , Sankt-Antonius-Rauch and similar names). In addition, there are usually general symptoms such as vomiting , confusion, delusions , headaches , ringing in the ears and diarrhea . Acute poisoning can lead to death through respiratory or cardiac arrest, chronic poisoning can lead to loss of limbs with poor blood supply, secondary infections and subsequent sepsis .

Diagnosis

The most important diagnostic criterion is the recognition of the ergotamine intake. The medical history and in particular the medical history is therefore usually decisive. If necessary, apparatus-based examinations can also be used, for example Doppler sonography of the extremity vessels.

First mural of the
Isenheim Altarpiece created by Matthias Grünewald for the Antoniterkloster in Issenheim : Anyone who fell ill with the Antonius fire was brought before the altar before the start of medical treatment in the hope that Saint Antonius could perform a miraculous healing or give the sick person spiritual consolation.

therapy

As a first measure, the triggering medication must be discontinued immediately. If this alone is not sufficient, the blood vessels can be dilated by administering nitrates , calcium antagonists and / or prostaglandin infusions ( vasodilation ).

Synonyms

Ergotism has a number of mostly regional names, such as Antoniusfeuer , Sankt-Antonius-Rache , (St.-) Antonius-Plage , Kriebelkrankheit. , Magdalenenflechte (Spain), Muttergottesbrand ( Westphalia ), ergot brandy , St. Antonius fire , St. John's rot ( Bohemia ) or St. Martialis fire . as well as cramp addiction , distemper , dragging epidemic and dragging sickness .

Rye interspersed with ergot (dark,
grain- like structures)

history

The first documented, epidemic-like case of ergotism occurred in the year 857 at Xanten . In 943, around 40,000 people across Europe - mainly in France and Spain - are said to have fallen victim to an ergot epidemic. The disease was called Antoniusfeuer (named after St. Antonius ) or ignis sacer "holy fire", with these and similar names including other diseases or symptoms ( phlegmon , erysipelas , herpes zoster ) , especially those associated with ulcerous tissue breakdown of the extremities. were understood.

Above all, the Antoniter Order had made it its business to treat and care for those who were sick with the Antonius fire. In the 15th century, the Antonites maintained around 370 hospitals throughout Europe, in which around 4,000 patients were cared for. The disease was so feared that processions and ceremonies were held to ward it off. Even today, the "Focolare di Sant 'Antonio" (Antonius fire) is celebrated in Sardinia every year in January to ward off diseases and other evils.

Despite the connection between grain infected with fungi or rot and epidemic diseases, as well as clear indications of a connection between the use of mother-grain flour and the occurrence of ergotism in the Middle Ages, it was only after new epidemics 1716–1717 in Dresden and in Legislative measures were taken across Europe in 1770 and 1777. After the development cycle of the ergot fungus Claviceps purpurea had been elucidated and described by the mycologist LR Tulasne around 1853 , Charles Tanret extracted a substance from ergot - albeit quite contaminated - which he called "ergotinine". Just like the "ergotoxin" that was discovered in 1907, it is a mixture of different ergot alkaloids. It was not until Arthur Stoll that ergotamine was used to isolate the first pure ergot alkaloid in 1918 .

In the 19th century, ergot mass poisoning was largely a thing of the past and since only adequately purified grain has been consumed in Europe, ergot generally no longer poses a threat to human health there. However, there were still isolated cases in the 20th century from poisoning. In the years 1926 and 1927 there was mass poisoning in the Soviet Union ; officially there were over 11,000 deaths from bread containing mother-grain. The last - albeit controversial - poisoning incident, with 200 sick people and seven dead, is said to have occurred in 1951 in Pont-Saint-Esprit ( France ).

Since today more and more unground grain is consumed, which comes directly from the farmer, it can z. For example, unpurified rye from direct sales can lead to poisoning. In Germany in 1985 poisoning could be traced back to muesli containing mother grain . The investigation offices of the federal states also found occasionally harmful alkaloid contents in grain products in random samples from 2004 to 2011. The state of the art in mills in the 2010s to avoid poisoning is to separate contaminated grain using color sorters .

literature

  • Veit Harold Bauer: The Antonius fire in art and medicine (= session reports of the Heidelberg Academy of Sciences. Mathematical and natural science class. Born 1973, supplement). Springer, Heidelberg / Berlin 1973, ISBN 3-540-06593-8 .
  • Henry Chaumartin: Le mal des ardents et le feu Saint-Antoine. Étude historique, médicale, hagiographique et légendaire. Avec une préface du Prof. Laignel-Lavastine. Isère, Vienna 1946. See Guitard Eugène-Humbert, in: Revue d'histoire de la pharmacie. Volume 35, No. 117, 1947, pp. 159-160.
  • Irmtraut Sahmland: Ergotism. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , p. 367 f.

Web links

Wiktionary: Ergotism  - explanations of meanings, word origins, synonyms, translations
Commons : Ergotism  - collection of images, videos and audio files

Individual evidence

  1. Entry on ergotism in Flexikon , a wiki from DocCheck , accessed on January 8, 2013.
  2. Early New High German Dictionary . Volume 1: Introduction, a - apple core. De Gruyter, Berlin et al. 1989, ISBN 3-11-007821-X , p. 1535.
  3. Jump up ↑ sickness. In: Meyers Großes Konversations-Lexikon. Volume 11: A to Astigmatism. New imprint. Bibliographisches Institut, Leipzig et al. 1907, pp. 659–660, (at zeno.org).
  4. Hans Cousto: Bicycle Day in taz.blogs from April 19, 2016.
  5. ^ Leo Perutz : St. Petri-Schnee. Roman (= Rororo. 12283). Rowohlt, Reinbek bei Hamburg 1991, ISBN 3-499-12283-9 , p. 112.
  6. Wilhelm Fabry von Hilden : Thorough report of the hot and cold fire, which Gangraena et Sphacelus or S. Antonii- and Martialis fire is called. After the second German edition published in 1603, edited and edited by Erich Hintzsche . Huber, Bern / Stuttgart 1965 (= Huber's classics of medicine and natural sciences. Volume 4), ISSN  0441-3865 .
  7. ^ Veit Harold Bauer: The Antonius fire in art and medicine. 1973, p. 23.
  8. elxikon: Kornstaupe .
  9. Ernst Conrad Wicke: Attempt of a monograph on the great St. Vitus dance and the involuntary muscle movement, along with remarks on the tarantula dance and the beriberi. Brockhaus, 1844, p. 23, digitized in the Google book search
  10. Thomas Bateman: Practical presentation of skin diseases according to Willan's system. Rengersche Buchhandlung, Halle 1815, p. 217.
  11. ^ Wissenschaft-Online-Lexika: Entry ergot in the Lexicon of Medicinal Plants and Drugs, accessed on November 10, 2011.
  12. ^ Sven Moeschlin: Clinic and therapy of poisoning. 7th, revised and expanded edition. Thieme, Stuttgart et al. 1986, ISBN 3-13-378407-2 , pp. 634-666.
  13. a b c Entry on Ergot alkaloids. In: Römpp Online . Georg Thieme Verlag, accessed on November 9, 2011.
  14. In English, St. Anthony's Fire is a name for the erysipelago.
  15. ^ Max Höfler: German book of names of diseases. Piloty & Loehle, Munich 1899, pp. 489 , 886 and 914 .
  16. ^ Gerhard Eis : To the history of the Antonius fire. In: Medical monthly. Volume 5, 1951, pp. 792 f.
  17. Wilhelm Fabry von Hilden: Thorough report on the hot and cold fire, which is called Gangraena et Sphacelus or S. Antonii- and Martialis fire (= Huber's classics of medicine and natural sciences. 4). Reprint of the 2nd German edition published in 1603. Edited and edited by Erich Hintzsche. Huber, Bern et al. 1965, pp. 30 and 44 f.
  18. Werner Dettelbacher: From the work of the Antonites in Würzburg. In: Würzburg medical history reports. Volume 22, 2003, pp. 81-88.
  19. ^ Fire of St Anthony in Sardinia , accessed on February 22, 2015.
  20. ^ Elinor Lieber: Galen on contaminated cereals as a cause of epidemics. In: Bulletin of the History of Medicine. Vol. 44, No. 4, 1970, pp. 332-345, JSTOR 44450781 .
  21. ^ Réné-Louis Bouchet: L'affaire du "pain maudit" de Pont-Saint-Esprit. Des hypothèses jamais vérifiées. In: Phytoma. Défense des cultures. Volume 22, No. 323, 1980, pp. 33-36.
  22. Hans Jürgen Pfänder, Klaus Ulrich Seiler, Albrecht Ziegler: Morning “Muesli” meal as the cause of chronic poisoning with Secale alkaloids. In: Deutsches Ärzteblatt. Volume 82, No. 27, 1985, pp. 2013-2016.
  23. CVUA Sigmaringen, Annual Report 2009 (PDF; 2.7 MB) Chemical and Veterinary Investigation Office Sigmaringen: Food Monitoring and Environmental Protection - Annual Report 2009, published on October 25, 2010, accessed on November 6, 2011.
  24. Annual report SUAH 2004  ( page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. . Landesbetrieb Hessisches Landeslabor, Annual Report 2004, pp. 39 and 137, accessed on November 7, 2011.@1@ 2Template: Toter Link / www.lhl.hessen.de  
  25. Download page of the LHL annual reports ( memento of the original from September 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Landesbetrieb Hessisches Landeslabor, annual reports 2006–2009, each under "Grain", accessed on November 7, 2011. @1@ 2Template: Webachiv / IABot / www.lhl.hessen.de
  26. K. Münzing: Ergot alkaloids in food . Technical possibilities of minimizing ergot alkaloids in cereals. In: Journal for Consumer Protection and Food Safety . No. 1 . Birkhäuser Verlag, 2006, ISSN  1661-5751 , p. 155 , doi : 10.1007 / s00003-006-0027-0 .