Last week’s Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention includes a report on anticholingeric poisoning from the consumption of jimsonweed in July of 2008.
Jimsonweed is a plant that was historically used by American Indians for medicinal and religious purposes. It grows wild and is used as an ornamental plant in the United States. It is also known as thorn apple, angel’s trumpet, and Jamestown weed.
The plant contains alkaloids, which cause toxicity in humans. The concentration of toxins varies over time and in different parts of the plant, with the seeds having the highest concentration. Jimsonweed’s toxins can be fatal in small doses.
On July 8, 2008, six adult family members shared a meal of homemade stew and bread. The stew contained potatoes, garlic, onion, tomato, curry powder, and leaves from two plants growing in the yard–mint and another plant that grew wild. The person who prepared the stew did not know the identify of the other plant from the yard.
Approximately one hour after the family members consumed the stew, another relative arrived at the home where it had been prepared and eaten and found the six who had eaten the stew laughing, confused, and complaining of hallucinations, dizziness, and thirst. This family member called emergency medical services.
In the early morning hours of July 9, all six adult members were transported to a Maryland hospital by ambulance. All were suffering from hallucinations, confusion, dilated pupils, and irregular heartbeat, and had been suffering from these symptoms for several hours.
By the time they reached the emergency department, two of the six family members were unconscious. The other four were awake but were unable to provide a meal history or provide physicians with a list of food exposures that could be responsible for their illness.
All six patients’ symptoms continued for the next several hours and they were admitted to the hospital, five to the intensive care unit.
The relative who had called emergency services reported that pesticides had been sprayed on mint leaves, and believed that the pesticides could be the source of illness. The treating physician consulted with a poison control center and learned that the symptoms exhibited by patients were inconsistent with the ingestion of pesticides, but were consistent with anticholingeric poisoning from the consumption of jimsonweed.
Jimsonweed poisoning causes dry mucous membranes and skin, thirst,
flushing, fever, blurred vision, altered mental status, mydriasis
(excessive dialation of the pupile), urinary retention, tachycardia
(rapid heart rate), coma, and, in rare cases, death.
is difficult because of the wide range of symptoms associated with the
poisoning. Clinical laboratory tests are not routinely available to
detect anticholingeric toxicity.
Although all family members were still unable to communicate reliable information for a foodborne illness investigation, on July 9 the Montgomery County Dept of Health and Human Services (MCDHHS) and Maryland Dept of Health and Mental Hygiene (MDHMH) interviewed unaffected family members and were able to collect samples of plants they believed had been used in the stew.
The following day, investigators and a horticulture expert visited the home. They found leftover stew that contained cooked leaves visible in the bottom of the pot, as well as plant material in the kitchen trash. The plant material was identified by the horticulture expert as jimsonweed. The expert also found jimsonweed plants with recent cutting marks in the stew preparer’s yard.
Meanwhile, the family members slowly recovered.
Four were discharged on the third hospital day, one on the fourth hospital day, and one on the fifth hospital day, each with a final diagnosis of altered mental status secondary to food poisoning. The patient reported to have eaten the most stew was the slowest to recover and was hospitalized for the longest period of time. All patients fully recovered.
The authors of the report conclude with the recommendation that, “Health-care providers and public health officials should be aware of the signs of anticholinergic toxicity and should consider jimsonweed poisoning as a cause of any food-related outbreak of anticholinergic toxicity; consultation with horticulturalists, poison control centers, and specialized laboratories can facilitate the timely diagnosis of affected patients.”