Alternative names: St. Anthony's fire
Fungal species involved: most often a Claviceps species (C. purpurea, C. paspali, other); also species in genera Acremonium, Epichloe, Balansia
Chemistry: indole alkaloids; includes lysergic acid (used to synthesize LSD)
Epidemiologic findings:
(1) food prepared from moldy grains such as wheat or rye
(2) animals eating grain are symptomatic (gangrene, ataxia, abortion, convulsion, reduced lactation)
Effects of the alkaloids may be:
(1) partial agonists (lower doses) or antagonists (higher doses)
(2) alpha-adrenergic, dopamine and serotonin receptors
Clinical findings depend on:
(1) the mixture of the different alkaloids
(2) the concentration of each alkaloid
(3) central vs peripheral effects
(4) acute or chronic exposure
Onset may be within 4 hours of ingestion or delayed for 12-24 hours.
Vascular changes:
(1) arterial vasospasm with ischemia in an organ or extremity, with pain, paresthesias, pallor, loss of pulse and/or gangrene
(2) vasodilatation
(3) bradycardia or tachycardia
(4) hypotension or hypertension
(5) cardiac arrhythmias (atrial fibrillation, ventricular fibrillation, asystole)
Central nervous system manifestations:
(1) headache
(2) lethargy
(3) coma
(4) seizures (convulsive)
(5) miosis or mydriasis
(6) hyperthermia
(7) hallucinations or psychosis
(8) focal neurological deficits
Abdominal signs:
(1) vomiting
(2) abdominal cramps
(3) diarrhea
(4) acute pancreatitis (associated with ischemia)
(5) hepatitis
(6) renal toxicity with oliguria or anuria, hematuria, flank pain
(7) uterine contractions
