Ergotism

Ergotism, also known as ergot poisoning, is a form of toxin poisoning caused by ergot alkaloids produced by the fungus Claviceps purpurea on cereal grains, most notably rye. Historically, outbreaks were common in Europe, and the condition earned the name Saint Anthony’s Fire for the burning sensations described by victims.

Clinical features are traditionally divided into convulsive ergotism and gangrenous ergotism. Convulsive ergotism presents with seizures, spasms, diarrhea, paresthesias, hallucinations, and mental disturbances. Gangrenous ergotism results from intense vasoconstriction leading to cold, pale, numb extremities; prolonged ischemia can cause dry gangrene and tissue loss.

Causes and mechanism: Ingested contaminated grain contains ergot alkaloids such as ergotamine and ergometrine. These compounds act on multiple neurotransmitter receptors, including serotonin, dopamine, and adrenergic receptors, producing vasoconstriction, hallucinations, and neuromuscular symptoms. Some ergot alkaloids are also uterotonic and have long been used in controlled medical settings to induce labor or control postpartum hemorrhage.

History and epidemiology: Outbreaks occurred in medieval and early modern Europe when contaminated rye flour caused widespread illness. Improvements in grain cleaning, milling, and storage greatly reduced risk, though sporadic cases and outbreaks can occur in contexts of poor storage or contaminated products.

Diagnosis and treatment: Diagnosis relies on history of exposure and clinical presentation, with confirmation possible through analysis of grain or biological samples. Management focuses on removing the source of exposure and providing supportive care. In modern medicine, ergot preparations are used in controlled circumstances, while poisoning requires cessation of exposure and symptomatic treatment.

Prevention: Good agricultural and storage practices, routine grain testing, and regulatory controls reduce the risk of ergot contamination. Ergotism is now rare in developed regions but can occur wherever contaminated grain is consumed.