Gangrenous ergotism in cattle grazing fescue (Festuca elatior L.) in South Africa.

The 1st outbreak of fescue toxicosis in South Africa was recently confirmed in a Brahman herd at Perdekop, near Standerton, in Mpumalanga province, South Africa. Within 3 weeks of being placed on a fescue pasture in mid-winter, 50 of 385 cattle developed lameness and/or necrosis of the tail. The farmer had established Festuca elatior L. (tall fescue, Iewag variety) on c. 140 ha for winter grazing. Fescue may be infected by an endophyte, Neotyphodium coenophialum, which produces ergot alkaloids, in particular ergovaline. Ergovaline concentrations in basal leaf sheaths and grass stems collected during the outbreak ranged from 1720-8170 ppb on a dry-matter basis.

Correlation of endophyte toxins (ergovaline and lolitrem B) with clinical disease: fescue foot and perennial ryegrass staggers.

Fescue foot, summer syndrome, reproductive problems, and ryegrass staggers are all diseases of livestock related to endophyte toxins in pasture grasses. Range finding experiments and case studies of fescue foot relative to ergovaline toxin found in endophyte infected tall fescue and lolitrem B present in endophyte infected perennial ryegrass were conducted. Within 42 d of initiating a feeding trial with chopped tall fescue straw containing 825 ppb ergovaline and at environmental temperatures of 15.9 C clinical signs of fescue foot were seen in cattle. Sheep on tall fescue pastures in November consuming feed with 540 ppb ergovaline and at environmental temperatures of 7.8 C developed fescue foot in 21 d while sheep on the adjacent field in the previous 2 mo with environmental temperatures of 16.6 C and 12.8 C and 458 ppb ergovaline in the pasture grasses did not. In a field outbreak of fescue foot affecting 42/425 feeder lambs in November, the ergovaline of sample pasture grasses had a mean concentration of 813 ppb. Perennial ryegrass staggers was seen in 42/237 feeder lambs when mean lolitrem B in the sampled grass was 2,135 ppb. Overgrazing both tall fescue and ryegrass fields increased probability of clinical disease since the highest levels of toxin were found in the crowns and basal leaf sheaths of tall fescue and perennial ryegrass respectively. Based on these findings, ergovaline dietary levels of 400 to 750 ppb to cattle and 500 to 800 ppb to sheep and lolitrem B levels of 1,800 to 2,000 ppb in feed for both species are approximated threshold values for disease. Cold environmental temperatures are equally important to toxin concentrations in precipitating fescue foot disease.

Severe iatrogenic ergotism: incidence and clinical importance.

Ergot's derivatives are widely used to treat and prevent migraine and, associated with heparin, for the prevention of deep vein thrombosis. During a five-year period, 7 patients have been admitted in our hospital for severe vasospasm of one or several extremities due to ergot's derivatives. All patients presented with acute severe ischemia of the lower limb requiring iv infusion of vasodilator drugs. Ergotamine tartrate was the responsible drug in four patients and dihydroergotamine(DHE)-heparin in three patients. Intravenous administration of sodium nitroprusside (n = 6) relieved vasospasm in all but one of the patients within hours to days and no amputation was required. Ankle or great toe to arm systolic pressure index was normalized in the majority of the patients after treatment. A sympathectomy was performed in two patients which did not improve the clinical course. Distal necrosis developed in two patients (DHE-heparin). It is concluded that incidence of severe ergotism is less than 0.5/100,000/year in Geneva. This contrasts with the high prevalence (15%) of subclinical ergotism reported by others. No amputation was required in this series in spite of severe and prolonged vasospasms. Subclinical ergotism most probably precedes for weeks the onset of severe vasospasm, which calls for close monitoring of patients taking ergot's derivatives.

Ischemic pancreatitis and hepatitis secondary to ergotamine poisoning.

Acute ergotamine intoxication in a 29-year-old man was complicated by peripheral ischemia, pancreatitis, and hepatitis. The patient was treated with sodium nitroprusside infusion. Complications and treatment of ergotamine poisoning are discussed.

Bilateral focal cortical atrophy and chronic ergotamine abuse.

A 67-year-old patient took 5 mg of ergotamine daily for 18 months. His headaches and dysphoria were greatly improved by stopping this drug. Brain imaging by CT and magnetic resonance techniques showed numerous atrophic lesions that may represent infarcts due to occlusion of superficial cortical vessels.

Intrauterine death from ergotamine overdosage.

Fetal death in a primigravid patient who had taken an overdose of ergotamine tartrate is presented. Non-stress cardiotocography performed shortly after admission was technically unsatisfactory for interpretation but revealed the presence of very frequent uterine contractions. The cause of fetal death in this patient is discussed. Overdosage of ergotamine must be considered a serious threat to the well-being of the fetus in utero.

Prostaglandin E1 for alleviating symptoms of ergot intoxication: a case report.

A woman was admitted after ergotamine tartrate overuse for migraine headaches and her symptoms of arterial vasospasm were treated with PGE1, the first reported use of the vasodilator for ergot intoxication. The advantages of producing local vasodilatation without systemic effect, as well as inhibiting the formation of arterial microthrombi, suggest PGE1 as the agent of choice for relief of symptoms due to peripheral vasoconstriction caused by ergot. Treatment with PGE1 may allow sufficient collateral to preserve limb function and integrity, while awaiting remission of anatomic changes after withdrawal of ergot.

Ergotaminism after a single dose of ergotamine tartrate.

A 32-year-old female developed classical signs and symptoms of ergotaminism after taking a single rectal suppository of ergotamine tartrate. Her symptoms gradually resolved with minimal therapy over the next week. Ergotaminism is the most frequent form of ergotism and should be considered in all patients with vascular insufficiency who are taking ergotamine-containing drugs.

Ergot intoxication: historical review and description of unusual clinical manifestations.

Clinical ergotism as seen today results almost exclusively from the excessive intake of ergotamine tartrate in the treatment of migraine headache. Although both gangrenous and convulsive symptoms are seen in naturally occurring ergotism resulting from the ingestion of fungus infected rye, only gangrenous ergotism has been reported following the excessive ingestion of ergotamine tartrate. The symptoms of both iatrogenic and naturally occurring ergotism appear to result from regional ischemia caused by ergot induced vasospasm. This report discribes experiences in the diagnosis and management of two patients with unusual manifestations of iatrogenic ergotism. One patient presented with ischemia of all extremities and bilateral foot drop probably due to ischemic damage to the common peroneal nerves, a finding not previously described in ergot intoxication. The foot drop totally resolved in several months following the discontinuation of ergot. A second patient presented with unilateral leg ischemia and transient monocular blindness, both of which resolved after discontinuation of ergot. Both patients displayed typical angiographic findings of ergotism. There is no convincing evidence that any treatment other than discontinuation of ergotamine is of benefit in the treatment of iatrogenic ergotism.