Massive fatal overdose of abrin with progressive encephalopathy

Published on May 3, 2020in Clinical Toxicology3.659
· DOI :10.1080/15563650.2019.1655150
B. Zane Horowitz16
Estimated H-index: 16
(OHSU: Oregon Health & Science University),
Rachel Castelli1
Estimated H-index: 1
(OHSU: Oregon Health & Science University)
+ 3 AuthorsJerry D. Thomas19
Estimated H-index: 19
(CDC: Centers for Disease Control and Prevention)
Source
Abstract
AbstractIntroduction: The jequirity bean (Abrus precatorius) seed contains abrin, a toxalbumin, that irreversibly binds the 60-s ribosomal subunit inhibiting protein synthesis. Neurologic manifesta...
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#1Elizabeth C. Ninan (Amrita Vishwa Vidyapeetham)H-Index: 1
#2Emmanuel James (Amrita Vishwa Vidyapeetham)H-Index: 3
Abstract Abrus precatorius, commonly known as ‘Rosary pea’ or ‘Jequirity pea’ and known as ‘Shisham, Batrah-Hindi or Ain Alfreeth’ in the Middle East, grows wild in the tropical and subtropical areas of the world. The seeds of the plant contain one of the most potent toxins known to man. Poisoning with abrus seeds is a rare occurrence as the harder outer coat of the seeds generally resists digestion and such reports are scarce in the literature. We present here a case of a 22 year old lady who d...
3 CitationsSource
#1Samantha L. Isenberg (CDC: Centers for Disease Control and Prevention)H-Index: 9
#2Melissa D. Carter (CDC: Centers for Disease Control and Prevention)H-Index: 9
Last. Rudolph C. Johnson (CDC: Centers for Disease Control and Prevention)H-Index: 18
view all 9 authors...
: Ricin and abrin are toxic ribosome-inactivating proteins found in plants. Exposure to these toxins can be detected using the biomarkers ricinine and abrine, which are present in the same plant sources as the toxins. The concentration of the biomarkers in urine and blood will be dependent upon the purification of abrin or ricin, the route of exposure, and the length of time between exposure and sample collection. Here, we present the first diagnostic assay for the simultaneous quantification of...
8 CitationsSource
#1Jiliang Huang (JNU: Jinan University)H-Index: 1
#2Wenbin ZhangH-Index: 1
Last. Xiaobing GongH-Index: 1
view all 7 authors...
AbstractRationale:Abrin is a highly toxic protein obtained from the seeds of Abrus precatorius, but poisoning due to ingestion of A precatorius is extremely rare in China.Patient concerns:A 16-year-old girl, perfectly healthy before, was admitted to the department of gastroenterology owing to intent
4 CitationsSource
#1Joe V. Wooten (CDC: Centers for Disease Control and Prevention)H-Index: 6
#2Christopher T. Pittman (CDC: Centers for Disease Control and Prevention)H-Index: 3
Last. Rudolph C. Johnson (CDC: Centers for Disease Control and Prevention)H-Index: 18
view all 7 authors...
Introduction The seeds of Abrus precatorius contain the highly toxic plant protein abrin. There is no antidote for abrin poisoning. Management, largely supportive, may consist of administering intravenous fluids, anti-emetics, and activated charcoal depending on the time of exposure. We report the presentation of a single case of unintentional abrin poisoning confirmed by the quantitation of l-abrine biomarker.
14 CitationsSource
#1David H. Jang (NYU: New York University)H-Index: 16
#2Robert S. Hoffman (NYU: New York University)H-Index: 69
Last. Lewis S. Nelson (NYU: New York University)H-Index: 57
view all 3 authors...
Objective Abrus precatorius is cultivated in many subtropical areas. The seeds exist in a variety of colors such as black, orange, and most commonly, glossy red. A black band is found at the end of the seed. The plant contains multiple pods which typically contain three to five Abrus seeds. The seeds contain abrin, which inhibits ribosomal function, halting protein synthesis and leading to cellular death. A unique aspect of this case is the use of the internet to order a potentially lethal poiso...
25 CitationsSource
#1Rudolph C. Johnson (CDC: Centers for Disease Control and Prevention)H-Index: 18
#2Yingtao Zhou (CDC: Centers for Disease Control and Prevention)H-Index: 6
Last. John R. Barr (CDC: Centers for Disease Control and Prevention)H-Index: 55
view all 7 authors...
Abrin is a toxic protein found in the jequirity seed. L-Abrine (Nmethyl-tryptophan) is also found in the jequirity seed and can be used as a biomarker for abrin exposure. Analysis of L-abrine was added to an existing method for quantifying ricinine as a marker for ricin exposure in human urine and analytically validated. Accuracy and reproducibility were enhanced by including a newly synthesized 13 C 1 2H3-L-abrine internal standard. One-milliliter urine samples were processed using solid-phase ...
26 CitationsSource
#1Dharanipragada Subrahmanyan (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 1
#2Jomal Mathew (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 4
Last. Mithun Raj (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 5
view all 3 authors...
Abrus precatorius seeds are highly toxic and are often ingested as a means of suicide in India. Hemorrhagic gastroenteritis with erosions, hemolysis, acute renal damage, hepatotoxicity with elevated liver enzymes, and seizures are common manifestations of toxicity. We report two cases of Abrus precatorius poisoning with raised intracranial pressure (ICP) and papilledema that have not been described earlier in literature. One patient recovered completely with conservative management to lower rais...
27 CitationsSource
#1Ratnakar Sahoo (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 4
#2Abdoul Hamide (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 15
Last. B. Srikant Narayana (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 1
view all 4 authors...
Introduction. Poisoning from Abrus precatorius is attributed to a toxalbumin (abrin) that acts by inhibiting protein synthesis and rarely can cause immuno-mediated demyelination. We report a case of abrin poisoning with demyelination. Case report. A 19-year-old man presented with a history of ingesting crushed Abrus precatorius seeds following a family quarrel. He developed vomiting, abdominal pain, and bloody diarrhea, followed by a seizure and an altered sensorium. Magnetic resonance imaging (...
22 CitationsSource
#1Lisa Reedman (Memorial Hospital of South Bend)H-Index: 1
#2Richard D. ShihH-Index: 15
Last. Oliver L. HungH-Index: 9
view all 3 authors...
Abrus precatorius seeds contain one of the most potent toxins known to man. However, because of the seed’s outer hard coat the vast majority of ingestions cause only mild symptoms and typically results in complete recovery. If the seeds are crushed and then ingested, more serious toxicity, including death, can occur. We present a case of a man who survived an intentional ingestion of crushed Abrus seeds after he was treated with aggressive gastric decontamination and supportive care. [WestJEM. 2...
25 Citations
#1Vaibhav Sahni (Drexel University)H-Index: 7
#2Agarwal Sk (MAMC: Maulana Azad Medical College)H-Index: 11
Last. Sunandan Sikdar (MAMC: Maulana Azad Medical College)H-Index: 6
view all 4 authors...
Introduction. Castor and jequirity beans are uncommon causes of poisoning. The more common but less severe castor poisoning is well described, but jequirity bean (Abrus Precatorius) poisoning is rare. The toxicity is attributed to toxalbumins (ricin and abrin) that act by inhibiting protein synthesis. Their use as agents of biological warfare, mechanisms of action, and clinical features of poisoning are summarized. Case Report. A 30-year-old previously healthy female presented with bloody diarrh...
23 CitationsSource
Cited By2
Newest
Summary null null L-abrine and ricinine are two small molecules found respectively in the seeds of Abrus precatorius and Ricinus communis. L-abrine and ricinine are extracted simultaneously with the toxins ricin and abrin from the seeds and are therefore exposure markers for these toxins. We developed and validated a fast and simple method for the simultaneous quantitation of ricinine and L-abrine in plasma and urine by ultra-high performance liquid chromatography coupled with a tandem mass spec...
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#1Sylvia WorbsH-Index: 12
Last. Brigitte G. DornerH-Index: 24
view all 10 authors...
Abrin, the toxic lectin from the rosary pea plant Abrus precatorius, has gained considerable interest in the recent past due to its potential malevolent use. However, reliable and easy-to-use assays for the detection and discrimination of abrin from related plant proteins such as Abrus precatorius agglutinin or the homologous toxin ricin from Ricinus communis are sparse. To address this gap, a panel of highly specific monoclonal antibodies was generated against abrin and the related Abrus precat...
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