Medical Toxicology of Natural Substances

Foods, Fungi, Medicinal Herbs, Plants, and Venomous Animals

Donald G. Barceloux

• Publisher: Wiley
• Year: 2012
• Print ISBN: 9780471727613
• eBook ISBN: 9781118382769
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Industrial & Technical Chemistry

Interest and information in the field of medical toxicology has grown rapidly, but there has never been a concise, authoritative reference focused on the subjects of natural substances, chemical and physical toxins, drugs of abuse, and pharmaceutical overdoses. Medical Toxicology of Natural Substances finally gives you an easily accessible resource for vital toxicological information on foods, plants, and animals in key areas in the natural environment.

PART 1
FOODBORNE and MICROBIAL TOXINS

PART 1 FOODBORNE and MICROBIAL TOXINS

I Chemical Contamination and Additives

by Cyrus Rangan, MD, FAAP

1 Food Contamination

2 Food Additives and Sensitivities

II Staples and Spices

3 Akee Fruit and Jamaican Vomiting Sickness

(Blighia sapida Köenig)

4 Cinnamon

(Cinnamomum Species)

5 Cyanogenic Foods

(Cassava, Fruit Kernels, and Cycad Seeds)

6 Cycad Seeds and Chronic Neurologic Disease

(Cycas Species)

7 Djenkol Bean

[Archidendron jiringa (Jack) I. C. Nielsen]

8 Grass Pea and Neurolathyrism

(Lathyrus sativus L.)

9 Nutmeg

(Myristica fragrans Houtt.)

10 Pepper and Capsaicin

(Capsicum and Piper Species)

11 Potatoes, Tomatoes, and Solanine Toxicity

(Solanum tuberosum L., Solanum lycopersicum L.)

12 Rhubarb and Oxalosis

(Rheum Species)

III Microbes

A Bacteria

by Cyrus Rangan, MD, FAAP

13 Bacillus cereus

14 Campylobacter jejuni

15 Clostridium botulinum

(Botulism)

16 Clostridium perfringens

17 Escherichia coli

18 Listeria monocytogenes

19 Salmonella

20 Shigella Species

(Shiga Enterotoxins)

21 Staphylococcus aureus

22 Streptococcus Species

23 Vibrio Species

24 Yersinia enterocolitica

B Other Microbes

25 Cyanobacteria

26 Protozoa and Intestinal Parasites

27 Gastrointestinal Viruses

IV Seafood

28 Amnesic Shellfish Poisoning and Domoic Acid

29 Azaspiracid Shellfish Poisoning and Azaspiracid Toxins

30 Diarrhetic Shellfish Poisoning and Okadaic Acid

31 Neurotoxic Shellfish Poisoning and Brevetoxins

32 Paralytic Shellfish Poisoning and Saxitoxins

33 Ciguatera Fish Poisoning and Ciguatoxins

34 Puffer Fish Poisoning and Tetrodotoxin

35 Red Whelk and Tetramine

36 Scombroid Fish, Scombrotoxin, and Histamine

I Chemical Contamination and Additives

Chapter 1

FOOD CONTAMINATION

CYRUS RANGAN, MD, FAAP

Records of outbreaks of human illness caused by toxic contaminants in foods appeared at least several centuries BC, when mad honey poisoning was associated with an illness among troops under the command of the Greek historian and mercenary, Xenophon.¹ One of the first recorded foodborne outbreaks of ergotism occurred in Limoges, France during the Capetian Dynasty in 994 AD.² The ingestion of rye bread contaminated with ergot alkaloids during this epidemic caused the deaths of approximately 20,000–50,000 victims. Numerous episodes of ergotism have occurred throughout history. Although ergotism is a possible explanation for the bizarre behavior that occurred before and during the Salem Witch Trials of 1692, there is no definite evidence that ergotism was a contributing factor.³ In the 1950s, mining operations in the Toyama region of Japan released cadmium into the Jinzu River. The use of this water for drinking and for irrigation of nearby rice fields resulted in a disease called itai-itai (translation: “ouch-ouch”), manifest by osteoporosis and renal dysfunction primarily in middle-aged women.⁴ In the same decade, numerous neonates born near Minamata Bay, Japan, developed birth defects and neurological abnormalities after pregnant women were exposed to seafood contaminated by methyl mercury released into the bay from a local factory. A methyl mercury-based fungicide caused an outbreak of mercury poisoning in Iraq in 1971 after grain seeds treated with the fungicide were inadvertently used for food manufacturing instead of planting.⁵ Prominent outbreaks of illnesses associated with chemical contamination of cooking oils include tri-ortho-cresyl phosphate-induced neuropathy (Morocco, 1959),⁶ yusho (“rice oil disease,” Japan, 1968), yu-cheng (“oil disease,” Taiwan, 1979), toxic oil syndrome (Spain, 1981), and epidemic dropsy (India, 1998). Some contaminants are unavoidable in food manufacturing. In the United States, the Food and Drug Administration (FDA) imposes “Current Good Manufacturing Practices” (CGMP) on food manufacturers. These mandatory codes enable the FDA to cite food products as unfit if an unavoidable contaminant poses a risk of harm by violating a standard or action level for that unavoidable contaminant (e.g., aflatoxin). Food products are considered adulterated when concentrations of avoidable contaminants (e.g., pesticides) exceed established standards, sometimes prompting food recalls after sale and distribution.

Metal contaminants such as lead, mercury, arsenic, and cadmium come from factory emissions, mining operations, and metal-containing industrial products used in food production. Methyl mercury found in commercially sold seafood is deemed an unavoidable contaminant because contamination preexists in the raw material; therefore, the contamination does not result from food processing or distribution. Fish and shellfish acquire methyl mercury primarily from microorganisms that methylate environmental inorganic mercury compounds released primarily from industrial sources.

YUSHO and YU-CHENG

HISTORY

The first known case of yusho (rice oil disease) involved a 3-year-old girl in northern Kyushu, Japan, who had an acute onset of an acneiform rash (chloracne) in June, 1968. Her family members, followed by other familial clusters, presented to a single clinic with complaints of acneiform rash, hyperpigmentation, and eye discharge over the next 2 months. By January 1969, 325 cases were reported. After a small minority of patients initially identified rice oil as the causative agent of yusho, Kyushu University convened the Study Group for Yusho to investigate yusho; about 2,000 afflicted patients were subsequently identified. The clinical features of yusho included fatigue, headache, cough, abdominal pain, peripheral numbness, hepatomegaly, irregular menstrual cycles, nail deformities, and hypersecretion of sebaceous glands. A field survey of canned rice oil associated the disease with the use of “K Rice Oil” produced or shipped by the K Company on February 5–6, 1968.⁷ The yu-cheng epidemic involved over 2,000 individuals in Taiwan in 1979, when an accidental leakage of thermal exchange fluid resulted in the contamination of rice-bran oil with polychlorinated biphenyls (PCBs), dibenzofurans (PCDFs), and quaterphenyls (PCQs).⁸ The clinical features of yu-cheng and yusho were similar.

EXPOSURE

Source

Polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs) are thermal heat exchanger compounds used in food processing machinery. Leakage of these compounds into rice oils during manufacturing led to the yusho and yu-cheng outbreaks.

Yusho

Epidemiological studies revealed that 95.7% (p < 0.01) of surveyed patients recalled consumption of rice oil from K Company in Western Japan.⁷ A case-control study revealed rice oil as the only associated etiologic factor, and a cohort study demonstrated a 64% risk of yusho in K rice oil consumers compared with no risk for nonexposed individuals.⁷ Food engineers confirmed the leakage of dielectric thermal exchange fluid (Kanechlor 400) containing PCBs into the rice oil. This contaminant contained PCB compounds, primarily tetra-chlorinated biphenyls. In 1969, the Study Group initially concluded that PCBs caused yusho.⁹ However, a lack of similar symptoms (besides chloracne) in PCB workers who had significantly higher tissue burdens (mean blood PCB level: 45 ppb) contradicted this conclusion. Furthermore, the dermatological lesions could not be reproduced in animals following the oral administration of PCB compounds or by Kanechlor 400, and the severity of the clinical features of yusho did not correlate to serum concentrations of PCB compounds. Therefore, other compounds (e.g., polychlorinated dibenzofurans) in the adulterated rice oil probably contributed to the development of yusho.^10,11

Yu-cheng

As with the yusho incident, the suspected causative agents of yu-cheng were PCDFs rather than PCBs.¹² Contamination of the cooking oil occurred when PCBs used for the indirect heating of rice-bran oil leaked into the cooking oil. Repeated heating of the partially degraded PCBs produced PCDFs, as well as polychlorinated terphenyl and polychlorinated quaterphenyl compounds.¹³

Food Processing

High temperatures (>200 °C) in dielectric thermal exchange fluid during the deodorization step of oil refining contributed to the development of yusho and yu-cheng by degrading PCBs in the contaminated rice oil to PCDFs, PCDDs (polychlorinated dibenzo dioxins), and PCQs (polychlorinated quaterphenyls).¹⁴

DOSE RESPONSE

Exposure to toxic contaminants in the rice oil from the yusho and yu-cheng epidemics was assessed by recording the lot numbers of purchased oil containers and comparison of the volume of oil purchased to the volume of oil remaining in the containers retrieved from affected households. Consumption of the contaminated rice oil by household members was estimated by proportional distribution to each family member. Positive relationships were observed between estimated individual oil consumption and incidences of yusho and yu-cheng.^15,16 The mean concentrations of PCBs, polychlorinated quaterphenyls (PCQs), and PCDFs in five samples of contaminated cooking oil from the yu-cheng outbreak were 62 ppm, 20 ppm, and 0.14 ppm, respectively.¹⁷ The congeners of these compounds were similar in the cooking oils from these two outbreaks, but ye-cheng cooking oil samples contained about 10% of the concentrations of these compounds found in cooking oil from the yusho incident along with three to four times lower PCQs/PCBs and PCDFs/PCBs ratios.

A cross-sectional study of 79 patients with ...

Table of contents

• Cover
• Title page
• Copyright page
• Dedication
• FOREWORD
• PREFACE
• ACKNOWLEDGMENTS
• REVIEW PANEL
• PART 1: FOODBORNE and MICROBIAL TOXINS
• PART 2: FUNGAL TOXINS
• PART 3: MEDICINAL HERBS and ESSENTIAL OILS
• PART 4: TOXIC PLANTS
• PART 5: VENOMOUS ANIMALS
• Index
• Color Plates