General characteristics

Pyrrolizidine alkaloid intoxication is a rare toxicosis caused by consumption of plant material containing these alkaloids. The plants may be consumed as food, for medicinal purposes, or as contaminants of other agricultural crops. Cereal crops and forage crops are sometimes contaminated with pyrrolizidine-producing weeds, and the alkaloids find their way into flour and other foods, including milk from cows feeding on these plants. Many plants from theBoraginaceae,Compositae, andLeguminosaefamilies contain well over 100 hepatotoxic pyrrolizidine alkaloids.

Disease symptoms

Most cases of pyrrolizidine alkaloid toxicity result in moderate to severe liver damage. Gastrointestinal symptoms are usually the first sign of intoxication, and consist predominantly of abdominal pain with vomiting and the development of ascites. Death may ensue from 2 weeks to more than 2 years after poisoning, but patients may recover almost completely if the alkaloid intake is discontinued and the liver damage has not been too severe.

Diagnosis

Evidence of toxicity may not become apparent until sometime after the alkaloid is ingested. Early clinical signs include nausea and acute upper gastric pain, acute abdominal distension with prominent dilated veins on the abdominal wall, fever, and biochemical evidence of liver disfunction. Fever and jaundice may be present. In some cases the lungs are affected; pulmonary edema and pleural effusions have been observed. Lung damage may be prominent and has been fatal. Chronic illness from ingestion of small amounts of the alkaloids over a long period proceeds through fibrosis of the liver to cirrhosis, which is indistinguishable from cirrhosis of other aetiology.

Associated foods

The plants most frequently implicated in pyrrolizidine poisoning are members of theBorginaceae,Compositae, andLeguminosaefamilies. Consumption of the alkaloid-containing plants as food, contaminants of food, or as medicinals has occurred.

Most result from the use of medicinal preparations as home remedies. However, intoxications of range animals sometimes occur in areas under drought stress, where plants containing alkaloids are common. Milk from dairy animals can become contaminated with the alkaloids, and alkaloids have been found in the honey collected by bees foraging on toxic plants. Mass human poisonings have occurred in other countries when cereal crops used to prepare food were contaminated with seeds containing pyrrolizidine alkaloid.

Prevention

Avoiding the plants containing the substances is the only way of prevention. However, these plants are not normally consumed in a European diet.

Risk populations

All humans are believed to be susceptible to the hepatotoxic pyrrolizidine alkaloids. Home remedies and consumption of herbal teas in large quantities can be a risk factor and are the most likely causes of alkaloid poisonings.