Luc de Haro

Health impact of unicellular algae of the Ostreopsis genus blooms in the Mediterranean Sea: experience of the French Mediterranean coast surveillance network from 2006 to 2009

Objective. Ostreopsis ovata and Ostreopsis siamensis are tropical unicellular algae that have been found recently in the Mediterranean. Both of these dinoflagellates produce palytoxin (PTX)-like toxins that are powerful vasoconstrictors in mammals. Since 2003, Ostreopsis blooms in Italy and Spain have been accompanied by reports of respiratory problems and skin/mucosa irritation in persons in contact with toxic microalgal cells (epiphytes, plankton, or sea spray) or associated toxins. Methods. In France, a surveillance network has been set up to monitor water conditions and to protect swimmers from contamination due to Ostreopsis. Results. Between 2006 and 2009, a total of nine blooms were observed on the French Mediterranean coast including five that led to manifestations in divers, swimmers, and shoreline inhabitants. A total of 47 patients presented symptoms of involving benign or mild skin, mucosal, and/or respiratory irritation that regressed spontaneously without treatment within 12–72 h (4–12 h with nonsteroidal anti-inflammatory drugs). During the study period, five beaches were temporarily closed. Discussion. In the Mediterranean, Ostreopsis blooms induce skin and respiratory disorders when human beings are exposed to saltwater with a high concentration of algal cells. However, palytoxin dosages carried out on the food chain (urchins, mussels) indicate that this risk of toxins accumulation in seafood must be taken into account and that the surveillance network should be upgraded accordingly.

Emergence of imported ciguatera in Europe: report of 18 cases at the Poison Control Centre of Marseille.

Abstract Background. Ciguatera is a disease caused by the ingestion of fish containing the toxins of Gambierdiscus toxicus. This dinoflagellate is frequently found in damaged coral reef systems. Previously rare in Europe, this disease entity is now seen in tourists returning from tropical countries. Case series. Eighteen patients were examined between 1997 and 2002. Nine poisonings occurred in Atlantic Ocean islands, eight in Pacific Ocean islands, and one in the Egyptian Red Sea coast. Gastrointestinal signs were always present in the Atlantic areas, but were less severe or absent in the Pacific areas. All patients had sensory disturbances, and two of them had motor disturbances affecting the respiratory muscles and leading to the death of a 73‐year‐old man in Cuba. The 17 surviving patients returned to France and for 2 to 18 months suffered from arthralgias, myalgias, or pruritis. Conclusion. Ciguatera is a newly imported intoxication in Europe. As the number of international tourists grows each year, this type of poisoning will be seen more frequently. Furthermore, as the condition of coral reefs declines around the world and the prevalence of G. toxicus increases, physicians in non‐tropical countries should be prepared to manage such poisoned patients.

Asp Viper (Vipera aspis) envenomation: experience of the Marseille Poison Centre from 1996 to 2008.

A retrospective case review study of viper envenomations collected by the Marseille’s Poison Centre between 1996 and 2008 was performed. Results: 174 cases were studied (52 grade 1 = G1, 90 G2 and 32 G3). G1 patients received symptomatic treatments (average hospital stay 0.96 day). One hundred and six (106) of the G2/G3 patients were treated with the antivenom Viperfav* (2.1+/-0.9 days in hospital), while 15 of them received symptomatic treatments only (plus one immediate death) (8.1+/-4 days in hospital, 2 of them died). The hospital stay was significantly reduced in the antivenom treated group (p < 0.001), and none of the 106 antivenom treated patients had immediate (anaphylaxis) or delayed (serum sickness) allergic reactions. Conclusion: Viperfav* antivenom was safe and effective for treating asp viper venom-induced toxicity.

Morsures d’araignées : les aranéismes d’importance médicale

Points essentiels • Un risque limite Bien que la quasi-totalite des especes d’araignees soient venimeuses, une dizaine d’entre elles seulement sont susceptibles d’entrainer de veritables envenimations humaines. • Du point de vue systematique, on distingue les araneomorphes, ou araignees “vraies”, des mygalomorphes. Il existe des especes potentiellement toxiques pour l’homme dans les 2 groupes. • Concernant les araignees “vraies”, 2 envenimations sont remarquables par leur frequence, leur ubiquite et leur eventuelle gravite : le latrodectisme (symptomatologie essentiellement neurologique) entraine par la morsure des veuves du genre Latrodectus, et le loxoscelisme (symptomatologie cutaneo-viscerale). • Chez les mygalomorphes, les especes australiennes responsables de l’atraxisme (symptomatologie neurologique) sont, a juste titre, considerees comme les araignees les plus dangereuses. La plupart des autres mygalomorphes n’entrainent, lors de morsures, que des problemes loco-regionaux benins. • Une arme defensive supplementaire existe chez certaines especes sud-americaines; il s’agit des soies urticantes susceptibles d’entrainer de serieuses lesions oculaires.

Management of snakebites in France

Although not a major health problem in Europe, snakebite in the old continent was the focus of recent studies to evaluate their overall incidence and define management techniques. The purpose of this three-part report is to present the experience of the Marseille Poison Centre with snakebite in France. The first section deals with viper envenomation that now benefits from a validated therapeutic protocol using of purified antivenom of proven efficacy and tolerance in patients showing grade 2 and 3 symptoms. The second section describes the highly variable snakebite situation in French overseas territories that include areas where local species require specialized management, e.g. Martinique and French Guiana. The third section involves the emerging problems associated with the keeping of exotic snakes as pets with problems related to the use of antivenoms from foreign countries. The exotic-snake pets fashion was at the origin of the creation of a national antivenom bank by two French poison centers (Angers and Marseille) to ensure prompt delivery of antivenoms for exotic snake envenomation anywhere in mainland France.

Intoxications accidentelles par cannabis chez l’enfant : expérience du centre antipoison de Marseille

OBJECTIVE To assess the frequency and severity of accidental cannabis poisoning in children. METHODS A retrospective study of cases of accidental cannabis poisoning in people aged under 18 years old, reported to the Marseille poison center from 1993 through 2007. We excluded cases where cannabis was definitively ruled out, and neonatal withdrawal syndromes in newborns from cannabis users. RESULTS We collected 93 cases, including 56 boys and 37 girls, 86% of whom were younger than 3 years. The principal form was cannabis resin (hashish), reported in 80% of the cases and belonging to one of the parents or a household member. In almost all cases, the poisoning took place at the childs home. The frequency has risen in recent years, with 2/3 of the cases occurred in the second half of the study period. Five serious cases were reported, two with convulsions. CONCLUSION Considering the observed increase in cases each year, mostly benign but potentially serious, prevention and information efforts have to be improved for drug users with young children and for healthcare professionals led to manage this kind of accident.

Self-poisoning with baclofen in alcohol-dependent patients: national reports to French Poison Control Centers, 2008–2013

Abstract Background: Alcohol use disorders are frequently associated with self-intoxication in attempted suicide. In France since 2008, the off-label use of baclofen for treatment of alcohol dependence has greatly increased, leading to temporary regulation of use of the drug. At the request of the national authorities, the French Poison Control Centers carried out a retrospective survey to give an overview of baclofen exposure in this population. Methods: A retrospective study was carried out from January 2008 to December 2013, focusing on baclofen exposures in alcohol-dependent patients managed by the nine national French Poison Control Centers. Results: 294 observations of baclofen exposures in alcohol-dependent patients were identified in our database. Of these, 220 were suicide attempts by self-poisoning and 74 were unintentional. The mean age of patients was 41.7 years, with a sex-ratio of 1.6. Patients attempting suicide with baclofen were younger than those with unintentional exposures, and 43.6% of them were women (vs 22.9%, p < 0.01). The mean supposed ingested dose was higher (480.7 mg) in patients who attempted suicide (vs 192.5 mg, p < 0.0001). 21.8% of intentional exposures involved baclofen alone. Psychiatric comorbidity (50.4%) was more frequent in the group of self-poisoning (p < 0.001). 132 patients were coded as severely exposed (60.0%). Nine victims died, but the causal link between self-poisoning with baclofen and fatal outcome should be interpreted with particular caution. Conclusions: Baclofen self-poisoning by alcohol-dependent patients is a serious concern for the French health authorities. Our results are similar to those previously published, suggesting that most patients with baclofen overdose should be admitted to an intermediate or intensive care unit as the clinical course requires close monitoring. Because suicidal ideation and suicide attempts are more prevalent in people with substance use disorders than in the general population, and because of the lack of recommendations governing baclofen prescription in such a situation, its use needs to be better controlled.

Portuguese man-of-war (Physalia physalis) envenomation on the Aquitaine Coast of France: An emerging health risk

Context. The Portuguese man-o-war is a cnidaria classically found in tropical waters. It can cause serious and even life-threatening envenomation in swimmers, surfers and seafarers. Presence of the Atlantic species Physalia physalis has long been reported in European coastal waters but was always an exceptional event. Objective. To describe the experience of the Bordeaux Poison centre about Physalia stings since the first collective episode reported in 2008. Methods. Clinical retrospective description of cases series of Physalia envenomations reported to the local poison centre from 2008 to 2011 inclusive. Results. In the summer of 2008, multiple-case incident involving 40 victims were recorded on the same day on one beach in the Southern French Atlantic coast. The following year in 2009, no envenomation cases were reported in the same area, but in the next 2 years, numerous man-of-war envenomations occurred along the Aquitaine coast, that is, 154 cases in 2010 and 885 in 2011. Portuguese man-o-war stings led to severe manifestations with 15–20% of patients suffering of general symptoms that were sometimes severe enough to be considered as potentially life-threatening (8% of patients in 2011, most frequent signs: muscle pain and cramps with fasciculations, confusion and drowsiness, fainting, respiratory distress). No deaths due to Portuguese man-o-war envenomation were reported over the 4-year study period. Conclusion. The results suggest that national multidisciplinary summer surveillance program in the Aquitaine coast is required in order to provide alerts to the public, to better identify patients at risk for developing severe clinical symptoms, and hopefully to improve quality of health care.

Hallucinatory fish poisoning (ichthyoallyeinotoxism): two case reports from the Western Mediterranean and literature review.

Ichthyoallyeinotoxism is a rare kind of food poisoning contracted following the ingestion of fish. The responsible toxins are unknown, and the clinical feature is characterized by the development of CNS disturbances, especially hallucinations and nightmares. As the implicated fish species may be also related to ciguatera poisoning, there may be possible confusion between the two fish-borne intoxications. In order to clarify this, the literature pertaining to “dreamfish” was reviewed and two cases are presented. A 40-year-old man experienced mild digestive troubles and terrifying visual and auditory hallucinations after eating a specimen of Sarpa salpa in a restaurant. As he had severe behaviour troubles, he was managed in the hospital and recovered 36 h after the meal. He was unable to recall the hallucinatory period. Another man, 90-years-old and previously healthy, had auditory hallucinations 2 h after eating a specimen of Sarpa salpa. The two following nights, he had numerous nightmares and recovered spontaneously after a period of 3 days.

Efficacité variable de l'antivenin Viperfav® pour traiter les envenimations vipérines avec neurotoxicité

1 Les auteurs tiennent à noter que les antihistaminiques, corticoïdes et anticoagulants préventifs n’ont aucun intérêt lors de la prise en charge d’une telle envenimation. Au sein d’une même espèce de serpent venimeux, la qualité et la composition du venin peuvent être variables [1–3]. Ainsi, il existe dans le Sud-Est de la France une population neurotoxique de vipères aspics en cours d’extension (sous-espèce nominale Vipera aspis aspis) [2–6]. De même, la sous-espèce Vipera aspis zinnikeri vivant dans le Sud-Ouest du pays est elle aussi caractérisée par des populations neurotoxiques en Aveyron et dans l’Hérault [2,5–7]. Quelle que soit la sous-espèce de vipère impliquée, plusieurs publications font état d’une bonne efficacité de l’antivenin Viperfav actuellement utilisé en France métropolitaine sur les symptômes neurotoxiques [8,9]. Les auteurs publient ici deux observations d’envenimation vipérine avec signes de neurotoxicité soulevant plusieurs interrogations.