Un cas d’intoxication aiguë par la belladone (Atropa belladona) chez une enfant de 2 ans

doi:10.1016/j.arcped.2010.11.006

Archives de Pédiatrie

Volume 18, Issue 2, February 2011, Pages 186-188

https://doi.org/10.1016/j.arcped.2010.11.006 Get rights and content

Résumé

Les intoxications par les végétaux représentent 5 % des cas d’intoxications recensés par les centres antipoisons français. Nous rapportons un rare cas d’intoxication par la belladone (Atropa belladona) chez une enfant de 2 ans. Celle-ci s’était présentée aux urgences avec un syndrome atropinique central et périphérique, après une ingestion de baies sauvages quelques heures auparavant. Les fruits et les feuilles apportées par la mère permettaient au centre antipoison contacté, au vu des signes cliniques, d’incriminer la belladone. L’enfant était admise en unité de soins intensifs pendant 48 h, l’évolution a été favorable sous traitement symptomatique.

Summary

Plant intoxications account for 5% of all intoxication cases according to French anti-poison centers. We report an uncommon case of intoxication with deadly nightshade (Atropa belladonna) in a 2-year-old child. The child presented at the ER with an atropinic syndrome, both central and peripheral, after ingestion of wild berries a few hours before. The fruit and leaves brought in by the mother allowed the anti-poison center to identify belladonna, in agreement with clinical findings. The child was kept in the intensive care unit for 48 h and progression was favorable with symptomatic treatment.

Introduction

La belladone est une plante rare et dangereuse : l’ingestion de 10 baies serait toxique pour un adulte, 2 à 3 pour un enfant [1]. Le risque d’intoxication chez les enfants est important en raison des possibilités de confusion avec d’autres baies (cassis, myrtilles). Nous décrivons ici l’observation d’une enfant qui s’était présentée aux urgences avec un tableau de syndrome atropinique incomplet après ingestion de belladone en Haute-Vienne.

Section snippets

Observation

L’enfant âgée de 2 ans, sans antécédent particulier, était amenée aux urgences pédiatriques, pour des troubles du comportement, des hallucinations et une érythrose du visage.

Les premiers signes cliniques étaient apparus 5 h après une ingestion de baies sauvages constatée par la mère de l’enfant. À son arrivée, elle présentait un érythème du visage, une sécheresse buccale et labiale, une mydriase bilatérale peu réactive, des troubles de l’équilibre avec chute en position assise et des mouvements

Discussion

Les intoxications par les végétaux représentent 5 % des cas d’intoxications recensés par les centres antipoisons français. La belladone, plante herbacée vivace de la famille des solanacées, est assez peu fréquente à l’état sauvage en France. Les feuilles sont ovales, pétiolées, alternes à la partie inférieure de la tige et de taille inégale à la partie supérieure. La fleur a une corolle en forme de grosse clochette, de couleur brun violacé à jaune brun. Les fruits sont des baies noires

Conclusion

L’intoxication à la belladone doit être connue en raison de sa gravité potentielle. Les signes d’intoxication atropinique doivent faire l’évoquer ainsi que l’identification de la plante. Le traitement est essentiellement symptomatique.

Conflit d’intérêt

Aucun.

Références (7)

P. Nisse
(2003)
F. Schneider et al.
Plasma and urine concentration of atropine after the ingestion of cooked deadly nightshade berries
J Toxicol Clin Toxicol
(1996)
M.R. Lee
Solanaceae IV: Atropa belladonna, deadly nightshade
J R Coll Physicans Edinb
(2007)

There are more references available in the full text version of this article.

Cited by (14)

Common anticholinergic solanaceaous plants of temperate Europe - A review of intoxications from the literature (1966–2018)
2020, Toxicon
Citation Excerpt :
Much more commonly, Atropa belladonna is consumed as a result of being mistaken as an edible plant, or simply by children being drawn to its appealing berries. Reports from France (Laffargue et al., 2011), Germany (Thiermann et al., 2009), Slovenia (Vončica et al., 2014), Switzerland (Montoya et al., 2009), and Turkey (Demirhan et al., 2013; Fidan, 2009; Solmaz et al., 2017) illustrate this well. Indeed, this appears to be by far the most common reason for exposure, with mistaken identity being the cause of 68.49% of Atropa belladonna intoxications in Switzerland between 1995 and 2009 (Fuchs et al., 2011) and 98% of paediatric cases in Van, Turkey between 1996 and 2003 (Çaksen et al., 2003).
Datura stramonium, Atropa belladonna, Hyoscyamus niger, and Scopolia carniolica are all temperate plants from the family Solanaceae, which as a result of their anticholinergic tropane alkaloids, hyoscyamine/atropine and scopolamine, have caused many cases of poisoning around the world. Despite the danger these nightshade plants represent, the literature often presents incomplete cases lacking in details and filled with ambiguity, and reviews on the topic tend to be limited in scope. Many also point to a gap in knowledge of these plants among physicians. To address this, the following review focuses on intoxications involving these plants as reported in the literature between 1966 and 2018, with brief mention to pertinent related plants to contextualise and provide a fuller picture of the situation surrounding the presently discussed temperate plants. Analysis of the literature displays that D. stramonium is largely associated with drug use among teens while A. belladonna is primarily ingested as a result of the berries being mistaken for edible fruits. H. niger was found to be largely ingested when mistaken for other plants, and S. carniolica was the cause of incredibly few intoxications.
Atropa belladonna neurotoxicity: Implications to neurological disorders
2018, Food and Chemical Toxicology
Citation Excerpt :
The fruits are cherry-like berries, dark purple/black, juicy, and contain many seeds that are the most toxic part of the plant (Fatemeh Ashtiania, 2011; Lacković, 2017) (Fig. 1). In Europe, Africa and Asia, where the plant grows in the wild, confusion between black/dark belladonna fruit berries with other edible berries and the sweet and pleasant taste of belladonna berries poses a danger to children and adults (Laffargue et al., 2011). The berries, leaves, and roots of Atropa belladonna contain up to 20 different tropane alkaloid including atropine, scopolamine, and hyoscyamine that function as the plant's chemical defense in conditions of stress (Wink and Roberts, 1998).
Atropa belladonna, commonly known as belladonna or deadly nightshade, ranks among one of the most poisonous plants in Europe and other parts of the world. The plant contains tropane alkaloids including atropine, scopolamine, and hyoscyamine, which are used as anticholinergics in Food and Drug Administration (FDA) approved drugs and homeopathic remedies. These alkaloids can be very toxic at high dose. The FDA has recently reported that Hyland's baby teething tablets contain inconsistent amounts of Atropa belladonna that may have adverse effects on the nervous system and cause death in children, thus recalled the product in 2017. A greater understanding of the neurotoxicity of Atropa belladonna and its modification of genetic polymorphisms in the nervous system is critical in order to develop better treatment strategies, therapies, regulations, education of at-risk populations, and a more cohesive paradigm for future research. This review offers an integrated view of the homeopathy and neurotoxicity of Atropa belladonna in children, adults, and animal models as well as its implications to neurological disorders. Particular attention is dedicated to the pharmaco/toxicodynamics, pharmaco/toxicokinetics, pathophysiology, epidemiological cases, and animal studies associated with the effects of Atropa belladonna on the nervous system. Additionally, we discuss the influence of active tropane alkaloids in Atropa belladonna and other similar plants on FDA-approved therapeutic drugs for treatment of neurological disorders.
Homeopathic products: The importance of correct information
2014, Anales de Pediatria
Severe atropine poisoning mimicking acute stroke
2012, Revue Neurologique
L’atropine est un puissant antagoniste compétitif des récepteurs muscariniques, utilisé dans de nombreuses affections pour ses propriétés anticholinergiques.
Nous rapportons un cas d’intoxication à l’atropine par ingestion accidentelle d’un collyre ophtalmologique responsable d’un tableau neurologique grave, mimant une urgence neurovasculaire et dont le diagnostic a pu être redressé par la détection d’atropine dans le liquide céphalorachidien de la patiente.
L’intoxication atropinique peut prendre des masques neuropsychiatriques trompeurs également pseudo-vasculaire. Elle doit être évoquée devant une encéphalopathie inexpliquée accompagnée de signes anticholinergiques et en particulier une mydriase bilatérale.
Atropine is a strong antagonist of muscarinic receptors widely used in various diseases because of its anticholinergic action.
We report here a case of accidental poisoning due to ingestion of atropine eyes drops that caused severe neurologic disorders mimicking an acute stroke. Correct diagnosis was finally made by detecting atropine in the cerebrospinal fluid of the patient.
Atropinic poisoning can induce misleading neuropsychiatric disorders mimicking stroke. Therefore, this diagnosis should be considered in patients presenting an unexplained encephalopathy with anticholinergic manifestations, especially when bilateral mydriasis occurs.
Atropa belladonna (Deadly Nightshade)
2023, Exploring Poisonous Plants: Medicinal Values, Toxicity Responses, and Therapeutic Uses
Handbook of 200 medicinal plants: A comprehensive review of their traditional medical uses and scientific justifications
2020, Handbook of 200 Medicinal Plants: A Comprehensive Review of Their Traditional Medical Uses and Scientific Justifications

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Archives de Pédiatrie

Résumé

Summary

Introduction

Section snippets

Observation

Discussion

Conclusion

Conflit d’intérêt

Références (7)

Plasma and urine concentration of atropine after the ingestion of cooked deadly nightshade berries

J Toxicol Clin Toxicol

Solanaceae IV: Atropa belladonna, deadly nightshade

J R Coll Physicans Edinb

Cited by (14)

Common anticholinergic solanaceaous plants of temperate Europe - A review of intoxications from the literature (1966–2018)

Atropa belladonna neurotoxicity: Implications to neurological disorders

Homeopathic products: The importance of correct information

Severe atropine poisoning mimicking acute stroke

Atropa belladonna (Deadly Nightshade)

Handbook of 200 medicinal plants: A comprehensive review of their traditional medical uses and scientific justifications

Fait cliniqueUn cas d’intoxication aiguë par la belladone (Atropa belladona) chez une enfant de 2 ansDeadly nightshade (Atropa belladonna) intoxication in a 2-year-old child

Résumé

Summary

Introduction

Section snippets

Observation

Discussion

Conclusion

Conflit d’intérêt

Plasma and urine concentration of atropine after the ingestion of cooked deadly nightshade berries

J Toxicol Clin Toxicol

Solanaceae IV: Atropa belladonna, deadly nightshade

J R Coll Physicans Edinb

Fait clinique
Un cas d’intoxication aiguë par la belladone (Atropa belladona) chez une enfant de 2 ansDeadly nightshade (Atropa belladonna) intoxication in a 2-year-old child