Sixty-seven scorpion species have been described in France and its territories, where they have b... more Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey’s incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one ...
Abstract Context Contact with the setae of larvae (caterpillars) of pine or oak processionary mot... more Abstract Context Contact with the setae of larvae (caterpillars) of pine or oak processionary moths could induce urticarial or allergic reactions in humans. These species are present in France and presently expanding towards highly populated areas due to climate change and/or human-mediated translocations. We aimed to describe the symptomatic cases of exposure to processionary larvae in France. Methods We conducted a retrospective study of symptomatic cases of exposure to processionary larvae registered by the French poison control centres between 1 January 2012 and 31 July 2019. We reviewed all medical records coded with the agent “larvae”. Results Of the 1274 included cases, 59% and 27% corresponded to pine and oak processionary larvae, respectively; the 14% remaining cases concerned unspecified processionary larvae. While the annual number of cases due to pine processionary larvae fluctuated during the study period, cases associated with oak processionary larvae increased steadily. Most of the annual cases occurred between January and May for pine processionary larvae, and April and August for oak processionary larvae (with a peak in March or June, respectively). Among the 1022 cases for which information was available, the sex ratio was 1.2 and the median age was 11 years old. Skin symptoms were reported by 96,3% of the cases, such as pruritus or urticaria. The severity was mild in 96.3% of cases, moderate in 3.5%, and severe in 0.2% (two cases). Ocular or oral exposures led more frequently to severe symptoms than dermal ones (respectively 31% and 18% vs. 2% of cases, p < 10−3). Conclusion Since processionary moth larvae exposure is a growing health concern, which can cause severe injuries particularly after ocular or oral exposures, the population, and the professionals should be informed of existing recommendations to avoid exposure and measures to be taken after being exposed.
Introduction: Ciguatera fish poisoning (CFP) is a common Poisoning in the tropical countries. Fra... more Introduction: Ciguatera fish poisoning (CFP) is a common Poisoning in the tropical countries. France is directly concerned with French tourists in endemic area and with French citizens living in the French overseas territories. Method: Retrospective, descriptive study of CFP cases handled by the French Poison Control Centre Network from 2012 through 2019. Results: Fifty-two events were studied concerning 130 patients. The fish species was identified for 41 events, mainly belonging to five fish families: 14 groupers, 11 snappers, 5 jacks, 4 parrotfishes, 4 barracudas. The origin of the fish was the Atlantic Ocean (23 events), the Indian Ocean (17 events) and the Pacific Ocean (12 events). 91% of the poisonings occurring in the Atlantic Ocean began with gastrointestinal effects while in 44% of events occurring in the Pacific Ocean, the patients had no gastrointestinal effects (onset with neurological symptoms: paraesthesia and dysesthesia). The evolution of the 130 patients has been classic for CFP with persistent symptoms during 1 to 45 weeks. Numerous patients reported exacerbation of neurological signs several months after poisoning following consumption of alcoholic beverages (23 patients) or seafood (19 patients). Discussion: Medical practitioners in Europe must be trained to manage CFP as cases are reported with tourists returning from endemic areas but also with poisoned patients far from tropical areas after consumption of imported fish.
Abstract Introduction The aim was to assess the impact of the COVID-19 pandemic on French Poison ... more Abstract Introduction The aim was to assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics. Methods Reported cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, and 2020 were extracted from the French National Database of Poisonings. The collected data included call, patient, and exposure characteristics for both general calls and for calls involving sentinel xenobiotic categories related to the COVID-19 pandemic. The 2020 exposures were compared to 2018–2019 exposures by using simple logistic models in order to provide effect size with odds ratios. Results From March to April 2020, 32,182 exposures were reported to French PCCs with an overall increase of 5.6% compared to exposures in the same time frame in 2018–2019. A similar increase in calls was observed in non-epidemic and epidemic COVID-19 areas with an increase in calls from the public (+13.6%) while calls from health-professionals decreased (−7.5%). Despite the increase in exposures, the incidence of symptomatic exposures remained stable (−0.4%) with a decrease in severity (moderate/severe −17.2%). A significant increase in exposures to home cleaning products containing biocides, essential oils, and alcohol-based hand sanitizers (odds ratio >1.3, p < .0001) was observed. Discussion and conclusion The COVID-19 pandemic altered calls to French PCCs with a small increase in calls during the study period and changes in the pattern of exposure. These changes possibly reflected the indirect consequences of the COVID-19 pandemic i.e., limited access to primary care, fear of contracting COVID-19 and anxiety related to home isolation.
Overdoses of drugs with QRS-prolonging activity have a mortality rate that can exceed 10% [1]. QR... more Overdoses of drugs with QRS-prolonging activity have a mortality rate that can exceed 10% [1]. QRS prolongation and ventricular arrhythmias have been reported in large venlafaxine or quetiapine overdoses [2]. Flumazenil is a benzodiazepine reversant used as a diagnostic tool in comatose patients but also known to induce adverse effects like seizures [3]. We report a case of poly-intoxication with cardiotropic drugs complicated by severe and delayed cardiotoxicity. A 38-year-old woman was suspected of ingesting 12 g of venlafaxine XR, 48 g of quetiapine XR, 105mg of zopiclone, and an undefined quantity of bromazepam. Her medical history included anxiety depressive syndrome and a sleeve gastrectomy 4 years prior. Two hours after exposure, the Glasgow coma scale (GCS) was 12 with reactive intermediate pupils, blood pressure (BP) 109/56mmHg, and normal blood glucose. Initial electrocardiogram (ECG) showed sinus tachycardia at 120 bpm, a narrow QRS (80ms), and a corrected QT interval (QTc) of 450ms (Fridericia’s formula). Twelve hours after ingestion she developed increased central nervous system depression (GCS 3), mydriasis, and BP 80/60mmHg. The ECG showed a sinus rhythm, with a prolonged QTc of 480ms and QRS widening (182ms) (Figure 1). Because of significant neurological depression supposed to be induced by benzodiazepines, flumazenil (0.3mg) was administered, which was immediately followed by a tonic-clonic seizure. Immediately, intubation was performed due to neurological failure and noradrenaline was started due to mean BP at 50mmHg. Administration of 250mL of sodium bicarbonate (8.4%) was followed by a decrease in the QRS to 112ms and then a decrease in the dose of noradrenaline with hemodynamic improvement. Twenty hours after ingestion, EEG showed seizure activity, therefore levetiracetam was started. Transthoracic echocardiography showed a 70% left ventricular ejection fraction under noradrenaline administration. At 29 h after ingestion, there was further hemodynamic deterioration, with worsening of the ECG findings (Figure 2), which was interpreted as sinus rhythm with a prolonged QRS (160ms) and QTc (455ms). An additional 500mL of sodium bicarbonate (8.4%) with 120 g of intralipid solution was administrated followed by a decrease in the QRS to 88ms and the QTc to 375ms and improved hemodynamic stability, allowing the weaning of noradrenaline. Toxicity resolved 4 days after admission without neurological sequelae. Blood was analyzed 2 days after exposure using LC-HRMS with QTOF detection (Waters, Milford, MA, USA). The
Abstract Background and aims MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist (SCRA) t... more Abstract Background and aims MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist (SCRA) that has recently emerged. Data regarding clinical presentations in the event of intoxication is scarce. This study presents MDMB-4en-PINACA identification in cannabis consumers with clinical and analytical descriptions. Methods Between November 2020 and March 2021, all patients with unexpected or unusually severe effects and Poisoning Severity Score (PSS) greater than or equal to 2 after cannabis consumption were included. Blood and/or urine samples were collected for toxicological analysis. When available, drug material samples were also collected for analysis. Results Between November 2020 and March 2021, 13 patients were included. All cases typically presented with altered mental status (n = 13), and nearly all had returned to a normal or quasi-normal state after around 11 h of observation. Neurological symptoms included headaches (n = 3), hallucinations (3), mydriasis (3), amnesia (2) and seizures (5). Psychiatric symptoms were paranoia (6) and anxiety (2). Digestive symptoms were nausea (2) and vomiting (6). No deaths were recorded. All patients were positive for the SCRA MDMB-4en-PINACA in urine, blood and/or drug material sample. Results from toxicology testing paired with case history showed the potential for MDMB-4en-PINACA to cause or contribute to different clinical disorders. Conclusions This study highlights the risk of intoxication by SCRAs when taking low-THC cannabis products. Forensic scientists, public health and public safety officials, law enforcement personnel and clinicians should be aware of the impact that these emergent SCRAs may have in their work, especially MDMB-4en-PINACA.
Abstract Introduction In France, 57 species of scorpions are described with a limited number of c... more Abstract Introduction In France, 57 species of scorpions are described with a limited number of clinical studies. In this article, we report the epidemiology of scorpion sting events in mainland France and its overseas territories based on cases reported to the French poison-control centres (FPCC). Material and method This retrospective multicentre study was conducted with data from FPCC’s files about scorpion stings between January 1, 2011 and December 31, 2020. Result Among 975 recorded files, 624 patients were included because they were stung by scorpions native to French territories. Most stings occurred along the Mediterranean coast in summer and indoors (in persons’ homes) during the daytime. The scorpions were identified in 50% of cases. According to signs of envenoming, patients were divided into class III (2 cases; 1%), class II (51 cases; 8%), class I (444 cases; 71%) and asymptomatic stings (127 cases; 20%). Twelve pregnant women were stung and two of them had contractions, which triggered childbirth in one woman. Ten patients had local infections in the first week after the sting. One patient had venous thrombosis 2 days after the sting. Life-threatening scorpions, i.e., Tityus obscurus, Tityus sylvestris and Centruroides pococki, in French territories are limited to French Guiana and Lesser Antilles. Class II envenoming cases are recorded for Buthus occitanus, Euscorpius spp. in mainland France, and Isometrus maculatus in French Guiana, the Lesser Antilles (Guadeloupe and Martinique) and territories in the Indian Ocean (Mayotte and Réunion Island) and Pacific Ocean (French Polynesia). Only cases of local manifestation was reported for Belisarius xambeui in mainland France. Conclusion Scorpion stings in French territories are frequently on the Mediterranean coast and French Guiana. Life-threatening cases are limited to T. obscurus, T. sylvestris and Centruroides pococki stings in French Guiana and Lesser Antilles.
Journal of Venomous Animals and Toxins including Tropical Diseases, 2020
Background: The Amazon basin is one of the seven major geographical areas where scorpionism is re... more Background: The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was "one sting" (95.3%) by a "big" (47.6%), "black" (60%) and "small pincer" (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number of stings and percentage of general signs of envenomation were closely connected to a composite variable including the variation of the level of rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with general signs of envenomation. The presence of pulmonary; ear, nose, and throat (ENT); or gastrointestinal symptoms are related to major envenomation (p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia increased according to the envenomation grade whereas serum potassium and alkaline reserve decreased. Forty-six patients needed hospitalization and seven of them required intensive care. No patient died nor presented sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child activities and climatic conditions. Severe envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.
Objectifs En France metropolitaine, six especes de scorpions sont decrites : Buthus occitanus (Am... more Objectifs En France metropolitaine, six especes de scorpions sont decrites : Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) et quatre especes d’Euscorpius (Torell, 1778) : E. concinnus (Koch, 1837), E. italicus (Herbst, 1800), E. tergestinus (Koch, 1837) et Tetratrichobothrius flavicaudis (De Geer, 1778). Les cas d’envenimation en France metropolitaine sont peu severes. Notre objectif est de rechercher si des elements visuels, cliniques et geographiques permettent une identification d’un scorpion responsable d’envenimation. Methode Etude retrospective multicentrique a partir des appels aux centres antipoison francais (CAP) se rapportant aux piqures de scorpions autochtones survenues en France metropolitaine du 1er janvier 2011 au 31 decembre 2020. Nous etudions les photos et descriptions des scorpions presents dans les dossiers des CAP, et la repartition geographique des especes en cause. Ces donnees sont comparees aux descriptions des scorpions et a la repartition geographique des especes connues du Museum national d’histoire naturelle (MNHN). Les descriptions cliniques issues des dossiers des CAP sont etudiees a part dans l’hypothese d’une description clinique specifique selon les especes. Resultats Cinq cent soixante-quatorze cas sont en rapport avec une piqure de scorpion. Dans seulement 309 cas (53 %), le scorpion est identifie ou decrit. Cela permet d’identifier avec certitude 86 B. occitanus (27,9 %), 222 Euscorpius (71,8 %) et 1 B. xambeui (0,3 %). Premierement, les differentes descriptions des scorpions par le MNHN mettent en evidence des differences visuelles suffisantes pour permettre une identification aisee du genre entre Buthus (scorpion jaune), Belisarius (scorpion brun-orange) et Euscorpius (scorpion noir a pattes jaune). Cependant, l’espece d’Euscorpius n’est pas identifiable sans l’analyse du nombre de poils soyeux (trichobothries) ventraux sur la pince par un specialiste. Deuxiemement, la comparaison des donnees de repartition entre les donnees des CAP et celles du MNHN retrouve des similitudes dans les zones ou il existe un nombre significatif de piqures et des discordances dans les departements ou ces evenements sont plus rares. C’est ainsi que la repartition du B. xambeui est identique. Ce scorpion troglodyte responsable de peu d’envenimation se retrouve exclusivement dans les hauteurs des Pyrenees-Atlantiques. La repartition du B. occitanus est similaire entre notre etude et les donnees du MNHN. Il se retrouve surtout autour du bassin mediterraneen et dans quelques zones portuaires du nord de la France. Par contre, la repartition des Euscorpius est tres differente. Le MNHN le limitant au pourtour mediterraneen quand les CAP decrivent des cas de piqures egalement sur les voies fluviales (canal du Midi, Rhone, Seine) et dans les ports de commerce de la cote Atlantique. L’aire de repartition geographique etant similaire pour toutes les especes, celle-ci ne permet pas l’identification d’une espece de scorpion. Le terme de “scorpion ardechois” et de “scorpion languedocien” est donc a proscrire. Troisiemement, les presentations cliniques d’une envenimation entre B. occitanus et les Euscorpius sont similaires et peu specifiques ; elles ne permettent donc pas non plus de determiner a priori le scorpion responsable de l’envenimation. Et seul un cas d’envenimation par B. xambeui est decrit, ce qui ne nous permet pas de conclure. Conclusion En France metropolitaine, seule une description visuelle du scorpion en cause permet une identification fiable du genre sans permettre, neanmoins, de determiner l’espece pour les envenimations par un Euscorpius. Il serait donc tres utile lors d’un appel au CAP de se faire decrire le scorpion, ou de disposer d’une photo quand c’est possible. Ce recueil de donnees peut servir autant aux toxicologues qu’aux entomologistes pour permettre d’avoir des donnees de repartition fiables des especes presentes sur le territoire Francais. Les donnees des CAP permettant d’avoir des informations sur des localisations rares ou inattendues de ces especes lorsque l’identification est possible.
Objectifs L’utilisation des SMS (short messaging system) pourrait faciliter le suivi des patients... more Objectifs L’utilisation des SMS (short messaging system) pourrait faciliter le suivi des patients pris en charge par les centres antipoison. Neanmoins il faut mettre en perspective l’utilisation de cet outil par rapport au rappel telephonique de suivi encore majoritairement utilise. Nous nous sommes interesses a comparer le suivi des patients par rappel telephonique (TEL) et l’envoi de SMS entre le mois de fevrier et mars 2019 [1] . Methode Les patients inclus etaient ceux qui 1. Etaient asymptomatiques ou qui presentaient des symptomes mineurs au moment de l’appel 2. Qui avaient un numero de telephone portable 3. Ne necessitaient pas de consultation medicale a l’appel 4. Qui avaient donne leur accord (enregistrement de l’appel comme preuve). Le lendemain de l’appel initial, les patients recevaient soit un appel telephonique soit un SMS avec un texte predefini leur demandant de leurs nouvelles. La reponse au SMS etait lue par un infirmier forme, et le dossier complete. En fonction de la reponse (nouveaux symptomes, ou aggravation des symptomes), le patient etait rappele. En cas de non-reponse, le patient recevait un second SMS ou un second appel telephonique le lendemain. L’analyse des resultats a ete realisee sur le logiciel R. La comparaison de variables entre les groupes a ete realisee avec un test de Wilcoxon pour les donnees quantitatives et un test de Chi2 pour les donnees qualitatives. Les tests de correlation ont ete faits selon la methode de Spearman pour les variables non parametriques. Enfin, ont ete realises des regressions logistiques. Une etude multivariee a montre que le sexe, l’âge et le type de suivi n’influencent pas ce resultat. Resultats Sur les 1180 appels traites par le CAP de Bordeaux durant la periode de l’etude, 835 patients ont ete inclus. 441 ont ete recontactes par l’envoi d’un sms et 394 par rappel telephonique classique. Le taux de reponse par SMS a ete equivalent a celui obtenu par telephone (93,9 % dans le groupe SMS et 92,9 % dans le groupe TEL, pour un delai de reponse moyen de 3 heures). Une reponse a ete obtenue apres une seule tentative de rappel dans environs 70 % des cas dans les deux groupes. Discussion L’utilisation croissante des SMS dans de nombreux champs de la sante ainsi que le developpement actuel de techniques de dialogues automatisees nous poussent a nous interroger sur l’optimisation de son emploi afin d’en faire un outil privilegie pour le suivi des patients pris en charge par les centres antipoison. Neanmoins, concernant le taux de reponse, nous n’avons pas observe de difference entre les rappels telephoniques et les SMS. Comme souligne par Langrand et al. [2] , il parait maintenant important d’evaluer le cout de ces 2 modalites de suivi, notamment en terme de temps medical et/ou paramedical.
BackgroundPoisoning is one of the leading causes of admission to the emergency department and int... more BackgroundPoisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis.MethodsA committee composed of 30 experts from five scientific societies, theSociété de Réanimation de Langue Française(SRLF), theSociété Française de Médecine d’Urgence(SFMU), theSociété de Toxicologie Clinique(STC), theSociété Française de Toxicologie Analytique(SFTA) and theGroupe Francophone de Réanimation et d’Urgences Pédiatriques(GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to re...
BACKGROUND AND OBJECTIVES: In France, cannabis consumption is illegal. The health impact of its i... more BACKGROUND AND OBJECTIVES: In France, cannabis consumption is illegal. The health impact of its increasing use and higher tetrahydrocannabinol (THC) concentrations is still poorly documented, particularly that of unintentional pediatric intoxications. We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (2004–2014). METHODS: A retrospective, national, multicenter, observational study of a pediatric cohort. All children aged <6 years admitted to a tertiary-level pediatric emergency department (PED) for proven cannabis intoxication (compatible symptoms and positive toxicological screening results) during the reference period were included. RESULTS: Twenty-four PEDs participated in our study; 235 children were included, and 71% of the patients were 18 months old or younger. Annual admissions increased by a factor of 13. Hashish resin was the main form ingested (72%). During the study period, the evol...
Synthetic cathinones represent a large class of new popular drugs of abuse in France and in Europ... more Synthetic cathinones represent a large class of new popular drugs of abuse in France and in Europe, commonly called new psychoactive substances (NPS). We describe 11 cases of
Sixty-seven scorpion species have been described in France and its territories, where they have b... more Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey’s incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one ...
Abstract Context Contact with the setae of larvae (caterpillars) of pine or oak processionary mot... more Abstract Context Contact with the setae of larvae (caterpillars) of pine or oak processionary moths could induce urticarial or allergic reactions in humans. These species are present in France and presently expanding towards highly populated areas due to climate change and/or human-mediated translocations. We aimed to describe the symptomatic cases of exposure to processionary larvae in France. Methods We conducted a retrospective study of symptomatic cases of exposure to processionary larvae registered by the French poison control centres between 1 January 2012 and 31 July 2019. We reviewed all medical records coded with the agent “larvae”. Results Of the 1274 included cases, 59% and 27% corresponded to pine and oak processionary larvae, respectively; the 14% remaining cases concerned unspecified processionary larvae. While the annual number of cases due to pine processionary larvae fluctuated during the study period, cases associated with oak processionary larvae increased steadily. Most of the annual cases occurred between January and May for pine processionary larvae, and April and August for oak processionary larvae (with a peak in March or June, respectively). Among the 1022 cases for which information was available, the sex ratio was 1.2 and the median age was 11 years old. Skin symptoms were reported by 96,3% of the cases, such as pruritus or urticaria. The severity was mild in 96.3% of cases, moderate in 3.5%, and severe in 0.2% (two cases). Ocular or oral exposures led more frequently to severe symptoms than dermal ones (respectively 31% and 18% vs. 2% of cases, p < 10−3). Conclusion Since processionary moth larvae exposure is a growing health concern, which can cause severe injuries particularly after ocular or oral exposures, the population, and the professionals should be informed of existing recommendations to avoid exposure and measures to be taken after being exposed.
Introduction: Ciguatera fish poisoning (CFP) is a common Poisoning in the tropical countries. Fra... more Introduction: Ciguatera fish poisoning (CFP) is a common Poisoning in the tropical countries. France is directly concerned with French tourists in endemic area and with French citizens living in the French overseas territories. Method: Retrospective, descriptive study of CFP cases handled by the French Poison Control Centre Network from 2012 through 2019. Results: Fifty-two events were studied concerning 130 patients. The fish species was identified for 41 events, mainly belonging to five fish families: 14 groupers, 11 snappers, 5 jacks, 4 parrotfishes, 4 barracudas. The origin of the fish was the Atlantic Ocean (23 events), the Indian Ocean (17 events) and the Pacific Ocean (12 events). 91% of the poisonings occurring in the Atlantic Ocean began with gastrointestinal effects while in 44% of events occurring in the Pacific Ocean, the patients had no gastrointestinal effects (onset with neurological symptoms: paraesthesia and dysesthesia). The evolution of the 130 patients has been classic for CFP with persistent symptoms during 1 to 45 weeks. Numerous patients reported exacerbation of neurological signs several months after poisoning following consumption of alcoholic beverages (23 patients) or seafood (19 patients). Discussion: Medical practitioners in Europe must be trained to manage CFP as cases are reported with tourists returning from endemic areas but also with poisoned patients far from tropical areas after consumption of imported fish.
Abstract Introduction The aim was to assess the impact of the COVID-19 pandemic on French Poison ... more Abstract Introduction The aim was to assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics. Methods Reported cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, and 2020 were extracted from the French National Database of Poisonings. The collected data included call, patient, and exposure characteristics for both general calls and for calls involving sentinel xenobiotic categories related to the COVID-19 pandemic. The 2020 exposures were compared to 2018–2019 exposures by using simple logistic models in order to provide effect size with odds ratios. Results From March to April 2020, 32,182 exposures were reported to French PCCs with an overall increase of 5.6% compared to exposures in the same time frame in 2018–2019. A similar increase in calls was observed in non-epidemic and epidemic COVID-19 areas with an increase in calls from the public (+13.6%) while calls from health-professionals decreased (−7.5%). Despite the increase in exposures, the incidence of symptomatic exposures remained stable (−0.4%) with a decrease in severity (moderate/severe −17.2%). A significant increase in exposures to home cleaning products containing biocides, essential oils, and alcohol-based hand sanitizers (odds ratio >1.3, p < .0001) was observed. Discussion and conclusion The COVID-19 pandemic altered calls to French PCCs with a small increase in calls during the study period and changes in the pattern of exposure. These changes possibly reflected the indirect consequences of the COVID-19 pandemic i.e., limited access to primary care, fear of contracting COVID-19 and anxiety related to home isolation.
Overdoses of drugs with QRS-prolonging activity have a mortality rate that can exceed 10% [1]. QR... more Overdoses of drugs with QRS-prolonging activity have a mortality rate that can exceed 10% [1]. QRS prolongation and ventricular arrhythmias have been reported in large venlafaxine or quetiapine overdoses [2]. Flumazenil is a benzodiazepine reversant used as a diagnostic tool in comatose patients but also known to induce adverse effects like seizures [3]. We report a case of poly-intoxication with cardiotropic drugs complicated by severe and delayed cardiotoxicity. A 38-year-old woman was suspected of ingesting 12 g of venlafaxine XR, 48 g of quetiapine XR, 105mg of zopiclone, and an undefined quantity of bromazepam. Her medical history included anxiety depressive syndrome and a sleeve gastrectomy 4 years prior. Two hours after exposure, the Glasgow coma scale (GCS) was 12 with reactive intermediate pupils, blood pressure (BP) 109/56mmHg, and normal blood glucose. Initial electrocardiogram (ECG) showed sinus tachycardia at 120 bpm, a narrow QRS (80ms), and a corrected QT interval (QTc) of 450ms (Fridericia’s formula). Twelve hours after ingestion she developed increased central nervous system depression (GCS 3), mydriasis, and BP 80/60mmHg. The ECG showed a sinus rhythm, with a prolonged QTc of 480ms and QRS widening (182ms) (Figure 1). Because of significant neurological depression supposed to be induced by benzodiazepines, flumazenil (0.3mg) was administered, which was immediately followed by a tonic-clonic seizure. Immediately, intubation was performed due to neurological failure and noradrenaline was started due to mean BP at 50mmHg. Administration of 250mL of sodium bicarbonate (8.4%) was followed by a decrease in the QRS to 112ms and then a decrease in the dose of noradrenaline with hemodynamic improvement. Twenty hours after ingestion, EEG showed seizure activity, therefore levetiracetam was started. Transthoracic echocardiography showed a 70% left ventricular ejection fraction under noradrenaline administration. At 29 h after ingestion, there was further hemodynamic deterioration, with worsening of the ECG findings (Figure 2), which was interpreted as sinus rhythm with a prolonged QRS (160ms) and QTc (455ms). An additional 500mL of sodium bicarbonate (8.4%) with 120 g of intralipid solution was administrated followed by a decrease in the QRS to 88ms and the QTc to 375ms and improved hemodynamic stability, allowing the weaning of noradrenaline. Toxicity resolved 4 days after admission without neurological sequelae. Blood was analyzed 2 days after exposure using LC-HRMS with QTOF detection (Waters, Milford, MA, USA). The
Abstract Background and aims MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist (SCRA) t... more Abstract Background and aims MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist (SCRA) that has recently emerged. Data regarding clinical presentations in the event of intoxication is scarce. This study presents MDMB-4en-PINACA identification in cannabis consumers with clinical and analytical descriptions. Methods Between November 2020 and March 2021, all patients with unexpected or unusually severe effects and Poisoning Severity Score (PSS) greater than or equal to 2 after cannabis consumption were included. Blood and/or urine samples were collected for toxicological analysis. When available, drug material samples were also collected for analysis. Results Between November 2020 and March 2021, 13 patients were included. All cases typically presented with altered mental status (n = 13), and nearly all had returned to a normal or quasi-normal state after around 11 h of observation. Neurological symptoms included headaches (n = 3), hallucinations (3), mydriasis (3), amnesia (2) and seizures (5). Psychiatric symptoms were paranoia (6) and anxiety (2). Digestive symptoms were nausea (2) and vomiting (6). No deaths were recorded. All patients were positive for the SCRA MDMB-4en-PINACA in urine, blood and/or drug material sample. Results from toxicology testing paired with case history showed the potential for MDMB-4en-PINACA to cause or contribute to different clinical disorders. Conclusions This study highlights the risk of intoxication by SCRAs when taking low-THC cannabis products. Forensic scientists, public health and public safety officials, law enforcement personnel and clinicians should be aware of the impact that these emergent SCRAs may have in their work, especially MDMB-4en-PINACA.
Abstract Introduction In France, 57 species of scorpions are described with a limited number of c... more Abstract Introduction In France, 57 species of scorpions are described with a limited number of clinical studies. In this article, we report the epidemiology of scorpion sting events in mainland France and its overseas territories based on cases reported to the French poison-control centres (FPCC). Material and method This retrospective multicentre study was conducted with data from FPCC’s files about scorpion stings between January 1, 2011 and December 31, 2020. Result Among 975 recorded files, 624 patients were included because they were stung by scorpions native to French territories. Most stings occurred along the Mediterranean coast in summer and indoors (in persons’ homes) during the daytime. The scorpions were identified in 50% of cases. According to signs of envenoming, patients were divided into class III (2 cases; 1%), class II (51 cases; 8%), class I (444 cases; 71%) and asymptomatic stings (127 cases; 20%). Twelve pregnant women were stung and two of them had contractions, which triggered childbirth in one woman. Ten patients had local infections in the first week after the sting. One patient had venous thrombosis 2 days after the sting. Life-threatening scorpions, i.e., Tityus obscurus, Tityus sylvestris and Centruroides pococki, in French territories are limited to French Guiana and Lesser Antilles. Class II envenoming cases are recorded for Buthus occitanus, Euscorpius spp. in mainland France, and Isometrus maculatus in French Guiana, the Lesser Antilles (Guadeloupe and Martinique) and territories in the Indian Ocean (Mayotte and Réunion Island) and Pacific Ocean (French Polynesia). Only cases of local manifestation was reported for Belisarius xambeui in mainland France. Conclusion Scorpion stings in French territories are frequently on the Mediterranean coast and French Guiana. Life-threatening cases are limited to T. obscurus, T. sylvestris and Centruroides pococki stings in French Guiana and Lesser Antilles.
Journal of Venomous Animals and Toxins including Tropical Diseases, 2020
Background: The Amazon basin is one of the seven major geographical areas where scorpionism is re... more Background: The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was "one sting" (95.3%) by a "big" (47.6%), "black" (60%) and "small pincer" (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number of stings and percentage of general signs of envenomation were closely connected to a composite variable including the variation of the level of rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with general signs of envenomation. The presence of pulmonary; ear, nose, and throat (ENT); or gastrointestinal symptoms are related to major envenomation (p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia increased according to the envenomation grade whereas serum potassium and alkaline reserve decreased. Forty-six patients needed hospitalization and seven of them required intensive care. No patient died nor presented sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child activities and climatic conditions. Severe envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.
Objectifs En France metropolitaine, six especes de scorpions sont decrites : Buthus occitanus (Am... more Objectifs En France metropolitaine, six especes de scorpions sont decrites : Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) et quatre especes d’Euscorpius (Torell, 1778) : E. concinnus (Koch, 1837), E. italicus (Herbst, 1800), E. tergestinus (Koch, 1837) et Tetratrichobothrius flavicaudis (De Geer, 1778). Les cas d’envenimation en France metropolitaine sont peu severes. Notre objectif est de rechercher si des elements visuels, cliniques et geographiques permettent une identification d’un scorpion responsable d’envenimation. Methode Etude retrospective multicentrique a partir des appels aux centres antipoison francais (CAP) se rapportant aux piqures de scorpions autochtones survenues en France metropolitaine du 1er janvier 2011 au 31 decembre 2020. Nous etudions les photos et descriptions des scorpions presents dans les dossiers des CAP, et la repartition geographique des especes en cause. Ces donnees sont comparees aux descriptions des scorpions et a la repartition geographique des especes connues du Museum national d’histoire naturelle (MNHN). Les descriptions cliniques issues des dossiers des CAP sont etudiees a part dans l’hypothese d’une description clinique specifique selon les especes. Resultats Cinq cent soixante-quatorze cas sont en rapport avec une piqure de scorpion. Dans seulement 309 cas (53 %), le scorpion est identifie ou decrit. Cela permet d’identifier avec certitude 86 B. occitanus (27,9 %), 222 Euscorpius (71,8 %) et 1 B. xambeui (0,3 %). Premierement, les differentes descriptions des scorpions par le MNHN mettent en evidence des differences visuelles suffisantes pour permettre une identification aisee du genre entre Buthus (scorpion jaune), Belisarius (scorpion brun-orange) et Euscorpius (scorpion noir a pattes jaune). Cependant, l’espece d’Euscorpius n’est pas identifiable sans l’analyse du nombre de poils soyeux (trichobothries) ventraux sur la pince par un specialiste. Deuxiemement, la comparaison des donnees de repartition entre les donnees des CAP et celles du MNHN retrouve des similitudes dans les zones ou il existe un nombre significatif de piqures et des discordances dans les departements ou ces evenements sont plus rares. C’est ainsi que la repartition du B. xambeui est identique. Ce scorpion troglodyte responsable de peu d’envenimation se retrouve exclusivement dans les hauteurs des Pyrenees-Atlantiques. La repartition du B. occitanus est similaire entre notre etude et les donnees du MNHN. Il se retrouve surtout autour du bassin mediterraneen et dans quelques zones portuaires du nord de la France. Par contre, la repartition des Euscorpius est tres differente. Le MNHN le limitant au pourtour mediterraneen quand les CAP decrivent des cas de piqures egalement sur les voies fluviales (canal du Midi, Rhone, Seine) et dans les ports de commerce de la cote Atlantique. L’aire de repartition geographique etant similaire pour toutes les especes, celle-ci ne permet pas l’identification d’une espece de scorpion. Le terme de “scorpion ardechois” et de “scorpion languedocien” est donc a proscrire. Troisiemement, les presentations cliniques d’une envenimation entre B. occitanus et les Euscorpius sont similaires et peu specifiques ; elles ne permettent donc pas non plus de determiner a priori le scorpion responsable de l’envenimation. Et seul un cas d’envenimation par B. xambeui est decrit, ce qui ne nous permet pas de conclure. Conclusion En France metropolitaine, seule une description visuelle du scorpion en cause permet une identification fiable du genre sans permettre, neanmoins, de determiner l’espece pour les envenimations par un Euscorpius. Il serait donc tres utile lors d’un appel au CAP de se faire decrire le scorpion, ou de disposer d’une photo quand c’est possible. Ce recueil de donnees peut servir autant aux toxicologues qu’aux entomologistes pour permettre d’avoir des donnees de repartition fiables des especes presentes sur le territoire Francais. Les donnees des CAP permettant d’avoir des informations sur des localisations rares ou inattendues de ces especes lorsque l’identification est possible.
Objectifs L’utilisation des SMS (short messaging system) pourrait faciliter le suivi des patients... more Objectifs L’utilisation des SMS (short messaging system) pourrait faciliter le suivi des patients pris en charge par les centres antipoison. Neanmoins il faut mettre en perspective l’utilisation de cet outil par rapport au rappel telephonique de suivi encore majoritairement utilise. Nous nous sommes interesses a comparer le suivi des patients par rappel telephonique (TEL) et l’envoi de SMS entre le mois de fevrier et mars 2019 [1] . Methode Les patients inclus etaient ceux qui 1. Etaient asymptomatiques ou qui presentaient des symptomes mineurs au moment de l’appel 2. Qui avaient un numero de telephone portable 3. Ne necessitaient pas de consultation medicale a l’appel 4. Qui avaient donne leur accord (enregistrement de l’appel comme preuve). Le lendemain de l’appel initial, les patients recevaient soit un appel telephonique soit un SMS avec un texte predefini leur demandant de leurs nouvelles. La reponse au SMS etait lue par un infirmier forme, et le dossier complete. En fonction de la reponse (nouveaux symptomes, ou aggravation des symptomes), le patient etait rappele. En cas de non-reponse, le patient recevait un second SMS ou un second appel telephonique le lendemain. L’analyse des resultats a ete realisee sur le logiciel R. La comparaison de variables entre les groupes a ete realisee avec un test de Wilcoxon pour les donnees quantitatives et un test de Chi2 pour les donnees qualitatives. Les tests de correlation ont ete faits selon la methode de Spearman pour les variables non parametriques. Enfin, ont ete realises des regressions logistiques. Une etude multivariee a montre que le sexe, l’âge et le type de suivi n’influencent pas ce resultat. Resultats Sur les 1180 appels traites par le CAP de Bordeaux durant la periode de l’etude, 835 patients ont ete inclus. 441 ont ete recontactes par l’envoi d’un sms et 394 par rappel telephonique classique. Le taux de reponse par SMS a ete equivalent a celui obtenu par telephone (93,9 % dans le groupe SMS et 92,9 % dans le groupe TEL, pour un delai de reponse moyen de 3 heures). Une reponse a ete obtenue apres une seule tentative de rappel dans environs 70 % des cas dans les deux groupes. Discussion L’utilisation croissante des SMS dans de nombreux champs de la sante ainsi que le developpement actuel de techniques de dialogues automatisees nous poussent a nous interroger sur l’optimisation de son emploi afin d’en faire un outil privilegie pour le suivi des patients pris en charge par les centres antipoison. Neanmoins, concernant le taux de reponse, nous n’avons pas observe de difference entre les rappels telephoniques et les SMS. Comme souligne par Langrand et al. [2] , il parait maintenant important d’evaluer le cout de ces 2 modalites de suivi, notamment en terme de temps medical et/ou paramedical.
BackgroundPoisoning is one of the leading causes of admission to the emergency department and int... more BackgroundPoisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis.MethodsA committee composed of 30 experts from five scientific societies, theSociété de Réanimation de Langue Française(SRLF), theSociété Française de Médecine d’Urgence(SFMU), theSociété de Toxicologie Clinique(STC), theSociété Française de Toxicologie Analytique(SFTA) and theGroupe Francophone de Réanimation et d’Urgences Pédiatriques(GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to re...
BACKGROUND AND OBJECTIVES: In France, cannabis consumption is illegal. The health impact of its i... more BACKGROUND AND OBJECTIVES: In France, cannabis consumption is illegal. The health impact of its increasing use and higher tetrahydrocannabinol (THC) concentrations is still poorly documented, particularly that of unintentional pediatric intoxications. We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (2004–2014). METHODS: A retrospective, national, multicenter, observational study of a pediatric cohort. All children aged <6 years admitted to a tertiary-level pediatric emergency department (PED) for proven cannabis intoxication (compatible symptoms and positive toxicological screening results) during the reference period were included. RESULTS: Twenty-four PEDs participated in our study; 235 children were included, and 71% of the patients were 18 months old or younger. Annual admissions increased by a factor of 13. Hashish resin was the main form ingested (72%). During the study period, the evol...
Synthetic cathinones represent a large class of new popular drugs of abuse in France and in Europ... more Synthetic cathinones represent a large class of new popular drugs of abuse in France and in Europe, commonly called new psychoactive substances (NPS). We describe 11 cases of
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