What are the other Names for this Condition? (Also known as/Synonyms)

• Ergotamine-Induced Leg Ischemia
• Ergotoxicosis
• St. Anthony’s Fire

What is Ergotism? (Definition/Background Information)

• Ergotism is caused by alkaloids produced by fungi belonging to Claviceps spp. These fungi infect cereals (Examples: wheat, rice, rye), which is known as ergot or ergot disease. The dormant structures of the fungus, known as sclerotia, are rich in alkaloids. Ergonovine and ergotamine are tow such alkaloids derived from the fungal sclerotia, and are used for treating postpartum hemorrhage and migraine, respectively
• The alkaloids find their way into the human body through consumption of infected cereal, or through over-use of a medication containing the alklaloids 
• Ergotism may either be acute or chronic. Both are characterized by disorientation, muscle cramps, convulsions, and dry gangrene of fingers, toes, hands and feet. Pregnant women with Ergotism may miscarry
• Since the alkaloids from the fungal sclerotia constrict blood vessels, vasodilators may be used for treatment of the condition

Who gets Ergotism? (Age and Sex Distribution)

• Ergotism is a rare disorder, which may affect individuals of all ages and ethnicities
• Both males and females may be affected

What are the Risk Factors for Ergotism? (Predisposing Factors)

The risk factors for Ergotism may include:

• Ingestion of cereal contaminated with sclerotia of the fungus Claviceps spp.
• Over-use of medication containing ergotamine for migraine
• Overdose of ergonovine-derived medication for postpartum hemorrhage
• Being on anti-retroviral therapy for HIV infection/AIDS, along with medication containing ergot alkaloids

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ergotism? (Etiology)

Ergotism is caused by alkaloids produced by fungi belonging to Claviceps spp.

• These fungi infect cereals such as wheat, rice, and rye. Ingestion of flour milled from infected cereal grains (such as rye) may lead to symptoms of Ergotism
• The dormant structures of the fungus, known as sclerotia, are rich in alkaloids. Ergonovine and ergotamine are two alkaloids derived from the fungal sclerotia
• These alkaloids are used for treating postpartum hemorrhage and migraine, respectively. Over-use of these medications may also cause Ergotism
• In individuals with HIV/AIDS infection undergoing anti-retroviral therapy, there may be a decreased hepatic metabolism of ergot alkaloid containing medications. This may lead to life-threatening situations of Ergotism in such individuals

What are the Signs and Symptoms of Ergotism?

The signs and symptoms of Ergotism may include the following:

• Muscle cramps
• Hallucinations
• Burning pain in legs
• High blood pressure, which can lead to
  • Headache
  • Increased heart rate
  • Shortness of breath
  • Blurred vision
  • Confusion 
• Convulsions
• Dry gangrene of fingers, toes or limbs, which may cause
  • Pain
  • Numbness in the affected area
  • Skin being hot or cold or hard to touch
  • Fever
  • Shortness of breath

How is Ergotism Diagnosed?

Ergotism is diagnosed on the basis of the following information:

• Complete physical examination
• Thorough medical history evaluation
• Assessment of signs and symptoms
• Laboratory tests
• Imaging studies
• Biopsy studies, if necessary

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ergotism?

The complications of Ergotism may include:

• Risk of falls and injury due to convulsions
• Arrhythmia, due to high blood pressure
• Reduced motility due to gangrene
• Risk of infection in tissue with gangrene
• Loss of fingers, toes or limb
• Cardiac arrest 
• Miscarriage, in pregnant women

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Ergotism Treated?

The treatment for Ergotism may include the following:

• Discontinuation of ergotamine or ergonovine containing medication, if they are the cause
• Use of vasodilators in an attempt to reverse the effect of ergot alkaloids and decrease blood pressure. Such medications may include:
  • Nifedipine
  • Heparin
  • Prostaglandin
  • Nitroprusside
• Antibiotics, if gangrene leads to secondary bacterial infections
• Surgical amputation of digits or limb affected by Ergotism, if the effects of ergot alkaloids are irreversible 

How can Ergotism be Prevented?

• Ergotism is an acquired disorder, which may be preventable by considering the following steps:
  • Immediately discontinuing ingestion of food that may be contaminated with fungal sclera, if one feels unwell after consuming it once
  • Avoiding self-medication
  • Seeking medical attention for any reaction to medication containing ergotamine or ergonovine
• Regular medical screening at periodic intervals with tests and physical examinations are recommended

What is the Prognosis of Ergotism? (Outcomes/Resolutions)

• The prognosis of Ergotism is dependent upon the severity of the signs and symptoms and associated complications, if any
• Individuals with mild conditions have better prognosis than those with severe symptoms and complications
• Typically, the prognosis may be assessed on a case-by-case basis

Additional and Relevant Useful Information for Ergotism:

• Ergotism is also known by the following additional synonym: Ergot Poisoning
• The synonym “St. Anthony’s fire” stems from the fact that this condition yielded to treatment at the “Order of Hospitallers of St. Anthony”, in France. Affected individuals undertook a pilgrimage to the Order to seek treatment
• The sclerotia, which are dormant fungal entities, may be shaped like kernels of grain. Most sclerotia fall on the ground during the harvesting process. However, a few remaining sclerotia in the plants and grains can cause infection
• Although Ergotism was very common in individuals eating rye bread made with contaminated rye, the current practices and standards have minimized ergot contamination of grain and flour