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Bongkrekic acid is a mitochondrial ANT toxin and is reported primarily in outbreaks of food-borne poisoning involving coconut and corn. It should be considered in outbreaks of food-borne illness when signs and symptoms manifest involving the liver, brain, and kidneys and when coconut- or corn-based foods are implicated.

Introduction Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold–Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly. We present a case of accidental poisoning from Veratrum parviflorum mistaken for the edible Allium tricoccum (ramps, wild leek). Case history A 27-year-old man and his 25-year-old wife presented to the emergency department with nausea, vomiting, hypotension, and bradycardia after foraging and ingesting plants that they believed to be a local native species of wild leek. Methods We collected and analyzed the implicated fresh plant material and both patients’ serum/plasma. We used liquid chromatography–mass spectroscopy and high-resolution electrospray ionization time of flight tandem mass spectrometry to extract and characterize steroidal alkaloids from the foraged plant and patients’ serum. Results Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine. Discussion Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species. Conclusion V. parviflorum toxicity manifests with gastrointestinal and cardiac symptoms. Treatment is symptomatic and supportive as with previous case reports of toxicity with other Veratrum species.

Background: The Global Terrorism Database (GTD) is an open-source database that includes information on terrorist incidents that have occurred around the world since 1970. It is maintained by the Center for Terrorism and Intelligence Studies and the University of Maryland National Consortium for the Study of Terrorism and Responses to Terrorism (START), a Department of Homeland Security Center of Excellence. Objective: To characterize chemical terrorism incidents reported to the GTD and understand more about the kinds of chemical agents used, the associated morbidity and mortality, the geography of incidents, and the intended targets. Methods: We searched the GTD database to identify all terrorism incidents categorized as “chemical” or with “chemical weapon” in the incident description; we excluded duplicate entries and those not involving a chemical agent. We reviewed each incident and assigned it to one of eight chemical agent categories. We analyzed the total number of chemical terrorism incidents between 1970 and 2015 by chemical agent category, injury and fatality volume, geographic region, and target. We determined injury and fatality counts and mean number of injuries and fatalities by chemical agent category. Results: During the study period, 156,772 terrorism incidents were reported to the GTD, of which 321 (0.2%) were reported as “chemical” or “chemical weapons” incidents. Of these, 292 (90.1%) met our inclusion criteria for analysis (duplicate reports and incidents that did not involve a chemical terrorism agent were excluded). The reported chemical agent categories were: unknown chemical (30.5%); corrosives (23.3%); tear gas/mace (12.3%); unspecified gas (11.6%); cyanide (8.2%); pesticides (5.5%); metals (6.5%); and nerve gas (2.1%). On average, chemical terrorism incidents in this dataset resulted in 51 injuries (mean range across agents: 2.5–1622) and 7 deaths (mean range across agents: 0.0–224.3) per incident. Nerve gas incidents (2.1%) had the highest reported mean number of fatalities (n=224) and injuries (n=1622) per incident. The highest number of reported chemical terrorism incidents occurred in South Asia (29.5%), Western Europe (16.8%), Middle East/North Africa (13%), and South America (9.3%). The most common targets were private citizens (19.5%). Conclusions: This is the first publication to characterize chemical terrorism incidents collected by the GTD. Data suggest that morbidity and mortality vary by chemical category and by region. Results may be helpful in developing and optimizing regional chemical terrorism preparedness activities.

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