Clinical experience in poisonings following exposure to blasticidin S, a curiously strong fungicide.

The fungicide blasticidin S has been used against a rice blast disease. Reports on its human toxicity are extremely limited, and irritation to GI tract, eye and skin are the presenting symptoms in most afflicted cases. Fatalities resulting from profuse intestinal fluid loss with subsequent hypotension have also been recorded. In an attempt to delineate the clinical pictures of blasticidin S poisoning, a retrospective study covering an 8.5-y period was then conducted. A total of 28 blasticidin S poisoning exposures, including 24 suicidal ingestions, were recorded. The ingested amounts in most cases were rather large, while 2 cases were found with estimated dosages up to 10 g. The presented symptoms in most cases were immediate vomiting, abdominal pain, diarrhea and sore throat which were resolved after conservative treatment. Nevertheless, hypotension, arrhythmia, acrocyanosis, aspiration, and even coma occurred in severe cases. Fatalities were noted in 5 patients, in whom profound hypotension and severe aspiration pneumonitis were the main features. Poisoning following blasticidin S ingestion remains a challenge to acute health care physicians. Adequate administration of i.v. fluid and careful monitoring of electrolytes have been considered as the mainstay in the treatment of blasticidin S poisoning. Prevention of aspiration and ventilatory support are also crucial for life-saving since poisoning cases might succumb after massive aspiration.