Ackee Fruit Toxicity Clinical Presentation

Updated: Apr 23, 2015
  • Author: Dave A Holson, MD, MBBS, MPH; Chief Editor: Timothy E Corden, MD  more...
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Presentation

History

The clinical syndrome induced by the consumption of the unripe ackee fruit is known in Jamaica as "Jamaican vomiting sickness" or "ackee poisoning." The symptoms are similar to Reye syndrome. Jamaican vomiting sickness is characterized by a sudden onset of vomiting that is preceded by generalized epigastric discomfort starting 2-6 hours after the ingestion of a meal containing ackee. Once the sickness begins, symptom progression is rapid. Patients experience pronounced diaphoresis, tachypnea, tachycardia, headache, generalized weakness, paresthesia, and disturbed mental states. After a period of prostration, which may last as long as 18 hours, a second bout of vomiting may occur. Unless treatment is given, this episode is usually followed by convulsions, coma, and death. Death is more common in children than in adults.

  • Tonic-clonic convulsions occur in 25% of the patients.

  • Seizures occur in 85% of all fatal cases.

  • Fatty degeneration of the liver similar to Reye syndrome also occurs.

  • The average time to death is 12.5 hours.

  • Symptoms of the disease do not include fever or diarrhea.

Guidelines for the diagnosis and management of other foodborne illnesses have been established by the American Medical Association, American Nurses Association, American Nurses Foundation, Centers for Disease Control and Prevention, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, Food Safety and Inspection Service, and US Department of Agriculture. [7]

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Physical

The general physical examination is important in deciding how aggressively to resuscitate the patient. Observed clinical manifestations, listed by degree of severity, are as follows:

  • I - Asymptomatic with normal vital signs

  • II -Dehydration and hypotension as a result of the intense vomiting

  • III - Delirium or coma

  • IV - Seizure (an ominous sign)

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Causes

See the list below:

  • Potential risk behaviors for ackee poisoning include the following:

    • Consumption of unripe ackee fruit

    • Consumption of ackee that has been forcibly opened

    • Reuse of the water in which an unripe ackee has been cooked

  • Undernutrition is also thought to be associated with individualized susceptibility to Jamaican vomiting sickness and the severity of the disease.

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