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.
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Tonic-clonic convulsions occur in 25% of the patients.
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Seizures occur in 85% of all fatal cases.
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Fatty degeneration of the liver similar to Reye syndrome also occurs.
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The average time to death is 12.5 hours.
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Symptoms of the disease do not include fever or diarrhea.
Physical Examination
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:
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I - Asymptomatic with normal vital signs
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II - Dehydration and hypotension as a result of the intense vomiting
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III - Delirium or coma
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IV - Seizure (an ominous sign)
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Freshly picked Ackee fruit
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Black seeds surrounded by a thick, oily, yellow aril (edible portion).
