Artist/ Title/ Date

Matthias Grünewald. Isenheim Altarpiece (Christ Detail). 1512–1516. Oil on panel. Musée Unterlinden, Colmar, France.

Description of Disease & Etiology

Ergotism is toxicosis caused by the consumption of grains contaminated with the fungus Claviceps purpurea, which primarily infects rye. During the Middle Ages, ergotism was often conflated with other dermatologic conditions and referred to collectively as Saint Anthony’s Fire. This fungus produces pharmacologically active substances known as ergot alkaloids. These alkaloids can cause a range of physiological effects due to their structural similarity to various neurotransmitters.1

Signs/Signifiers of Illness

This piece depicts Christ on the cross and is installed in a monastery hospital that treated skin diseases. Displayed are some of the more apparent signs characteristic of ergotism. First, the various sores on the body, as well as the greenish hue to the skin, may be indicators of the gangrenous nature of ergotism. Additionally, the figure displays dystonic posturing of the extremities and muscle rigidity, which is indicative of the convulsive effects ergot alkaloids have on neuronal signaling.1

Pathology

Ergot alkaloids have structural similarities to neurotransmitters such as noradrenaline, serotonin, and dopamine. Their effects vary depending on the receptors they interact with in the central nervous system. The alkaloids' impact on the circulatory and nervous systems is varied, as they activate different adrenergic, dopaminergic, and 5-HT3 receptors due to their molecular similarities to these neurotransmitters.2 Ergotism manifests in two main forms: gangrenous and convulsive. Gangrenous ergotism is caused by the vasoconstrictive properties of certain ergot alkaloids, leading to restricted blood flow. This can result in ischemia and necrosis, often necessitating amputation of affected limbs. Convulsive ergotism presents with involuntary muscle spasms, dyskinesias, and neuropsychiatric symptoms such as hallucinations, agitation, mania, and delirium.1-2

Treatment

Modern treatment of ergotism begins with removing the source of ergot exposure, the contaminated grains. Pharmacologic treatment counteracts the vasoconstrictive effects of ergot poisoning with the use of vasodilators. Anticonvulsants combat neuromotor symptoms. Of course, supportive care may include pain management, wound debridement or amputation in cases of gangrene, and psychiatric intervention as needed.3

Social Determinants of Illness

Ergotism outbreaks were more common in regions where rye and similar grains were staple foods, especially following wet winters and warm springs, which promote fungal growth. Contributing factors include limited dietary diversity, poverty, and poor grain storage practices, all of which increase the likelihood of consuming contaminated food.4

Author(s): Victoria Rhodes

Citations:

* 1) Schardl, C. L., Panaccione, D. G., & Tudzynski, P. (2006). Chapter 2 Ergot Alkaloids – Biology and Molecular Biology. In G. A. Cordell (Ed.), The Alkaloids: Chemistry and Biology (Vol. 63, pp. 45–86). Academic Press. https://doi.org/10.1016/S1099-4831(06)63002-2 * 2) Haarmann, T., Rolke, Y., Giesbert, S., & Tudzynski, P. (2009). Ergot: from witchcraft to biotechnology. Molecular Plant Pathology, 10(4), 563–577. https://doi.org/10.1111/j.1364-3703.2009.00548.x * 3) Ayarragaray, J. E. F. (2014). Ergotism: A Change of Perspective. Annals of Vascular Surgery, 28(1), 265–268. https://doi.org/10.1016/j.avsg.2013.02.005 * 4) Eadie, M. J. (2003). Convulsive ergotism: epidemics of the serotonin syndrome? The Lancet Neurology, 2(7), 429–434. https://www.proquest.com/docview/201501033/abstract/649855003EA44806PQ/1