From January 2011 to March 2018, 26 patients aged from 20 to 80 years old reported being sick in France after eating sea figs of the genus Microcosmus. The patients had symptoms evoking a cerebellar syndrome: blurred or double vision, ataxia and dizziness, asthenia, headache, muscle cramps, paresthesia and digestive disorders (nausea, vomiting and diarrhea). Three of the 18 food poisoning events recorded by the Poison Control Center in Marseille and involving four patients were further investigated as the meal leftovers were collected and analyzed. A previous study ruled out the presence of the regulated lipophilic marine toxins after high-resolution mass spectrometry, but further analyses were required to look for hydrophilic cyanotoxins. The sea fig leftovers from food poisoning case Numbers 1 (January 2011), 6 (December 2012) and 17 (March 2018) of this published case series were analyzed by hydrophilic interaction liquid chromatography coupled to low- and high-resolution mass spectrometry to investigate the presence of hydrophilic cyanotoxins. The sea fig samples showed anatoxin-a (ATX-a) concentrations ranging from 193.7 to 1240.2 µg/kg. The sea fig control sample analyzed was also contaminated with ATX-a but in a much smaller concentration (22.5 µg/kg). To the best of our knowledge, this is the first report of human food poisoning involving ATX-a as the possible causative toxin where the cyanotoxin could be unequivocally identified.

Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey’s incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one of these scorpions requires hospital monitoring as long as systemic symptoms persist. Typical management includes the use of a lidocaine patch, pain killers, and local antiseptic. In the case of heart failure, the use of dobutamine can improve survival, and pregnant women must consult an obstetrician because of the elevated risk of preterm birth or stillbirth. France does not have scorpion antivenom, as scorpion stings are generally not fatal.

Clinical marine toxicology is a rapidly changing area. Many of the new discoveries reported every year in Europe involve ecological disturbances—including global warming—that have induced modifications in the chorology, behavior, and toxicity of many species of venomous or poisonous aquatic life including algae, ascidians, fish and shellfish. These changes have raised a number of public issues associated, e.g., poisoning after ingestion of contaminated seafood, envenomation by fish stings, and exposure to harmful microorganism blooms. The purpose of this review of medical and scientific literature in marine toxicology is to highlight the growing challenges induced by ecological disturbances that confront clinical toxicologists during the everyday job in the European Poison Centers.

In European countries, vitamin A toxicity is most often the result of an excessive intake of vitamin supplements and rarely the consequence of the ingestion of a large carnivorous fish liver. We report 3 cases of vitamin A poisoning after fish liver ingestion in mainland and overseas France. The patients were a 12-y-old girl, a 36-y-old pregnant woman, and a 62-y-old man. They experienced headache, nausea, emesis, and desquamation. Laboratory examination showed a high serum retinol level in the girl. The woman’s pregnancy progressed to a miscarriage. This case series shows that this kind of poisoning is not restricted to the polar regions. In patients presenting with flushing combined with signs of intracranial hypertension, accurate questioning of the patient’s diet is crucial to avoid misdiagnosis and unnecessary examinations. Pregnant women or women of child-bearing age should be informed of the risk to pregnancy in the case of excessive fish liver ingestion.

We aimed to describe the symptoms, patient demographics, and trends over time of adverse effects related to liquorice consumed in the diet reported to French poison centres. We performed a retrospective study of data from French poison centres of cases of adverse effects of liquorice consumed in the diet, with a high causality score, between 2012 and 2021 (10 years). Sixty-four cases were included. The annual number of cases ranged from three to nine, with no significant variation over the study period. Liquorice-induced reactions were very rare (0.008% of all cases with symptoms reported to French poison centres). The products consumed were non-alcoholic beverages (non-alcoholic pastis, liquorice-based Antésite^®, and liquorice syrup), alcoholic beverages of the pastis type (10.9%), confectionery containing liquorice (12.5%), confectionery made with liquorice extract only (9.4%), herbal teas (12.5%) and food supplements (4.7%). Consumption was commonly chronic (67.2%) and non-compliant (70.3%). Chronic users presented with symptoms suggestive of pseudohyperaldosteronism, the severity of which seemed to correlate with the amount of glycyrrhizin ingested. Severity was high in 43.8% of cases. When the outcome was known (56.3%), it was favourable in almost all cases (94.4%), often after inpatient care, particularly in an intensive care unit. One patient had sequelae due to a stroke, and one fatality was reported. Severe cases were observed with all types of products, except liquorice syrup and food supplements, and more frequently with beverages (pastis with or without alcohol, and Antésite^®). Due to significant variability in response to glycyrrhizin, some patients presented signs and symptoms suggestive of pseudohyperaldosteronism such as hypokalaemia, salt and water retention, and hypertension despite consuming the product as directed. Liquorice-induced effects were rarely reported to French poison centres, but their severity was high. Most patients were adults with chronic and non-compliant consumption, especially of soft drinks, with a clinical presentation suggestive of pseudohyperaldosteronism.