A fatal case of pepper poisoning

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Abstract

An 8 month old infant died as the result of administration of a traditional remedy, given orally as an infusion of a red powder. The symptoms on admission were coughing with diarrhoea and vomiting. Analysis of the powder using high-performance liquid chromatography (HPLC) confirmed the suspicion of capsaicin. Pepper preparations, which are used as traditional medicines, are highly toxic and their use on infants should be discouraged.

Introduction

Black and red peppers contain volatile oils, which are known to have antibacterial activity [1]. Black pepper contains the alkaloid piperine and red peppers contain capsaicin (8-methyl-N-vanililyl-6-noneanide) (Fig. 1). The latter is used for the treatment of pain [2], itching [3], psoriasis [4] and diabetic neuropathy [5]. Capsaicin, which is highly neurotoxic, can also lead to burns on exposed skin and mucous membranes [6], [7]. In high doses, it gives rise to a number of features, notably coughing [8], with bronchospasm and later gastro-intestinal damage. The neuropharmacology of capsaicin has been reviewed [9].

Section snippets

Case details

An 8 month old well-nourished black male infant was admitted to hospital with a history of 7 days of severe coughing and 3 days of diarrhoea and vomiting. These symptoms followed by treatment with a traditional remedy by his grandmother. The original illness was not elucidated, but on questioning the relatives stated that the herb used was red pepper in the form of a red powder for which the Afrikaans name is “Rooipoeier”.

The child was obtunded, profoundly shocked and acidotic (pH 7.1, HCO3-9 

Pathology

The liver was enlarged, tan coloured with normal vessels and bile ducts. There were a few lymphocytes in the portal tracts. There was microvesicular fatty change throughout (steatosis). There was no evidence of tuberculosis, viral cytopathic effects or metabolic storage disorders. No post mortem tissues or fluids were available for us to confirm the presence of capsaicin.

Method of analysis

The powder was boiled in distilled water for 1 h and filter sterilised using 0.22 μm filters. The preparation was then extracted using solid phase extraction on oasis columns, eluted and dried under nitrogen at 60°C. The product was reconstituted into 200 μl methanol containing decanoyl-4-hydroxy-3 methoxybenzyl amide as internal standard. The high-performance liquid chromatography (HPLC) instrument used was Beckman System Gold fitted with a diode array detector.

Fifty micro litres of the extract

Results

The spectra of capsaicin and the red powder extract are shown in Fig. 2. A spectrum similar to that of the red powder was obtained from an extract of chilli pepper.

The HPLC traces for capsaicin standard and the extracts of the remedy and fresh chilli pepper are shown in Fig. 3. The retention time for capsaicin relative to the internal standard was 1.55.

Discussion

This child suffered a severe acute fatal illness following treatment with what we confirmed was red pepper. The amount used was unknown, but the coughing and neurotoxic symptoms would fit with this form of poisoning. Red pepper poisoning is an unusual clinical finding, but a small number of instances have been reported in which red peppers were used for deliberate child abuse [11], [12]. This does not appear to have been the motive in this case.

Capsicum annum and related species contain the

Acknowledgements

This work was supported by the research endowment trusts of the South African Institute for Medical Research and the University of the Witwatersrand. We are grateful to Dr. C. Hajinicolou for permission to report this case. We would like to thank the Department of Pharmacy for use of their facilities as well as Mr. Ntiyiso Shingwenyana for access to the diode array instrument.

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