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BACKGROUND: The “Ospedali Riuniti’s Poison Center” (Foggia, Italy) provides a 24 h telephone consultation in clinical toxicology to the general public and health-care professionals, including drug information and assessment of the effects of commercial and industrial chemical substances, toxins but also plants and mushrooms. It participates in diagnosis and treatment of the exposure to toxins and toxicants, also throughout its ambulatory activity. METHODS: To report data on the epidemiology of mushroom poisoning in people contacting our Poison Center we made computerized queries and descriptive analyses of the medical records database of the mushroom poisoning in the poison center of Foggia from January 2018 to December 2018. RESULTS: A total of 69 mushroom poisonings cases were recorded in our poison center the period from January 2018 to December 2018. Our poison center serves all the Italian territory but most of the calls about mushrooms poisonings, in 2018, came from Apulia, Campania, and Basilicata, which are bordering regions of Italy. About 80.2 % of calls were made by the physicians (particularly, 73.9% by emergency room, 18.8% and 4.3% by hospital ward, and 1.4% both by a general practitioner and by the American Sign Language [“ASL”]) and 18.8% by the public. Cooked mushrooms were involved in all the cases (single and multiple species). The most frequent calls were made in the period between September 2018 and December 2018; in the other months, there were only sporadic cases. All were intentional exposures in adults (>18 years). CONCLUSIONS: Mushroom exposures and poisonings are an important problem in those regions of Italy where many people adventuring in mushroom’s research without any license. This fact has contributed substantially to morbidity due to mushroom poisoning. Our database is a valuable national resource for the collection and monitoring of Italian mushroom poisoning cases in 2018 but limited to the people who called our poison center, which is one of the nine poisons centers in Italy. And since in most cases, the mushroom’s species remains unknown, it is important to quickly recognize symptoms and most frequent species involved on the Italian territory, in particular in South Italy.

The Apulian Poison Centre (PC) of Foggia, Italy, annually manages numerous consultations concerning certain or suspected poisonings from pesticides, starting at the same time a careful activity related to the risk assessment phase. The management of the exposure to pesticides and to other chemicals, and the alerting of the “National center for chemicals, cosmetics and consumer protection” at the Istituto Superiore di Sanità (ISS), actively contributes to the improvement of products quality and safety. Thus, leading to a reduction in the number of intoxications - and therefore of the accesses to the emergency services - allows greater protection for workers, bystanders, residents and consumers. The reported case of methomyl poisoning has been of fundamental importance both from the medical point of view and for the management of the intoxicated patient, both for the risk assessment actions, and for cooperation with the competent authorities, generating discussion points on the regulations in force between PCs and National Competent Authority. It follows that the feedback of intoxication in an emergency can lead to improvements in the management and risk mitigation measures in order to reach a greater protection of human, animal, and environmental health. In addition, the regulatory feedback deriving from these reports is an input to the increase product quality improvement (mixtures, labels, packaging, and risk communication) leading to a greater protection of potential exposed subjects. The importance of creating an information and management network that allows the optimization of the flow of information deriving from PCs arises. The actions taken are therefore described, both relating to the management of the emergency, and relating to the subsequent information flow and to the measures for containing the consequent risks.

BACKGROUND: The spiders of the Loxosceles genus, commonly denoted as “brown spiders” or “Mediterranean recluse” or “brown recluse,” belong to the spider family Sicariidae, suborder Labidognatha, order Araneida, class Arachnida, and phylum Arthropoda. This spider is widespread in Africa and South/Central America, but it is also distributed in North America, in the West Indies, in the Mediterranean Europe, and in China. CASE REPORT: Here, we report the case of a severe dermonecrotic loxoscelism identified in Southern Italy, probably due to the bite of Loxosceles rufescens. The patient was a women admitted at hospital ER because of a little skin erythema that evolved toward a severe necrosis and ulceration within 20 days. After clinical and laboratory data excluded other local and systemic diseases, she was treated with a systemic and local therapy using corticosteroids and antibiotics with the diagnosis of loxoscelism. The healing from the local skin lesion occurred within 2 months, but the local pain, weakness, and discomfort lasted for a long time. CONCLUSION: It is the fisrt time that a possible case of systemic loxoscelism with skin generalized urticaria is reported in Italy.

Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy.

Foodborne Botulism is clinically characterized by a symmetric flaccid paralysis of the cranial nerves with a descending involvement of voluntary and breathing muscles leading to respiratory arrest. Asymmetric neurological signs are unusual and in these cases diagnosis could be delayed or frequently missed. We described a 63-year-old man with a clinical picture related to type A botulism characterized by an asymmetric and left lateralized onset of neurological signs associated with a monolateral parotitis. Physicians must be aware that lateralized onset of neurological signs does not rule out the botulism, and it should be considered even in cases of atypical clinical picture.