(See original question here.)

ANSWER: Jequirity Bean

The jequirity bean (Abrus precatorius) is a very ordinary looking climbing plant found in warm climates across the world that has very attractively colored seeds that are very toxic. Seeds are often used in jewelry, strung on a line for necklaces or bracelets, or used in rattles because of their hard shell.

Common names: Buddhist Rosary Bead, Crab’s Eyes, Indian Bead, Jequirity Bean, Love Bean, Prayer Bean, Precatory Bean, Rosary Pea, Seminole Bead.

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Plant: Abrus p. was introduced to the United States from its native habitat in Asia in the 1930s. It is now considered an ‘undesired invasive weed and cultivation is prohibited in many areas. The plant is an herbaceous perennial climbing plant with small deep green oval leaves (image 1) and a deep tap root that makes it difficult to eradicate. It has grouped pale pink flowers that bloom from May to September. Seed pods develop later (Image 2) and each contains 3-6 strikingly colored scarlet-red, shiny seeds with a black spot (Image 3). These seeds are so uniform in size and weight (about 7 mm and 1/10th of a gram) they were historically used in India as standard unit (Ratti) for weighing gold.

Exposure: Typical exposure is oral in humans and pet animals (although birds can eat them without injury). Illness and subsequent fatality depend upon the amount, route, and mechanism of exposure. Most described exposures are from seed ingestion (either suicidal or inadvertent) where degree of toxicity depends upon the integrity of the seed’s water impermeable shell. If they were swallowed whole, the toxicity may be limited; if the seed was chewed or if the seed shell was drilled open and strung in a line (e.g., for a bracelet) toxicity may be more profound. Intentional large dose ingestions and parenteral exposures produce severe illness and can be fatal.

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Toxicity/Toxin: The entire plant contains abrin, a toxalbumin. This is the most toxic naturally occurring plant poison known. The jequirity seeds have the highest abrin amount per weight-with an estimated fatal human dose between 0.1-1 microgram/kg or about one chewed seed-this is about twice the potency of caster bean’s ricin.

Mechanism: Abrin contains a sulfur-linked A and B chain. The B chain binds to the cell membrane and causes invagination and delivery of the A chain to the ribosomes. The A chain attacks the ribosomes 60S subunit and removes adenine from positions 4 and 324 of the 28S rRNA which stops protein synthesis and causes acute cellular death. Abrin induces cellular death, vascular leak syndrome (tissue edema), and red blood cell agglutination; inhalation of the toxin results in pulmonary edema.

Symptoms: While many exposures have mild to moderate symptoms before resolution, severe symptoms may develop. After seeds are eaten, if symptoms occur, they usually develop in hours or days, Initially, the findings are suggestive of viral gastroenteritis. A retrospective analysis of 112 cases supports the most common initial symptoms are GI: nausea, vomiting, severe abdominal pain and bloody diarrhea-pharyngeal pain with ulcerative lesions of mouth and esophagus can develop. Severe symptoms include prostration, hallucinations, cerebral edema and seizures; fatal exposures will develop hypotension, high heart rates, shock and fever; ultimately with multi-organ failure-renal, CNS, and liver.”

Management/Treatment

• General: Avoidance and education. These include don’t buy the poison seed bracelet, don’t put the poison seeds in your mouth.
• GI decontamination: If early in exposure (e.g. just happened or suspected ingestion prior to onset of symptoms) activated charcoal with WBI may be considered. Ipecac use with cathartics has been previously described. Antiemetics, fluid resuscitation for volume and electrolyte repletion as needed.
• Laboratory assessment: serial evaluations for electrolyte derangement, LFTs, renal function, assessment of mental status.

There is no antidote for abrin poisoning-care is primarily supportive.

The author thanks the brilliant and observant Dr. Jordan Celeste of Central Florida, who sent him seeds that were growing wild in her neighborhood.

Dr. Hack is chief of the division of medical toxicology and vice chair for research at East Carolina University in Greenville, North Carolina

References

1. Reedman L, Shih RD, Hung O. Survival after an intentional ingestion of crushed abrus seeds. West J Emerg Med. 2008 Aug;9(3):157-9.
2. Jang DH, Hoffman RS, Nelson LS. Attempted suicide by mail order: Abrus precatorius. J Med Toxicol. 2010 Dec;6(4):427-30.
3. Das A, Jain V, Mishra A. A brief review on a traditional herb: abrus precatorius Plant. Forensic Med Toxicol Sci. 2016;1(1):1-10.
4. Dickers K, Bradberry SM, Rice P, et al. Abrin poisoning. Toxicol Rev. 2003;22(3):137-42.
5. Fodstad O, Olsnes S, Pihl A. Toxicity distribution and elimination of the cancerostatic lectins abrin and ricin after parenteral injection into mice. Br J Cancer. 1976 Oct;34(4):418-25.
6. Alhamdani M, Brown G, Mbaisa T. Abrin poisoning in an 18-month-old child. Am J Case Rep. 2015 Mar 10;16:146-8.
7. Karthikeyan G, Senniappan S, Rajamanickam A. Abrus precatorius Poisoning: A Retrospective Study of 112 Patients. Indian J Crit Care Med. 2017 Apr;21(4):224-225.
8. Bradberry S. Ricin and abrin. Medicine. 2008 Volume 36 Issue 2, 109-110.
9. Peggy A. Kinamore, Robert W. Jaeger, Fernando J. DeCastro & Kenneth F. Lampe (1980) Abrus and Ricinus Ingestions: Management of Three Cases, Clinical Toxicology, 17:3, 401-405.