Tremor syndrome associated with a fungal toxin: sequelae of food contamination

Peter R Lewis, Michael B Donoghue, Lucy Cook, Linda V Granger and Ailsa D Hocking
Med J Aust 2005; 182 (11): 582-584.

We report on an elderly couple who presented with a syndrome that included severe generalised tremor and incoordination after eating soup from a damaged can. Black mould contaminating the can was subcultured and the fungus Penicillium crustosum was identified. This fungus usually produces a potent neurotoxin called penitrem A. The couple displayed symptoms consistent with penitrem A ingestion, all of which resolved fully. Penitrem A intoxication has been well documented in animals, but not in humans.

An elderly couple was admitted to hospital after sudden onset of severe muscle tremors. The husband (aged 89) and wife (aged 84) described an uneventful morning. At about 12:00, they had shared a can of soup and toast, followed by chocolate cake, before catching a bus to the local shopping centre. They noticed the soup had a bitter taste, but dismissed the finding because it was a new brand and type to them. There had been no recent changes to their medications, and no recent exposure to garden sprays, insecticides or pesticides.

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  • Peter R Lewis1
  • Michael B Donoghue2
  • Lucy Cook3
  • Linda V Granger4
  • Ailsa D Hocking5

  • 1 Central Coast Health, Gosford, NSW.
  • 2 Food Science Australia, CSIRO, North Ryde, NSW.


  • 1. Hocking AD, Pitt JI. Mycotoxigenic fungi. In: Hocking AD, editor. Foodborne microorganisms of public health significance. 6th ed. Sydney: AIFST Food Microbiology Group, 2003: 641-674.
  • 2. Pitt JI, Hocking AD. Fungi and food spoilage. London: Blackie Academic and Professional, 1997.
  • 3. Rundberget T, Skaar I, Flaoyen A. The presence of Penicillium and Penicillium mycotoxins in food wastes. Int J Food Microbiol 2004; 90: 181-188.
  • 4. Cavanagh JB, Holton JL, Nolan CC, et al. The effects of the tremorgenic mycotoxin penitrem A on the rat cerebellum. Vet Pathol 1998; 35: 53-63.
  • 5. Breton P, Bizot JC, Buee J, De La Manche I. Brain neurotoxicity of penitrem A: electrophysiological, behavioral and histopathological study. Toxicon 1998; 36: 645-655.
  • 6. Hocking AD, Holds K, Tobin NF. Intoxication by tremorgenic mycotoxin (penitrem A) in a dog. Aust Vet J 1988; 65: 82-85.
  • 7. Boysen SR, Rozanski EA, Chan DL, et al. Tremorgenic mycotoxicosis in four dogs from a single household. J Am Vet Med Assoc 2002; 221: 1441-1444.
  • 8. Walter SL. Acute penitrem A and roquefortine poisoning in a dog. Can Vet J 2002; 43: 372-374.
  • 9. Young KL, Villar D, Carson TL, et al. Tremorgenic mycotoxin intoxication with penitrem A and roquefortine in two dogs. J Am Vet Med Assoc 2003; 222: 52-53.
  • 10. Cole RJ, Dorner JW, Cox RH, Raymond LW. Two classes of alkaloid mycotoxins produced by Penicillium crustosum thom isolated from contaminated beer. J Agric Food Chem 1983; 31: 655-657.
  • 11. El-Banna AA, Leistner L. Production of penitrem A by Penicillium crustosum isolated from foodstuffs. Int J Food Microbiol 1988; 7: 9-17.
  • 12. Frisvad JC, Filtenborg O. Terverticillate penicillia: chemotaxonomy and mycotoxin production. Mycologia 1989; 18: 837-861.
  • 13. Gordon KE, Masotti RE, Waddell WR. Tremorgenic encephalopathy: a role of mycotoxins in the production of CNS disease in humans? Can J Neurol Sci 1993; 20: 237-239.
  • 14. dos Santos VM, Dorner JW, Carreira F. Isolation and toxigenicity of Aspergillus fumigatus from moldy silage. Mycopathologia 2003; 156: 133-138.
  • 15. Pitt JI, Leistner L. Toxigenic Penicillium species. In: Smith J, Henderson R, editors. Mycotoxins and animal foods. Boca Raton, Fl: CRC Press, 1991: 91-99.


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