Melia Azedarach Ingestions Reported to Texas Poison Centers

Background: Melia azedarach, also known as the chinaberry tree, is native to Southeast Asia and northern Australia but has become an invasive species in the United States. M. azedarach contains limonoid tetranotriterpenes, found in highest concentrations in its berries. Ingestion has been reported to result in adverse clinical effects affecting the gastrointestinal, cardiovascular, respiratory, and neurologic systems. Objective: The objective of this investigation was to describe M. azedarach ingestions in Texas. Methods: Cases were M. azedarach ingestions reported to Texas poison centers from 2000–2018. The distribution of cases was determined for various factors related to patient demographics, ingestion circumstances, management, and outcome. Results: Of 990 total M. azedarach ingestions, 87.4% involved the berry. There was a seasonal pattern with 42.9% reported between March and May. The patients were male in 55.1% of cases; 86.6% of the patients were ≤5 years of age. Patients were managed outside of a health care facility in 89.9% of cases; 95.2% of the ingestions resulted in no or at most minor clinical effects. The most frequently reported clinical effects were gastrointestinal (8.9%) and neurologic (2.1%). The most common treatments were dilution (67.2%) and food/snack (16.8%). Conclusion: In this study that focused on M. azedarach ingestions reported to Texas poison centers, the ingestions tended to involve berries. Most of the patients were young children. The ingestions often occurred between March and May. The ingestions typically were managed outside of a health care facility and did not result in serious outcomes. The most common clinical effects were gastrointestinal and neurologic.