Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March-April 2019.

Autor: Mutebi RR; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. mutebi2r@musph.ac.ug., Ario AR; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.; Ministry of Health, Kampala, Uganda., Nabatanzi M; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Kyamwine IB; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Wibabara Y; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Muwereza P; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Eurien D; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Kwesiga B; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Bulage L; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Kabwama SN; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Kadobera D; Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda., Henderson A; Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Callahan JH; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., Croley TR; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., Knolhoff AM; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., Mangrum JB; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., Handy SM; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., McFarland MA; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., Sam JLF; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA., Harris JR; Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.; US Centers for Disease Control and Prevention, Kampala, Uganda., Zhu BP; Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.; US Centers for Disease Control and Prevention, Kampala, Uganda.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2022 Mar 30; Vol. 22 (1), pp. 623. Date of Electronic Publication: 2022 Mar 30.
DOI: 10.1186/s12889-022-12854-1
Abstrakt: Background: Jimsonweed (Datura stramonium) contains toxic alkaloids that cause gastrointestinal and central nervous system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous crops, mixing with them during harvesting. On 13 March 2019, more than 200 case-patients were admitted to multiple health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and magnitude of the outbreak and recommended evidence-based control and prevention measures.
Methods: We defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea, or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1 March-30 April 2019. We reviewed medical records and canvassed all villages of the eight affected subcounties to identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed 211 residents about dietary history during 11-15 March. We used modified Poisson regression to assess suspected food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic, DNA, and microbiological testing in one national and three international laboratories.
Results: We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2-12 h after Batch X of fortified corn-soy blend (CSB +) was distributed. In the retrospective cohort study, 66% of 134 persons who ate CSB + , compared with 2.2% of 75 who did not developed illness (RR adj  = 22, 95% CI = 6.0-81). Samples of Batch X distributed 11-15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and scopolamine (1-10 ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant laboratory findings were observed.
Conclusion: This was the largest documented outbreak caused by food contamination with tropane alkaloids. Implicated food was immediately withdrawn. Routine food safety and quality checks could prevent future outbreaks.
(© 2022. The Author(s).)
Databáze: MEDLINE
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