Fatal Outbreak from Consuming Xanthium strumarium Seedlings during Time of Food Scarcity in Northeastern Bangladesh

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Gurley, Emily S. ; Rahman, Mahmudur ; Hossain, M. Jahangir ; Nahar, Nazmun ; Faiz, M. Abul ; Islam, Nazrul ; Sultana, Rebeca ; Khatun, Selina ; Uddin, Mohammad Zashim ; Haider, M. Sabbir ; Islam, M. Saiful ; Ahmed, Be-Nazir ; Rahman, Muhammad Waliur ; Mondal, Utpal Kumar ; Luby, Stephen P.
• Description:
  Background
  
  An outbreak characterized by vomiting and rapid progression to unconsciousness and death was reported in Sylhet Distrct in northeastern Bangladesh following destructive monsoon floods in November 2007.
  
  Methods and Findings
  
  We identified cases presenting to local hospitals and described their clinical signs and symptoms. We interviewed patients and their families to collect illness histories and generate hypotheses about exposures associated with disease. An epidemiological study was conducted in two outbreak villages to investigate risk factors for developing illness. 76 patients were identified from 9 villages; 25% (19/76) died. Common presenting symptoms included vomiting, elevated liver enzymes, and altered mental status. In-depth interviews with 33 cases revealed that 31 (94%) had consumed ghagra shak, an uncultivated plant, in the hours before illness onset. Ghagra shak was consumed as a main meal by villagers due to inaccessibility of other foods following destructive monsoon flooding and rises in global food prices. Persons who ate this plant were 34.2 times more likely (95% CI 10.2 to 115.8, p-value<0.000) than others to develop vomiting and unconsciousness during the outbreak in our multivariate model. Ghagra shak is the local name for Xanthium strumarium, or common cocklebur.
  
  Conclusions
  
  The consumption of Xanthium strumarium seedlings in large quantities, due to inaccessibility of other foods, caused this outbreak. The toxic chemical in the plant, carboxyatratyloside, has been previously described and eating X. strumarium seeds and seedlings has been associated with fatalities in humans and livestock. Unless people are able to meet their nutritional requirements with safe foods, they will continue to be at risk for poor health outcomes beyond undernutrition.
• Subjects:
  • Research Article
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Foodborne Diseases
  • Humans
  • Infant
  • Male
  More +
• Source:
  PLoS One. 5(3).
• Pubmed ID:
  20305785
• Pubmed Central ID:
  PMC2841199
• Document Type:
  Journal Article
• Funding:
  U01 CI000298/CI/NCPDCID CDC HHS/United States
• Place as Subject:
  Bangladesh
• Volume:
  5
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/22932/cdc_22932_DS1.pdf
• File Type:
  [PDF - 221.63 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:74109deed32145f75ec4e6dd88df225b203ee0b07dbdda0325db9f2aa291374c