Question

For Toxicology Course Experts

Three dozen men ranging from 20-30 years of age attended a communal lunch in India at which they ate chapatti, cooked vegetables, pulses, and halva. They all developed nausea, vomiting, frequent urination and abdominal pain over the next three hours. The men were taken to a local primary healthcare center where they received treatment for their symptoms. Most responded to the treatment and were discharged home the same day. However, the condition of one patient deteriorated. His level of consciousness fell, developed respiratory distress, hypotension and generalized muscular weakness. The next day he was moved to an urban emergency hospital.

Initial treatment included intravenous fluids, antiemetics, and antibiotics. On the second day after admission to the urban emergency hospital, he developed respiratory insufficiency. Because he needed endotracheal intubation and intermittent positive pressure ventilation, he was transported immediately to a tertiary care hospital. Over the next 24 hours he developed type II respiratory failure with paralysis of thoracic, neck, and diaphragmatic muscles. He underwent tracheostomy and was ventilated mechanically for the next few days. He was treated with atropine and pralidoxime (1 g intravenously), but his neurological status did not improve appreciably, nor did his muscle strength improve much over the nine days after admission to hospital. On day 10 he had a cardiac arrest and could not be revived.

1. What are possible toxicants that these individuals may have been exposed to in this environment?
2. Why did the one individual suffer a lethal episode, but the others recovered quickly?

Answer 1

1)Travellers are at high risk of developing food borne illness or food poisoning because of the exposure to foods prepared outside home at unknown preparation and storage conditions.

In this case, the individuals might be exposed to bacteria( E. COLI, CLOSTRIDIUM BOTULINUM,STAPH. SPECIES .,etc) or virus like hepatitis A virus ,norovirus , rotavirus., or mycotoxins etc

The transmission might occur through food contaminated by infected person or through food contaminated by bacteria or virus or mycotoxins due to undercooked vegetables or in appropriate storage conditions before serving the food.

Food borne illness or food poisoning are self limiting but sometimes requires supportive symptomatic treatment.The same happened with all the men except the one.

2)One possibility that one individual suffered a lethal episode is because he might be immuno comprimised and he has no immunity to fight back to this acute infection thus leading to death.

second possibility is he might have had food allergy to legumes or to their seeds(pulses).So, when he exposed to the same food (pulses,tamarind, fenugreek , chickpeas, beans - that was seved to him) his immune system was triggered leading to respiratory distress, hypotension and muscle weakness and ultimately death.

third possibilty is he might develop hemolytic uremic syndrome that causes kidneys and other organs to shut down.