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

Abstract

BackgroundAn 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 FindingsWe 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.ConclusionsThe 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.

The genotoxic and anti-genotoxic effects of Stachys petrokosmos leaf extract in human lymphocytes using microsomal fractions

“…Hollman et al (1996) reported that the plant flavonoids had anti-inflammatory, anti-mutagenic and anti-allergic effects. However, adverse effects such as mutation, cancer, gastric problems and inflammatory disorders for some plant oils were reported (Qu et al 1992;Chiang et al 1997;Gurley et al 2010). …”

“…In contrast, the unconscious use of the plants in medicine could cause toxic (Qu et al 1992;Chiang et al 1997), mutagenic or cancerogenic effects (Gurley et al 2010;Háznagy-Radnai et al 2008;Rencuzogullari et al 2009;Buyukleyla and Rencuzogullari 2009;Kayraldiz et al 2010;Kocaman et al 2011). Azirak and Rencuzogullari (2008) also reported that thymol and carvacrol induced chromosomal abnormalities in bone marrow cells of rats.…”

Consumption of pesticide-treated wheat seed by a rural population in Malawi

“…During 2007, a fatal outbreak of illness occurred among villagers in Bangladesh when they consumed Xanthium strumarium seedlings (commonly known as cocklebur) after destructive monsoon flooding eliminated most of the available local food supply. 1 Consumption of large amounts of these seedlings resulted in nausea, vomiting, loss of consciousness, hepatotoxicity, and in some cases, death among villagers. 1 Epidemics of lathyrism and neurolathyrism, a condition resulting in irreversible spastic paraparesis (extremity weakness) of the lower limbs resulting from ingestion of the grasspea (Lathyrus sativus), have occurred throughout history in times of drought and food shortages.…”

“…1 Consumption of large amounts of these seedlings resulted in nausea, vomiting, loss of consciousness, hepatotoxicity, and in some cases, death among villagers. 1 Epidemics of lathyrism and neurolathyrism, a condition resulting in irreversible spastic paraparesis (extremity weakness) of the lower limbs resulting from ingestion of the grasspea (Lathyrus sativus), have occurred throughout history in times of drought and food shortages. 2,3 Konzo, a permanent spastic para-or tetraparesis, is reported to occur during dry seasons and is associated with consumption of improperly prepared cassava (Manihot esculenta).…”

Karyotype Analysis in 2 Morphological Forms of <i>Xanthium strumarium</i> L.

“…Recently some toxic effects of Xanthium strumarium have been reported from Bangladesh. After consuming the seed and seedlings of X. strumarium, an outbreak including vomiting and unconsciousness occurred in the people of the northeastern part of Bangladesh in 2007, including some fatalities (Gurley et al 2010). Although both the forms were reported as poisonous at the seedling stage, the purple form is more toxic (Dr. Mohammed Zashim Uddin, personal communication).…”