Involvement of Egyptian Foods in Foodborne Viral Illnesses: The Burden on Public Health and Related Environmental Risk Factors: An Overview.

Foodborne viral diseases are a major public health threat and pose a huge burden on the economies of both developed and developing countries. Enteric viruses are the causative agents of most foodborne illnesses and outbreaks. Egypt is classified by WHO among the regions with intermediate to high endemicity for various enteric viruses. This is manifested by the high prevalence rates of different enteric virus infections among Egyptian population such as Hepatitis A and E viruses, human rotaviruses, human noroviruses, human astroviruses, and human adenovirus. Recently, a number of foodborne gastroenteritis and acute hepatitis outbreaks have occurred in the US, Canada, Australia, and the European Union countries. Some of these outbreaks were attributed to the consumption of minimally processed foods imported from Egypt indicating the possibility that Egyptian foods may also be partially responsible for high prevalence of enteric virus infections among Egyptian population. In the absence of official foodborne-pathogen surveillance systems, evaluating the virological safety of Egyptian foods is a difficult task. In this review, we aim to provide a preliminary evaluation of the virological safety of Egyptian foods. A comprehensive review of prevalence studies on enteric virus infections shows hyperendemicity of several enteric viruses in Egypt and provides strong evidence of implication of Egyptian foods in these infections. We also address possible environmental risk factors that may lead to the contamination of Egyptian foods with enteric viruses. In addition, we describe potential obstacles to any plan that might be considered for improving the virological safety of Egyptian foods.

Mortality risk factors for listeriosis - A 10 year review of non-pregnancy associated cases in England 2006-2015.

LISTERIOSIS: is a foodborne illness that can result in septicaemia, Central Nervous System (CNS) disease, foetal loss and death in high risk patients. OBJECTIVES: To analyse the demographic trends, clinical features and treatment of non-perinatal listeriosis cases over a ten year period and identify mortality-associated risk factors. METHODS: Reported laboratory-confirmed non-pregnancy associated cases of listeriosis between 2006 and 2015 in England were included and retrospectively analysed. Multivariate logistic regression analysis was performed to determine independent risk factors for mortality. RESULTS: 1357/1683 reported cases met the inclusion criteria. Overall all-cause mortality was 28.7%; however, mortality rates declined from 42.1% to 20.2%. Septicaemia was the most common presentation 69.5%, followed by CNS involvement 22.4%. CNS presentations were significantly associated with age < 50 years, and septicaemia with older age. Age > 80 years (OR 3.32 95% CI 1.92-5.74), solid-organ malignancy (OR 3.42 95% CI 2.29-5.11), cardiovascular disease (OR 3.30 95% CI 1.64-6.63), liver disease (OR 4.61 95% CI 2.47-8.61), immunosuppression (OR 2.12 95% CI 1.40-3.21) and septicaemia (OR 1.60 95% CI 1.17-2.20) were identified as independent mortality risk factors. CONCLUSIONS: High risk groups identified in this study should be the priority focus of future public health strategies aimed at reducing listeriosis incidence and mortality.

Micetismo: reporte de dos casos fatales y revisión bibliográfica / Mycetism: Report of two fatal cases and review of the literature

Justificación:El micetismo es la intoxicación producida por la ingestión de setas silvestres, que puede presentarse clínicamente con diferentes síndromes toxicológicos, dependiendo de la especie de hongo involucrada y sus toxinas. Su importancia médicolegal radica en que la ingesta puede ocurrir de manera accidental, homicida o suicida. Objetivo: Revisar aspectos relevantes sobre el micetismo, para el reconocimiento de síndromes toxicológicos asociados a la ingesta de setas. Metodología:Se revisaron diferentes bases de datos utilizando las palabras clave: micetismo, Amanita phalloides, autopsia médicolegal, abordaje diagnóstico. Resultados:A. phalloides, contiene amatoxinas causantes de insuficiencia hepática aguda y las falotoxinas responsables de manifestaciones gastrointestinales 10 horas después de la ingesta, característica del síndrome tóxico faloidiano. Los casos que se describen corresponden a dos femeninas de la misma familia, una mujer adulta 36 años embarazada y su hija de seisaños, procedentes de una comunidad rural en la parte central de Honduras, que fallecieron después de la ingestión de setas silvestres y cuyas autopsias se realizaron en la Dirección de Medicina Forense de Tegucigalpa, para establecer la causa de muerte. En la historia médico legal se consignó que los hongos fueron cocinados por la madre y consumidos por ella y su hija. Conclusión:Es recomendable la capacitación continuade los médicos de emergencia en hospitales, para el reconocimiento de síndromes toxicológicos asociados a la ingesta de setas, con el propósito de tratar oportunamente estos pacientes y ofrecerles mejor oportunidad de sobrevivir...(AU)

Acute and chronic bovine pulmonary edema and emphysema in Uruguay / Edema e enfisema pulmonar agudo e crônico em bovinos do Uruguai

An outbreak of pulmonary edema and emphysema with acute and chronic cases is reported in a farm in Uruguay. In a herd of 40 Hereford steers, 20 died. The deaths began four days after a change of paddock, from an old pasture of Avena sativa to a lush growing pasture of the same grass. Acutely affected animals showed severe dyspnea, sialorrhea, cough, and subcutaneous edema, and died within 72 hours. Chronically affected steers showed dyspnea, respiratory noises, weight loss, and intolerance to exercise. The deaths began four days after the change of paddock. Ten days after the first death, the steers were withdrawn from the pasture, but continued dying throughout the following 40 days. Twenty animals died and six were necropsied. Grossly, the lungs were diffusely armed and glistening, with reddish and crepitant cut surface, and presented alveolar septae sharply distended by edema and emphysema. There was subpleural emphysema with air blebs distributed across the pleural surface. Presence of Dictyocaulus viviparus was observed in three steers. In some animals, the trachea was diffusely reddish with presence of pink foam; in some others, there was bloody liquid in the tracheal lumen. Histologic examination showed severe diffuse alveolar and interstitial emphysema, hyaline membranes adhered to the alveolar wall, thickening of the interlobular septae with proliferation of type II pneumocytes, and moderate-to-severe multifocal histiocytic, neutrophilic and eosinophilic infiltrate. In the trachea, there was submucosal hemorrhage and moderate multifocal eosinophilic and lymphocytic infiltrate. The steers with chronic signs presented similar lung lesions, but multifocal pulmonary fibrosis and cardiac dilatation were also observed. The diagnosis of acute bovine pulmonary emphysema and edema (ABPE) was based on the occurrence of the disease after introduction of the herd in a lush green pasture, on the characteristic gross and histologic lesions, and on the absence of other toxic or infectious agents causing similar lesions. Cattle raisers should be alert to the risks of occurrence of this disease after the introduction of the herds into paddocks with green and lush pastures.(AU)

Descreve-se um surto de edema e enfisema pulmonar com casos agudos e crônicos em bovinos em uma criação semi-intensiva no Uruguai. De um lote de 40 novilhos da raça Hereford morreram 20. As mortes começaram quatro dias após uma mudança de alimentação, de uma pastagem mais velha de Avena sativa, para uma pastagem recentemente plantada de aveia que estava em brotação. Os animais afetados apresentaram sinais clínicos agudos de dispneia, sialorreia, tosse e alguns desenvolveram edema subcutâneo, morrendo em até 72 horas. Outros novilhos mais cronicamente afetados apresentaram dispneia, ruídos respiratórios, perda de peso e intolerância ao exercício. As mortes começaram quatro dias após a mudança de pastagens. Dez dias após a primeira morte, os novilhos foram retirados do pasto, mas morreram ainda durante 40 dias mais. Ao total, morreram vinte animais e seis foram necropsiados. Nas necropsias dos animais mortos na fase aguda os pulmões estavam difusamente armados e brilhosos e ao corte de coloração avermelhada e crepitante, com os septos alveolares acentuadamente distendidos por edema e enfisema. Havia enfisema subpleural caracterizado por bolhas de ar distribuídas pela superfície pleural. Em três bovinos havia ainda presença de Dictyocaulus viviparus. Alguns animais apresentaram a traqueia difusamente avermelhada com espuma de coloração rósea ou liquido sanguinolento livre na luz traqueal. Histologicamente havia edema e enfisema alveolar e intersticial difuso severo, membranas hialinas espessas aderidas à parede alveolar, espessamento dos septos interlobulares com proliferação de pneumócitos tipo II e infiltrado inflamatório histiocítico, neutrofílico e eosinofílico multifocal moderado a severo. Na traqueia havia hemorragias na submucosa e infiltrado eosinofílico e linfocítico multifocal. Os novilhos com sinais crônicos apresentaram lesões pulmonares semelhantes, entretanto, foram observadas também, fibrose pulmonar multifocal e dilatação cardíaca. O diagnóstico de EEPAB baseou-se na ocorrência da doença após a introdução do rebanho em uma pastagem viçosa em brotação, nas características macroscópicas e histológicas e na ausência de outros agentes tóxicos ou infecciosos que causam lesões semelhantes. Se alerta para os riscos da ocorrência desta enfermidade, quando houver mudanças de pastagens.(AU)

La implementación de procedimientos estandarizados en la prevención de enfermedades transmitidas por los alimentos. Conteo microbiológico del Staphylococcus aureus en quesos frescos / Implementation of standardized procedures to prevent diseases transmitted by foodstuffs. Microbiological count of Staphylococcus aureus in freshcheese

Introducción: las enfermedades transmitidas por alimentos son una problemática mundial a la que la Organización Mundial de la Salud y los países brindan una atención especial. Dentro de los grupos de alto riesgo se encuentran los productos de origen animal, como la leche y sus derivados. Staphylococcus aureus es un microorganismo causante de brotes de las enfermedades transmitidas por alimentos, lo que genera la necesidad de estudiar la carga microbiana y establecer los controles adecuados. Objetivo: evaluar la calidad microbiológica en el proceso manufacturero en el área de producción de la Cooperativa de Producción Agropecuaria Chone LTDA, con el fin de asegurar la ausencia del Staphylococcus aureus en el queso fresco 100% chonero. Materiales y métodos: Se realizó un estudio de evaluación de la calidad en cuatro fases. Se realizaron exámenes microbiológicos iniciales, se identificaron las causas esenciales de contaminación identificadas por observación directa, revisión de documentos y entrevistas, como base para la elaboración e implementación de POE (Procedimientos Operativos Estandarizados) y POES (Procedimientos Operativos Estandarizados de Saneamiento). Se cumplieron los requerimientos éticos y se realizaron los análisis estadísticos utilizando porcentaje e índices como medida resumen y con el uso de IBM SPSS, versión libre, realizándose regresión logística binaria para determinar la probabilidad de éxito al aplicar dichos procedimientos. Resultados: los análisis microbiológicos iniciales (antes de implementación de POE y POES), dieron como resultado: 98, 116, 79, 120 y 13 UFC/g para las muestras: DiQ1, DiQ2, DiQ3, DiQ4 y DiQ5, respectivamente. Las causas esenciales de contaminación fueron falta de control microbiológico, falta de control del aspecto del personal y falta de control del agua) Una vez implementados los POE y POES, el análisis mostró ausencia en todas las muestras analizadas. Conclusiones: se concluye que la aplicación de POE y POES tiene un efecto significativo sobre la ausencia del Staphylococcus aureus, con probabilidad de éxito del 100% (AU).

Introduction: Diseases transmitted by foodstuffs (DTF) are a worldwide problem that receives special attention by WHO and different countries. High risk groups include foodstuff of animal origin, like milk and its by-products. Staphylococcus aureus is a microorganism responsible for DTF outbreaks which generates the necessity of studying its microbial burden and establishing the adequate controls. Objective: to evaluate the microbiological quality of the manufacturing process in the production area of the Farming and Stockbreeding Cooperative Chone LTDA, to assure the absence of Staphylococcus aureus in the manufacturing process of fresh cheese. Materials and methods: A study to assess the quality in four stages was carried out: initial microbiological tests, identification of the essential contamination causes by direct observation, documental review and inquires. They were used to elaborate and implement the Standardized Operational Procedures (SOP) and the Standardized Operational Procedures of Sanitation (SOPS). The ethical requirements were fulfilled and the statistical tests were performed using percentages and indexes as summary measures through IBM SPSS, free version; binary logistic regression was made to determine the success when applying those procedures. Results: initial microbiological controls (before implementing SOP and SOPS) gave these results 98, 116, 79, 120, and 13 UFC/g for samples DiQ1, DiQ2, DiQ3, DiQ4 and DiQ5 respectively. The main contamination causes were lack of microbiological control, lack of control on the staff's cleanliness and lack of control on the water. After implementing SOP and SOPS microbiological control found particularly clean samples. Conclusions: SOP and SOPS have a significant effect on the amount of Staphylococcus aureus, with 100% success probability (AU).

Surto de doença trasmitida por alimentos nos municipios de Mauá e Ribeirão Pires - SP / Outbreak of foodborne diseases in the municipalities of Maua and Ribeirao Pires - SP

Doenças de transmissão hídrica e alimentar (DTHA) acarretam importantes problemas econômicos e de saúde pública no mundo atual. Este estudo relata um surto de Doença Transmitida por Alimento - DTA que envolveu 12 pessoas de duas residências localizadas na Região do ABC paulista em dezembro de 2012. Quatro pessoas de uma residência tiveram sintomas de diarreia, cólica abdominal, náusea, vômito, febre e prostração, sendo que apenas duas consumiram o bolo preparado em Ribeirão Pires, SP - Brasil. Outras oito pessoas consumiram o mesmo alimento no município de Mauá e, além dos sintomas citados, houve também registro de insuficiência renal e parada cardiorrespiratória. Dentre os envolvidos, uma menina de oito anos veio a óbito após convulsão e bronco-aspiração. O período variou entre 2 e 22 horas após o consumo do alimento. A amostra de bolo foi analisada segundo a metodologia preconizada pelo BAM-FDA e teve como resultados: Coliformes termotolerantes (NMP = 4,6x104/g); Bacillus cereus (1,5x105 U.F.C./g) e presença de Salmonella Enteritidis em 25 gramas. Clostridium perfringens, Staphylococcus aureus e Listeria monocytogenes não foram isolados. Foram realizadas duas coproculturas que apresentaram resultados positivos para Salmonella Enteritidis. As cepas de Salmonella spp isoladas, tanto no alimento como nas fezes dos pacientes, apresentaram similaridade genética e mesmo perfil de suscetibilidade aos antimicrobianos. Assim, foi constatado o envolvimento do bolo como veiculador de patógenos e ressaltada a importância do trabalho em conjunto das vigilâncias sanitárias e epidemiológicas de ambos os municípios e o laboratório de referência em saúde pública, fundamental na elucidação deste surto.

Vital signs: Listeria illnesses, deaths, and outbreaks--United States, 2009-2011.

BACKGROUND: Older adults, pregnant women, and persons with immunocompromising conditions are at higher risk than others for invasive Listeria monocytogenes infection (listeriosis), a rare and preventable foodborne illness that can cause bacteremia, meningitis, fetal loss, and death. METHODS: This report summarizes data on 2009-2011 listeriosis cases and outbreaks reported to U.S. surveillance systems. The Listeria Initiative and PulseNet conduct nationwide surveillance to rapidly detect and respond to outbreaks, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, sentinel population-based surveillance to track incidence trends, and the Foodborne Disease Outbreak Surveillance System (FDOSS) receives reports of investigated outbreaks to track foods and settings associated with outbreaks. RESULTS: Nationwide, 1,651 cases of listeriosis occurring during 2009-2011 were reported. The case-fatality rate was 21%. Most cases occurred among adults aged ≥65 years (950 [58%]), and 14% (227) were pregnancy-associated. At least 74% of nonpregnant patients aged <65 years had an immunocompromising condition, most commonly immunosuppressive therapy or malignancy. The average annual incidence was 0.29 cases per 100,000 population. Compared with the overall population, incidence was markedly higher among adults aged ≥65 years (1.3; relative rate [RR]: 4.4) and pregnant women (3.0; RR: 10.1). Twelve reported outbreaks affected 224 patients in 38 states. Five outbreak investigations implicated soft cheeses made from pasteurized milk that were likely contaminated during cheese-making (four implicated Mexican-style cheese, and one implicated two other types of cheese). Two outbreaks were linked to raw produce. CONCLUSIONS: Almost all listeriosis occurs in persons in higher-risk groups. Soft cheeses were prominent vehicles, but other foods also caused recent outbreaks. Prevention targeting higher-risk groups and control of Listeria monocytogenes contamination in foods implicated by outbreak investigations will have the greatest impact on reducing the burden of listeriosis. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Careful attention to food safety is especially important to protect vulnerable populations. Surveillance for foodborne infections like listeriosis identifies food safety gaps that can be addressed by industry, regulatory authorities, food preparers, and consumers.

Integrating animal health and foodborne disease surveillance.

The control of foodborne diseases from an animal source has become an important part of public health policy. Since the agents that cause these diseases originate in animals, Veterinary Services, as well as Public Health Services, must be involved in their control. Control programmes should be established either through cooperation between the two Services or by the consolidation of all those involved into a single food control agency. Surveillance is an important part of these control programmes. The following questions must be addressed when planning an effective surveillance programme. What is the relative incidence, morbidity, mortality and economic cost of the foodborne disease in humans? Is the animal population the exclusive or a significant source of the human foodborne infection? What kind of surveillance is needed to identify the disease-causing agent in the animal population? Are we interested in identifying all cases of a disease in order to eradicate it or is our aim to reduce its incidence in the animal population? Do we have the ability to control the disease in the animal population? What disease detection tests are available? What are the sensitivity, specificity and cost of these diagnostic tests? Finally, does the country, region or agency involved have the legal, financial and educational resources to carry out this surveillance and follow it up with appropriate action? After these questions have been resolved,the veterinary and public health sectors must jointly decide if surveillance and control are feasible. If so, they can then begin to develop an appropriate programme.

Global burden of human food-borne trematodiasis: a systematic review and meta-analysis.

BACKGROUND: Food-borne trematodiases are a group of neglected tropical diseases caused by liver, lung, and intestinal parasitic fluke infections. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2010 study) and a WHO initiative, we assessed the global burden of human food-borne trematodiasis, as expressed in disability-adjusted life years (DALYs) for the year 2005. METHODS: We systematically searched electronic databases for reports about human food-borne trematodiasis without language restriction, between Jan 1, 1980, and Dec 31, 2008. We used a broad search strategy with a combination of search terms and parasite and disease names. The initial search results were then screened on the basis of title, abstract, and, finally, full text. Relevant quantitative and qualitative data on human prevalence, morbidity, and mortality of food-borne trematodiasis were extracted. On the basis of available information on pathological and clinical appearance, we developed simplified disease models and did meta-analyses on the proportions and odds ratios of specified sequelae and estimated the global burden of human food-borne trematodiasis. FINDINGS: We screened 33,921 articles and identified 181 eligible studies containing quantitative information for inclusion in the meta-analyses. About 56·2 million people were infected with food-borne trematodes in 2005: 7·9 million had severe sequelae and 7158 died, most from cholangiocarcinoma and cerebral infection. Taken together, we estimate that the global burden of food-borne trematodiasis was 665,352 DALYs (lower estimate 479,496 DALYs; upper estimate 859,051 DALYs). Furthermore, knowledge gaps in crucial epidemiological disease parameters and methodological features for estimating the global burden of parasitic diseases that are characterised by highly focal spatial occurrence and scarce and patchy information were highlighted. INTERPRETATION: Despite making conservative estimates, we found that food-borne trematodiases are an important cluster of neglected diseases. FUNDING: Swiss National Science Foundation; Institute for Health Metrics and Evaluation.

Reviews on trichinellosis (I): renal involvement.

Besides cardiac and neurological complications of trichinellosis, renal involvement is the most important as regards the cases published and discussed in literature and is generally characteristic of the severe forms of the disease. This article focuses exclusively on the renal disturbances that may occur in this parasitic illness and includes a synopsis of published cases. Our primary goal was to increase the awareness of infectious diseases specialists, nephrologists, and general practitioners about these complications with possible fatal outcome. To our knowledge, this is the first international review dedicated to this topic. Cases for which enough details were available have been analyzed, and the results indicated that the mean age of the affected patients was 31.6 years, with a slightly male predominance (56.2%). The fatality rate was 26.1%. Proteinuria was detected in 84.8% of cases, hematuria in 30.4%, and casts were observed in urine specimens from 23.9% of patients. Renal failure was evidenced in 8.7% of patients, whereas renal lesions were found by biopsy or necropsy in 43.5% of cases. Of the routine laboratory parameters that are relevant for trichinellosis, mean eosinophil count was 32.2% and mean leukocyte count was 17,312 cells/µL. Finally, we emphasize on the necessity of establishing an early and correct diagnosis of trichinellosis to avoid later and severe complications. Additionally, implementation of public health and food safety prophylactic measures against the disease must represent an immediate priority for the affected regions.

La increíble empresa de Sarmiento de Gamboa y su triste fin: Posibles causas de la tragedia en el Estrecho de Magallanes en el siglo XVI / The possible causes of the tragedy of “Port Famine” in the Strait of Magellan

The attempts to colonize the Strait of Magellan soon followed the discovery of this route. PeDro Sarmiento de Gamboa, a Spanish sailor, established human settlements to fortify those lands and control the transit of vessels, especially those of English corsairs, which devastated Chilean and Peruvian coasts. During the summer of 1584, approximately 500 soldiers, artisans, priests, women and children established two villages called “Nombre de Jesús” and “Rey Don Felipe”. From the beginning, these settlers had leadership and communication problems and difficulties to obtain food. After three winters only 17 to 18 people survived according to the testimony of one of the survivors, that was rescued by an English sailor named Cavendish, which renamed the village “Rey Don Felipe” as “Port Famine”. When he observed the scenes of abandonment and death, he supposed that the settlers died due to lack of food. Other factors that facilitated the desolation were hypothermia, execution, anthropophagy and lesions caused by natives. There is also a possibility that intoxication by red tide (harmful algal bloom) could explain in part the finding of unburied corpses in the strait beaches.

Tetrodotoxin poisoning following ingestion of the toxic eggs of the horseshoe crab Carcinoscorpius rotundicauda, a case series from 1994 through 2006.

Between 1994 and 2006, a total of 280 cases of varying degrees of tetrodotoxin poisoning following ingestion of the toxic eggs of the horseshoe crab, Carcinoscorpius rotundicauda, were admitted to the medical service of Chon Buri Hospital. The severity of the poisoning was classified into four stages based on clinical signs and symptoms of human tetrodotoxication. Of 245 available medical records; 100 were in stage 1, 74 were in stage 2, 3 were in stage 3 and 68 were in stage 4. The frequencies of symptoms and signs included the following : circumoral and lingual numbness (98%), hands and feet numbness (94.7%), weakness (59.6%), dizziness and vertigo (54.3%), nausea and vomiting (52.6%), transient hypertension (39.6%), respiratory paralysis (27.7%), fixed dilated pupils (14.7%), ophthalmoplegia (12.2%), blood pressure lower than 90/60 mmHg (5.7%), and polyuria (0.4%). All patients received symptomatic and supportive treatment. Endotracheal intubation and mechanical ventilation were considered when paralysis was progressing rapidly. The results of treatment are as follows: 239 patients (97.5%) showed complete recovery, 5 patients (2%) died, and 1 patient (0.4%) suffered anoxic brain damage. Horseshoe crab poisoning occurs both sporadically and epidemically in Chon Buri. Seasonal variation in the number of cases of poisoning was observed with a peak from December through March.

Identification of polycavernoside A as the causative agent of the fatal food poisoning resulting from ingestion of the red Alga Gracilaria edulis in the Philippines.

Outbreaks of seaweed poisonings are widely spread over the pacific area. Fatal glycosidic macrolides, polycavernosides, and potent tumor promoters, aplysiatoxins, have been previously isolated from edible seaweed. During 2002-2003, three fatal poisoning incidents occurred resulting from ingestion of two edible red alga, Acanthophora specifera and Gracilaria edulis, in Philippines causing eight deaths among 36 patients. Analytical methods for polycavernosides and aplysiatoxins were first developed, and the causative toxin from G. edulis, collected during the second poisoning event on December 2, 2002, was then investigated. The semipurified toxic fraction obtained from this alga based on mouse bioassay was applied to LC-diode array detection (LC-DAD) and LC/electrospray-MS (LC/ESI-MS) analyses. Both LC-DAD and LC/MS chromatograms of this fraction suggested the presence of polycavernoside A (PA) by comparison with the authentic PA. The amount of PA in the alga was estimated as 84 and 72 nmol/kg, using the standard calibration curves for LC-DAD and for LC/ESI-MS in single ion monitoring (SIM) mode, respectively. Other polycavernoside congeners, A2, A3, and B2, and aplysiatoxin and debromoaplysiatoxin were less than the detection limit (2 nmol/kg alga, signal-to-noise ratio: 3) by LC/ESI-MS SIM analysis. In ESI-MS/MS, authentic polycavernosides showed the daughter ions corresponding to a sequential loss of fucosylxylose residues. These fragmentations were applied to LC/ESI-MS/MS for polycavernosides in selective reaction monitoring (SRM) mode. On SRM mass chromatograms, the toxic fraction from the alga showed the peaks corresponding to PA, supporting the identification of PA as the cause of poisoning of G. edulis in Philippines.

Ethylene glycol exposures managed by the ASPCA National Animal Poison Control Center from July 1995 to December 1997.

Five-hundred and ten cases of ethylene glycol (EG) exposures in animals were compiled by the ASPCA National Animal Poison Control Center from July 1995 through December 1997. Case distribution was analyzed by species, sex, age, weight, seasonality, treatment intervention and final outcome. Dogs and cats were most commonly involved (98.0%). The sex distribution was approximately equal. Adult animals accounted for the majority of cases. Exposures were commonly (57.0%) from container spill, engine flush, or engine leak and were in or around the home (66.0%). Cases were reported throughout the year with slight increase during March-May. Among cases with a known final outcome, 59.0% did not show clinical signs and death/euthanasia, major and minor illness was reported in 28.0%, 5.0% and 8.0%. In view of the widespread use and potential toxicity of EG, the low number of EG exposures reported (510) among the total number of hazardous exposures (97,383) to all substances for the same period was remarkable. The EG exposures resulting in animal death/euthanasia were lower than previously published.

Toxic oil syndrome mortality: the first 13 years.

BACKGROUND: The toxic oil syndrome (TOS) epidemic that occurred in Spain in the spring of 1981 caused approximately 20000 cases of a new illness. Overall mortality and mortality by cause in this cohort through 1994 are described for the first time in this report. METHODS: We contacted, via mail or telephone, almost every living member of the cohort and family members of those who were known to have died in order to identify all deaths from 1 May 1981 through 31 December 1994. Cause of death data were collected from death certificates and underlying causes of death were coded using the International Classification of Diseases, 9th Revision. RESULTS: We identified 1663 deaths between 1 May 1981 and 31 December 1994 among 19 754 TOS cohort members, for a crude mortality rate of 8.4%. Mortality was highest during 1981, with a standardized mortality ratio (SMR) of 4.92 (95% confidence interval [CI]: 4.39-5.50) compared with the Spanish population as a whole. The highest SMR, (20.41, 95% CI: 15.97-25.71) was seen among women aged 20-39 years during the period from 1 May 1981 through 31 December 1982. Women <40 years old, who were affected by TOS , were at greater risk for death in most time periods than their unaffected peers, while older women and men were not. Over the follow-up period, mortality of the cohort was less than expected when compared with mortality of the general Spanish population, or with mortality of the population of the 14 provinces where the epidemic occurred. We also found that, except for deaths attributed to external causes including TOS and deaths due to pulmonary hypertension, all causes of death were decreased in TOS patients compared to the Spanish population. The most frequent underlying causes of death were TOS, 350 (21.1%); circulatory disorders, 536 (32.3%); and malignancies, 310 (18.7%). CONCLUSIONS: We conclude that while on average people affected by toxic oil syndrome are not at greater risk for death over the 13-year study period than any of the comparison groups, women <40 years old were at greater risk of death.

A cohort study on mortality and exposure to polychlorinated biphenyls.

In 1979, an outbreak of food poisoning ("Yu-Cheng") occurred in Central Taiwan, ROC, involving more than 2000 people. The event was caused by ingestion of rice oil contaminated with polychlorinated derivatives of biphenyls, dibenzofurans, and quaterphenyls. A retrospective cohort study on mortality was undertaken, and possible long-term health effects in the affected individuals were studied. The mortality experience of 1940 victims (929 males, 1011 females) between 1980 and 1991 was compared with the expected numbers, which were calculated from national and local mortality rates. By the end of 1991, 102 deaths were identified, thus producing a standardized mortality ratio (SMR) of overall mortality of 0.99 for males and 1.34 for females. Total cancer mortality was lower than in each comparison group. Mortality from liver diseases was elevated significantly (SMR = 3.22), especially during the first 3 y after the food-poisoning event (SMR = 10.76). Increased clinical severity of polychlorinated biphenyl intoxication was associated with increased mortality from all causes and from liver diseases. In summary, there was a positive association between mortality and intoxication dose, and severe polychlorinated biphenyl poisoning acutely affected mainly the liver. A continued follow-up of this cohort would be valuable in the study of long-term health effects of polychlorinated biphenyl poisoning.

Accumulation and physiological and biochemical effects of cadmium in a simple aquatic food chain.

The toxicity of cadmium with regard to the vegetative reproduction of duckweed, Lemna gibba, grown in sterile culture, was determined. The EC50 was found to be 800 ppb. Duckweed grown in 2.24 ppm cadmium (supplied as cadmium nitrate) for 7 days accumulated 98.5% of the available cadmium from the growth medium. Plants that had been grown for 7 days in 2.24 ppm cadmium and control plants were fed to red swamp crayfish, Procambarus clarkii, for 14 days. The concentrations of cadmium were measured in hepatopancreata and muscles of crayfish on Day 0 and in crayfish fed duckweed grown in cadmium for 14 days. Accumulation of this metal in hepatopancreata increased 26-fold, i.e., 176.80 ppb on Day 0 to 4657.56 ppb on Day 14, and in muscles almost 7-fold, i.e., 6.75 ppb on Day 0 to 46.28 ppb on Day 14. Crayfish fed cadmium-containing duckweed demonstrated inhibition (55% after 14 days of feeding) of acetylcholinesterase activity in their central nervous tissue compared to crayfish fed cadmium-free duckweed. The ovarian index and total lipids content in the ovaries of crayfish fed cadmium-containing duckweed demonstrated significant increases on Day 14.

Estimating the value of avoiding morbidity and mortality from foodborne illnesses.

When people consume products violating the Food, Drug, and Cosmetic (FD&C) Act they may experience morbidity or mortality from foodborne illness. Some studies have used survey data to estimate the dollar value of avoiding a few illnesses, but surveys are expensive and the resulting estimates cannot easily be generalized to the wide variety of foodborne illnesses. We develop a method that uses published data to estimate the value of avoiding morbidity and mortality from foodborne illnesses using two metrics--quality-adjusted life-years and dollars. The method first describes the effects of different illnesses on the patient and then converts these descriptions into changes in time spent in different health states with different relative utility weights. We use these estimated changes to compute losses in quality-adjusted life-years. We demonstrate our method and derive estimates for the value of avoiding a future case of botulism, salmonellosis, chronic hepatitis, and bladder cancer. Researchers can use our method to compare the value of avoiding all illnesses caused by violations of the FD&C Act. More importantly, government officials can use our method to quickly and cost-effectively generate morbidity and mortality valuation estimates for any illness for policy purposes.