Scombroid Poisoning: An Overview for the Emergency Nurse Practitioner.

Scombroid poisoning is a common fish-borne disease in clinical settings. Fish that has not been adequately stored after catching can allow bacteria to proliferate, which causes the conversion of histidine to histamine. Once histamine has formed, freezing or cooking the fish will not remove the histamine content. Once the fish is consumed, histamine is released, causing toxicity to the patient with symptoms including cutaneous, gastrointestinal, and anaphylactoid. Emergency nurse practitioners should identify, appropriately diagnose, and treat individuals with scombroid poisoning and avoid misdiagnosing it as fish allergy.

Molecular Mechanisms of Scombroid Food Poisoning.

Scombroid food poisoning (SFP) is a foodborne disease that develops after consumption of fresh fish and, rarely, seafood that has fine organoleptic characteristics but contains a large amount of exogenous histamine. SFP, like other food pseudo-allergic reactions (FPA), is a disorder that is clinically identical to allergic reactions type I, but there are many differences in their pathogenesis. To date, SFP has been widespread throughout the world and is an urgent problem, although exact epidemiological data on incidence varies greatly. The need to distinguish SFP from true IgE-associated allergy to fish and seafood is one of the most difficult examples of the differential diagnosis of allergic conditions. The most important difference is the absence of an IgE response in SFP. The pathogenesis of SFP includes a complex system of interactions between the body and chemical triggers such as exogenous histamine, other biogenic amines, cis-urocanic acid, salicylates, and other histamine liberators. Because of the wide range of molecular pathways involved in this process, it is critical to understand their differences. This may help predict and prevent poor outcomes in patients and contribute to the development of adequate hygienic rules and regulations for seafood product safety. Despite the vast and lengthy history of research on SFP mechanisms, there are still many blank spots in our understanding of this condition. The goals of this review are to differentiate various molecular mechanisms of SFP and describe methods of hygienic regulation of some biogenic amines that influence the concentration of histamine in the human body and play an important role in the mechanism of SFP.

[Tetrodotoxin Intoxications in Nagasaki, Japan: Symptoms of Patients, Tetrodotoxin Levels in Leftover Food and Clinical Urine and Serum Samples].

Incidents of food poisoning associated with tetrodotoxin (TTX) contamination occur every year throughout Japan. Here, we determined TTX levels in leftover foods and serum and urine samples from eight food poisoning incidents associated with TTX contamination in Nagasaki, Japan, from 2011 to 2017.Seven food samples associated with four of these food poisoning incidents were classified as weakly toxic (four samples), moderate-to-strongly toxic (two samples), and strongly toxic (one sample).In comparison with previous reports, TTX was detected at harmful levels in the urine samples, but the grade of poisoning symptoms varied.The patients' time to maximum serum TTX levels (Tmax) was estimated to be 12-24 h after ingestion of TTX-containing foods. Additionally, serum TTX levels of 19.5 ng/mL or higher within 24 h after ingestion indicated Grade 3 poisoning associated with respiratory abnormalities.These conditions were considered indicators of severe symptoms, while TTX levels of 1-3 ng/mL relate to the onset and disappearance of symptoms. A negative correlation was found between the logarithm of serum TTX concentration and the time after ingestion for two patients, indicating that the TTX serum levels decreased logarithmically. Furthermore, the TTX serum half-lives (T1/2) were 17.5 and 23.7 h.The results of this study enhance our understanding of TTX food safety and contribute to TTX risk assessment.

Current Status and Future Trends in Removal, Control, and Mitigation of Algae Food Safety Risks for Human Consumption.

With the rapid development of the economy and productivity, an increasing number of citizens are not only concerned about the nutritional value of algae as a potential new food resource but are also, in particular, paying more attention to the safety of its consumption. Many studies and reports pointed out that analyzing and solving seaweed food safety issues requires holistic and systematic consideration. The three main factors that have been found to affect the food safety of algal are physical, chemical, and microbiological hazards. At the same time, although food safety awareness among food producers and consumers has increased, foodborne diseases caused by algal food safety incidents occur frequently. It threatens the health and lives of consumers and may cause irreversible harm if treatment is not done promptly. A series of studies have also proved the idea that microbial contamination of algae is the main cause of this problem. Therefore, the rapid and efficient detection of toxic and pathogenic microbial contamination in algal products is an urgent issue that needs to be addressed. At the same time, two other factors, such as physical and chemical hazards, cannot be ignored. Nowadays, the detection techniques are mainly focused on three major hazards in traditional methods. However, especially for food microorganisms, the use of traditional microbiological control techniques is time-consuming and has limitations in terms of accuracy. In recent years, these two evaluations of microbial foodborne pathogens monitoring in the farm-to-table chain have shown more importance, especially during the COVID-19 pandemic. Meanwhile, there are also many new developments in the monitoring of heavy metals, algal toxins, and other pollutants. In the future, algal food safety risk assessment will not only focus on convenient, rapid, low-cost and high-accuracy detection but also be connected with some novel technologies, such as the Internet of Things (artificial intelligence, machine learning), biosensor, and molecular biology, to reach the purpose of simultaneous detection.

Descriptive study of foodborne disease using disease monitoring data in Zhejiang Province, China, 2016-2020.

BACKGROUND: This study aimed to identify the epidemiology, seasonality, aetiology and clinical characteristics of sporadic foodborne diseases in Zhejiang province during 2016-2020. METHODS: Descriptive statistical methods were used to analyze the data from surveillance network established by the Zhejiang Provincial Center for Disease Control and Prevention. There were 31 designated hospitals in all 11 cities which were selected using probability proportionate to size sampling method. RESULTS: During the study period, the surveillance system received 75,124 cases with 4826 (6.42%) hospitalizations from 31 hospitals. The most common cause was Norovirus, 6120 cases (42.56%), followed by Salmonella, 3351 cases (23.30%). A significant seasonal trend was observed for the V. parahaemolyticus, with the highest rates over the summer period, peaking in August, 1171 cases (38.75%), a similar trend was also observed with Salmonella and Diarrheagenic E. coli. Norovirus infections showed the highest rate in November (904, 14.77%) and March (660,10.78%), the lowest in August, 215 cases (3.51%). Patients between 19 ~ 40 years were more likely to infected by Norovirus, V. parahaemolyticus and Diarrheagenic E. coli, patients below 1 year were the highest among patients with Salmonella infection, 881 cases (26.3%). The Norovirus, V. parahaemolyticus and Diarrheagenic E. coli infection with the highest positive detection rates among the workers were observed. The largest number cases of food categories were from aquatic product infection. The private home was the most common exposure setting. CONCLUSION: Our study highlighted the necessity for conducting an active, comprehensive surveillance for pathogens in all age groups, to monitor the changing dynamics in the epidemiology and aetiology of foodborne diseases to guide policies that would reduce related illnesses.

Exploring Risk Factors of Recall-Associated Foodborne Disease Outbreaks in the United States, 2009-2019.

Earlier identification and removal of contaminated food products is crucial in reducing economic burdens of foodborne outbreaks. Recalls are a safety measure that is deployed to prevent foodborne illnesses. However, few studies have examined temporal trends in recalls or compared risk factors between non-recall and recall outbreaks in the United States, due to disparate and often incomplete surveillance records in publicly reported data. We demonstrated the usability of the electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS) for describing temporal trends and outbreak risk factors of food recalls in 1998-2019. We examined monthly trends between surveillance systems by using segmented time-series analyses. We compared the risk factors (e.g., multistate outbreak, contamination supply chain stage, pathogen etiology, and food products) of recalls and non-recalls by using logistic regression models. Out of 22,972 outbreaks, 305 (1.3%) resulted in recalls and 9378 (41%) had missing recall information. However, outbreaks with missing recall information decreased at an accelerating rate of ~25%/month in 2004-2009 and at a decelerating rate of ~13%/month after the transition from eFORS to NORS in 2009-2019. Irrespective of the contaminant etiology, multistate outbreaks according to the residence of ill persons had odds 11.00-13.50 times (7.00, 21.60) that of single-state outbreaks resulting in a recall (p < 0.001) when controlling for all risk factors. Electronic reporting has improved the availability of food recall data, yet retrospective investigations of historical records are needed. The investigation of recalls enhances public health professionals' understanding of their annual financial burden and improves outbreak prediction analytics to reduce the likelihood and severity of recalls.

Evaluating Completeness of Foodborne Outbreak Reporting in the United States, 1998-2019.

Public health agencies routinely collect time-referenced records to describe and compare foodborne outbreak characteristics. Few studies provide comprehensive metadata to inform researchers of data limitations prior to conducting statistical modeling. We described the completeness of 103 variables for 22,792 outbreaks publicly reported by the United States Centers for Disease Control and Prevention's (US CDC's) electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS). We compared monthly trends of completeness during eFORS (1998-2008) and NORS (2009-2019) reporting periods using segmented time series analyses adjusted for seasonality. We quantified the overall, annual, and monthly completeness as the percentage of outbreaks with blank records per our study period, calendar year, and study month, respectively. We found that outbreaks of unknown genus (n = 7401), Norovirus (n = 6414), Salmonella (n = 2872), Clostridium (n = 944), and multiple genera (n = 779) accounted for 80.77% of all outbreaks. However, crude completeness ranged from 46.06% to 60.19% across the 103 variables assessed. Variables with the lowest crude completeness (ranging 3.32-6.98%) included pathogen, specimen etiological testing, and secondary transmission traceback information. Variables with low (<35%) average monthly completeness during eFORS increased by 0.33-0.40%/month after transitioning to NORS, most likely due to the expansion of surveillance capacity and coverage within the new reporting system. Examining completeness metrics in outbreak surveillance systems provides essential information on the availability of data for public reuse. These metadata offer important insights for public health statisticians and modelers to precisely monitor and track the geographic spread, event duration, and illness intensity of foodborne outbreaks.

Surveillance for foodborne disease outbreaks in Zhejiang Province, China, 2015-2020.

BACKGROUND: Foodborne diseases are a major cause of morbidity and mortality and a major public health problem worldwide. We aim to explore characteristics of foodborne disease outbreaks (FBDOs) in Zhejiang Province and to provide data support for foodborne disease prevention and control. To our knowledge, few such analyses have been published at the provincial level. METHODS: Descriptive statistical methods were used to analyze the data reported by centers for disease control (CDC) at all levels in Zhejiang Province through Foodborne Disease Outbreaks Surveillance System (FDOSS) during 2015-2020. RESULTS: A total of 962 FBDOs were reported during this period, resulting in 8324 illnesses, 1028 hospitalizations, and 20 deaths. The number of outbreaks (410 outbreaks, 42.62%) and cases (4991 cases, 59.96%) caused by bacteria were the largest, followed by poisonous mushrooms (157 outbreaks, 587 cases), which was the main cause of death (15 deaths, 75%). The highest number of FBDOs occurred in households (381 outbreaks, 39.60%), followed by restaurants (219 outbreaks, 22.77%) and canteens (174 outbreaks, 18.08%). Animal-based foods were the most common single food reported (232 outbreaks, 24.12%), followed by poisonous mushrooms (162 outbreaks, 16.84%), and plant-based foods (133 outbreaks, 13.83%). Poisonous mushrooms took the first place in outbreaks in households (38.32%, 146/381), while bacteria took the first place in outbreaks outside households. Vibrio parahaemolyticus was responsible for the largest number of outbreaks (232 outbreaks, 24.12%), which mainly occurred in catering service units (93.10%, 216/232). Different types of bacteria tended to be found in different food categories, such as Vibrio parahaemolyticus, which was mainly found in aquatic products. CONCLUSIONS: Analysis of FBDOs can provide insight into the most important pathogens and sources of foodborne disease, helping authorities identify high-risk etiologies, high-risk foods, and high-risk settings to guide policies that would reduce FBDOs.

A cluster of tetrodotoxin poisoning in Oman.

INTRODUCTION: Tetrodotoxin (TTX) is a potent sodium channel blocker, with significant neurotoxicity, found in marine animals like pufferfish and blue-ringed octopus. The severity of toxicity depends on the amount of toxin ingested and the outcome depends on the time-lapse to appropriate medical care. CASES REPORT: We report five patients who presented with tetrodotoxin poisoning after consuming fried internal organs of local pufferfish from the coast of Oman. The patients' clinical manifestations were consistent with the expected TTX toxidrome of perioral and generalized paresthesia, weakness of upper and lower extremities, gastrointestinal manifestations, dyspnea, dysarthria, ascending paralysis, hypotension, bradycardia and coma. The severity varied among the patients who recovered completely except one patient who developed a subarachnoid hemorrhage without underlying aneurysms on computed tomography-angiogram. This complication was potentially related to TTX poisoning and has not been previously reported. In addition to standard supportive management, patients with severe illness should potentially receive the intravenous acetylcholinesterase inhibitor neostigmine, and intermittent dialysis. Urine specimens were sent to CDC in Atlanta, where they were analyzed using online solid phase extraction (SPE) with LC-MS/MS and confirmed the diagnosis in all five cases. DISCUSSION: In general, the patients' clinical manifestations were consistent with the expected TTX toxidrome except patient 3 who developed a subarachnoid hemorrhage early during his clinical course. Two patients received neostigmine and underwent dialysis with complete recovery.

Risk factors for food poisoning among self-catering university students.

Limited research has investigated self-catering university students' food hygiene practices that may increase their vulnerability to food poisoning. This study assessed the practice-related risk factors for food poisoning among 600 self-catering university students. A validated questionnaire was self-administered to collect data about their food hygiene practices in the previous 12 months. Factors associated with the prevalence of food poisoning were determined using logistic regression methods. Analyses showed significant associations of the use of wooden chopping boards and the consumption of unwashed fruits, with the prevalence of food poisoning (p < 0.05). However, the strongest association was for thawing of meat at room temperature (odds ratio for thawing at room temperature versus inside refrigerator, 6.07, 95% CI 3.98-9.25). Findings highlight the need for risk-based food hygiene training to inculcate safe food handling practices among self-catering university students.

Ciguatera fish poisoning in the age of discovery and the age of enlightenment.

BACKGROUND: Ciguatera fish poisoning (CFP) is the most common poisoning from seafood consumption with an estimated 50,000 cases per year worldwide. Attention to this malady in the English language literature has grown over the past five decades. Endemic areas include the South Pacific Ocean and the Caribbean Sea. It is likely that CFP has been present since ancient times, but records to substantiate this are scarce. OBJECTIVE: This historical review looks for clues in earlier writings about potential encounters with CFP as Europeans sailed farther from home into these endemic regions with little idea of what awaited them. We divide these records into the Age of Discovery and the Age of Enlightenment. METHODS: Review of available historical texts written by or about early European explorers with descriptions of illness attributed to eating fish. RESULTS: Fish poisonings appear in translated writings of early Spanish and Portuguese explorers in the 1500s, the writings of Captain James Cook's voyages to the South Pacific, and in Captain William Bligh's fateful voyage after the Mutiny on the Bounty. The most credible description of CFP comes from an early author in the Spanish colony of Cuba in the late 1700s. CONCLUSIONS: Although the quality of the observations varies, Parra in Cuba likely experienced CFP. Plausible CFP for Cook in the South Pacific and Locke in the Bahamas as both have elements of CFP. The descriptions from Quiros, Anghira, and Bligh lack sufficient detail to verify or to refute completely the possibility of CFP.

Acute coronary syndrome from scombroid poisoning: a narrative review of case reports.

BACKGROUND: Scombroid syndrome constitutes a toxic illness caused by ingestion of improperly stored fish, usually contaminated by Gram-negative bacteria producing histamine and other toxins. Scombroid currently accounts for approximately 5% of food toxicities in the United States. Though cardiovascular complications are infrequent, some patients experienced acute coronary syndrome (ACS) on admission to hospital. This article focuses on the main pathophysiology, clinical features, therapy, and outcomes in scombroid-related ACS. METHODS: Starting from the consolidated knowledge on histaminergic syndromes, we performed a literature search for studies describing patient series and single cases presenting at emergency department with scombroid toxicity complicated by myocardial ischemia. RESULTS: After a pathophysiological overview on histaminergic syndromes, we carefully analyzed a dataset of 19 patients from 13 studies, published from 1997 to December 2020. Electrocardiographic, echocardiographic, angiographic features, clinical course, hospital complications, and therapeutic approach were described. Shared and differential aspects of scombroid ACS with typical atherosclerotic ischemia, Kounis, MINOCA and Takotsubo syndromes are also discussed. CONCLUSION: An ischemic heart scombroid syndrome may occur in some patients after the eating of improperly stored fish food. Currently available studies indicate this as a benign condition, except for patients with history of coronary artery disease, previous ACS, or anaphylaxis. Of clinical concern, there is a potential of hemodynamic failure in the acute stage, even in apparently healthy people.

Outbreak of seafood-related food poisoning from undetectable Vibrio parahaemolyticus-like pathogen, Chiang Mai Province, Thailand, December 2020.

OBJECTIVE: On 1 December 2020, the Department of Disease Control of Thailand was notified of a cluster of food poisoning cases among participants at a church festival in Mae Ai district, Chiang Mai province. We conducted an outbreak investigation to confirm diagnosis, describe the epidemiological characteristics of the outbreak, identify possible sources of the outbreak and provide appropriate control measures. METHODS: We reviewed medical records of the food poisoning cases from the health care centres. Active case finding was conducted among participants who had consumed food and water at the festival. An environmental survey was done in the village where the festival was held. A case-control study was conducted to identify the source of the outbreak. Samples for laboratory analysis included rectal swabs and fresh stool specimens from the cases and food handlers, surface swabs of cooking equipment, food, water and ice samples. RESULTS: Among 436 participants surveyed, 368 (84.4%) cases of food poisoning were identified. The most common clinical manifestation was abdominal pain (89.7%), followed by watery diarrhoea (45.7%), nausea (43.5%), vomiting (38.9%), fever (18.5%) and bloody diarrhoea (4.6%). None died in this outbreak. The case-control study showed that mixed spicy seafood salad served in the festival was significantly associated with the disease by both univariable and multivariable analyses. However, the causative agent could not be identified. The environmental investigation suggested this seafood might have been undercooked. CONCLUSION: Clinical manifestations of the cases, incubation period and the suspected seafood salad suggested seafood-related food poisoning. Grimontia hollisae, the organism causing illness similar to Vibrio parahaemolyticus and commonly undetectable in the laboratory with routine testing, might be the pathogen that caused this outbreak. G. hollisae should be in differential diagnosis and identified in seafood-associated outbreaks.

Food Safety Practices and Associated Factors among Food Handlers of Fiche Town, North Shewa Zone, Ethiopia.

Background: Foodborne diseases remain a major public health problem globally, but the problem is severe in developing countries like Ethiopia. The objective of this study was to assess food safety practices and associated factors among food handlers of Fiche town. Methods: A cross-sectional study was conducted among 422 food handlers working in food and drink establishments. The data were collected using a structured questionnaire and observational checklist. Data were entered and coded into SPSS for analysis. Multivariable logistic regression was used to identify the predictor variables associated with the practice of food handlers (p < 0.05). Result: 61.6% of food handlers knew the potential risk of contaminating food with dirty hands, and 70% washed hands with soap before working with food. 52.8% of food handlers covered the hair with restraints. 66.8% of food handlers used outer garments, and the majority of food handlers (71.1%) had a trimmed fingernail. Two hundred thirteen (50.5%) of food handlers had good food handling practices. Medical checkup (AOR = 3.16; 95% CI 1.89, 5.26), sanitary inspection (AOR = 1.76; 95% CI 1.16, 2.69), knowledge (AOR = 2.31; 95% CI 1.53, 3.48), service year (AOR = 3.11; 95% CI 1.53, 6.31), and educational status (AOR = 3.42, 95% CI 1.29, 9.04) were found to be significantly associated with food handling practices. Conclusion: The food handlers should take various training concerning food hygiene and safety to enhance their knowledge and practice. Regular sanitary inspection of food and drink establishments is recommended.

Crowdsourcing and machine learning approaches for extracting entities indicating potential foodborne outbreaks from social media.

Foodborne outbreaks are a serious but preventable threat to public health that often lead to illness, loss of life, significant economic loss, and the erosion of consumer confidence. Understanding how consumers respond when interacting with foods, as well as extracting information from posts on social media may provide new means of reducing the risks and curtailing the outbreaks. In recent years, Twitter has been employed as a new tool for identifying unreported foodborne illnesses. However, there is a huge gap between the identification of sporadic illnesses and the early detection of a potential outbreak. In this work, the dual-task BERTweet model was developed to identify unreported foodborne illnesses and extract foodborne-illness-related entities from Twitter. Unlike previous methods, our model leveraged the mutually beneficial relationships between the two tasks. The results showed that the F1-score of relevance prediction was 0.87, and the F1-score of entity extraction was 0.61. Key elements such as time, location, and food detected from sentences indicating foodborne illnesses were used to analyze potential foodborne outbreaks in massive historical tweets. A case study on tweets indicating foodborne illnesses showed that the discovered trend is consistent with the true outbreaks that occurred during the same period.

An outbreak of food poisoning due to Escherichia coli serotype O7:H4 carrying astA for enteroaggregative E. coli heat-stable enterotoxin1 (EAST1).

In June 2020, a large-scale food poisoning outbreak involving about 3000 elementary and junior high school students occurred in Yashio, Saitama, Japan. A school lunch was the only food stuff ingested by all of the patients. Escherichia coli serotype O7:H4 carrying the astA gene for enteroaggregative E. coli (EAggEC) heat-stable enterotoxin 1 (EAST1) was detected in faecal specimens from the patients, and sample inspection revealed its presence in a seaweed salad and red seaweed (Gigartina tenella) as one of the raw materials. Analysis of the antibiotic sensitivity of the isolates revealed resistance to ampicillin and cefotaxime. All isolates were confirmed to be of the same origin by pulsed-field gel electrophoresis after digestion with the restriction enzyme XbaI, and single nucleotide polymorphism analysis using whole genome sequencing. To our knowledge, this is the first report of a large-scale food poisoning caused by E. coli O7:H4, which lacks well-characterized virulence genes other than astA.

Bacteriological safety of sprouts: A brief review.

The germination process causes changes in the chemical composition of seeds that improves the nutritional value of sprouts, while decreasing their microbiological safety, since the germination conditions are ideal for bacterial growth as well. This review explores the bacteriological safety of sprouts and their involvement in foodborne illness outbreaks, worldwide. Additionally, approaches to improve the shelf-life and microbiological safety of sprouts are discussed. According to the literature, sprout consumption is associated with more than 60 outbreaks of foodborne illness worldwide, since 1988. Alfalfa sprouts were most commonly involved in outbreaks and the most commonly implicated pathogens were Salmonella and pathogenic Escherichia coli (especially, Shiga toxin producing E. coli). In the pre-harvest stage, the implementation of good agricultural practices is an important tool for producing high-quality seeds. In the post-harvest stage, several methods of seed decontamination are used commercially, or have been investigated by researchers. After germination, seedlings should be kept under refrigeration and, if possible, cooked before consumption. Finally, microbiological analyses should be performed at all stages to monitor the hygiene of the sprout production process.

Evaluation of Electrocardiographic Parameters and the Presence of Interatrial Block in Patients with Mad Honey Intoxication.

Mad honey intoxication (MHI) is a food-induced clinical condition that usually presents with cardiovascular symptoms and can lead to life-threatening arrhythmias if not diagnosed and treated early. No data exist in the literature on the presence of interatrial block (IAB) after food intoxication. In our study, we sought to investigate atrioventricular electrocardiography (ECG) parameters and determine the frequency of IAB in patients with MHI. In total, 76 patients diagnosed with MHI were included in our retrospective study. Twelve-lead ECGs were performed and participants were divided into two groups according to the presence of IAB in the reference ECG. The P maximum (Pmax), P minimum (Pmin), P dispersion (Pdisp), T peak to T end (Tp-Te) interval and QT dispersion (QTdisp) values were compared between the two groups. IAB was detected in 28 (35.5%) of 76 MHI patients included in the final analysis. Pmax duration (122 ± 8; p < 0.001) and PD (69 ± 11; p < 0.001) were significantly higher in the IAB ( +) group. During regression analysis, Pmax [odds ratio (OR) 1.158, 95% confidence interval (CI) 1.036-1.294; p = 0.010] and Pd (OR 1.086, 95% CI 1.001-1.017; p = 0.046) were independently associated with IAB. Pmax and Pd area under the receiver operating characteristic curve values for IAB prediction were 0.926 (95% CI 0.841-1,000; p < 0.001) and 0.872 (95% CI 0.765-0.974; p < 0.001), respectively. ECG changes are common in patients presenting with MHI. These patients need to be followed up clinically in terms of progression to arrhythmic events that may occur in the future.

Lathyrism and Socioeconomic Disparities: A Neglected Public Health Problem in Northeast Ethiopia.

Lathyrism is an incurable neurological disorder, resulting from excessive consumption of grass pea (Lathyrus sativus), which clinically manifests as paralysis of lower limbs. Because of the high production of grass peas, a large number of people are expected to be affected by the disease in Northeast Ethiopia. However, there is no comprehensive study that quantified the magnitude of the problem. Therefore, in this study, we determined the prevalence of lathyrism and socioeconomic disparities in Northeast Ethiopia. A community-based cross-sectional study was used which used a quantitative method of data collection from January to February 2019. Data were collected from a total of 2,307 inhabitants in the study area using structured questionnaires. Lathyrism cases were identified using a case definition of symmetrical spastic leg weakness, and subacute or insidious onset, with no sensory deficit, and with a history of grass pea consumption before and at the onset of paralysis. The majority (56.8%) of participants were male, and 34.7% were aged 45 years or older. Overall, the prevalence of lathyrism was 5.5%, and it was higher in males (7.9%) than in females (2.5%). Moreover, the prevalence was higher among farmers (7.0%) than merchants (0.3%), very poor economic status (7.2%) than very rich (1.1%), who produced (9.6%) grass pea than not produced (0.9%), and those who used clay pottery (6.2%) than metal (4.8%) for cooking. The prevalence of lathyrism in Northeast Ethiopia is remarkably high. Therefore, we recommend lathyrism to be among the list of reportable health problems and incorporated in the national routine surveillance system.