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INTRODUCTION: The increasing incidence of new diseases as well as changing features of known diseases has partly been attributed to the impact of environmental changes. As a result, there have been calls from health experts for proper surveillance and monitoring of these changes.This is a report of mopane worm allergy in a 36 year old female from the Tswana tribe in Botswana. Mopane worm, the caterpillar stage of Gonimbrasia belina moths, is a seasonal delicacy to people in many communities in southern Africa. As a result, by adulthood, many residents of these communities have had substantial exposure to the worm. Gonimbrasia belina moths belong to the Lepidoptera order of insects. Though some members of this order are known to induce contact allergy, there is no reported incidence of ingestion allergy from mopane worm. Therefore, it is important to track this case for its epidemiological significance and to alert both clinicians and the vulnerable public on the incidence of mopane worm allergy in this region. CASE PRESENTATION: This is a case of a 36 year old woman from the Tswana ethnic group in Botswana, who was diagnosed with food allergy. She presented with itchy skin rash, facial swelling, and mild hypotension after eating mopane worm. She had no previous history of allergic reaction following contact or ingestion of mopane worm and had no atopic illness in the past. She was treated and her symptoms resolved after 4 days. CONCLUSION: The proper management of allergy involves patients' avoidance and clinicians' predictability. Though hypothetical, this report is expected to sensitize clinicians to anticipate and properly manage subsequent occurrence, as well as educate the public in these communities. In addition, tracking new disease patterns, with relationship to environmental changes, will compliment existing evidence in validating the importance of proper environmental surveillance and management.
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BACKGROUND: The ability of nucleoside reverse transcriptase inhibitors (NRTIs) to inhibit human mitochondrial polymerase-gamma results in impaired synthesis of mitochondrial enzymes that generate adenosine triphosphate (ATP) by oxidative phosphorylation. This has been associated with several long-term mitochondrial toxicities, which include lactic acidosis and pancreatitis, peripheral neuropathy, and lipoatrophy. METHODS: Enrolled highly active antiretroviral therapy (HAART)-treated adults have completed nearly 2 years of follow-up as part of the ongoing randomized clinical trial Adult Antiretroviral Treatment and Drug Resistance (Tshepo) study. All patients were intensively screened for the presence of ARV-related toxicities. RESULTS: Six hundred fifty adults (69% female) were initiated on NRTI-based HAART. Overall, 2.0% of patients developed moderate to severe symptomatic hyperlactatemia, with 7 (1.0%), all female, diagnosed with lactic acidosis. Female gender (P = 0.008) and being overweight, namely having a body mass index (BMI) of greater than 25 (P = 0.001), were predictive for the development of moderate to severe symptomatic hyperlactatemia or lactic acidosis. Older age (age >40 years) showed a statistical trend (P = 0.053) as a predictor for the development of toxicity, whereas exposure to d4T and/or ddI for 6 or more months was not predictive (P = 0.102). Those diagnosed with lactic acidosis had a mean BMI of 32.38 (interquartile range [IQR] = 29.4 to 35) at the time of toxicity and had been receiving HAART for a mean of 12.1 months (IQR = 7 to 20.8). Four of the 7 (57%) died of lactic acidosis and/or hemorrhagic pancreatitis; these 4 patients also had a comorbid diagnosis of severe clinical pancreatitis with grade 3/4 lipase elevations and abdominal symptoms at the time of their demise. CONCLUSIONS: Rates of lactic acidosis appear to be higher in southern Africa when compared with rates previously described elsewhere. Risk factors for the development of moderate to severe symptomatic hyperlactatemia or lactic acidosis appear to be multifactorial but include female gender and having a BMI of greater than 25. Additional studies are ongoing to evaluate for other possible risk factors, such as host genetic differences.