Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa.

Background: On 9 January 2015, in a rural town in Mozambique, >230 persons became sick and 75 died of an illness linked to drinking pombe, a traditional alcoholic beverage. Methods: An investigation was conducted to identify case patients and determine the cause of the outbreak. A case patient was defined as any resident of Chitima who developed any new or unexplained neurologic, gastrointestinal, or cardiovascular symptom from 9 January at 6:00 am through 12 January at 11:59 pm. We conducted medical record reviews, healthcare worker and community surveys, anthropologic and toxicologic investigations of local medicinal plants and commercial pesticides, and laboratory testing of the suspect and control pombe. Results: We identified 234 case patients; 75 (32%) died and 159 recovered. Overall, 61% of case patients were female (n = 142), and ages ranged from 1 to 87 years (median, 30 years). Signs and symptoms included abdominal pain, diarrhea, vomiting, and generalized malaise. Death was preceded by psychomotor agitation and abnormal posturing. The median interval from pombe consumption to symptom onset was 16 hours. Toxic levels of bongkrekic acid (BA) were detected in the suspect pombe but not the control pombe. Burkholderia gladioli pathovar cocovenenans, the bacteria that produces BA, was detected in the flour used to make the pombe. Conclusions: We report for the first time an outbreak of a highly lethal illness linked to BA, a deadly food-borne toxin in Africa. Given that no previous outbreaks have been recognized outside Asia, our investigation suggests that BA might be an unrecognized cause of toxic outbreaks globally.

Relação entre a ocorrencia de cryptospoidium SPP e cystoisospora belli com o estadio da infecção por HIV, em pacientes com diarreia internados nos serviços de medicina interna, HCM (Março de 2016 - Março de 2017) / Relationship between the occurrence of cryptospoidium SPP and cystoisospora belli with the stage of HIV infection in patients with diarrhea admitted to internal medicine services, HCM (March 2016 - March 2017)

As Infecções por Cryptosporidium spp e Cystoisospora belli são causas importantes de diarréia em pacientes com VIH (Vírus de Imunodeficiência humana). No entanto, informações relativas a estes dois parasitas são escassas em muitos países africanos, incluindo Moçambique. Objectivos: Avaliar a relação entre a ocorrência de Cryptosporidium spp e Cystoisospora belli com as características clínicas e da infecção por VIH em pacientes com diarreia, internados nos Serviços das Medicinas do HCM. Metodologia: Foi feito um estudo transversal, com recurso a um questionário e colhida amostras de fezes e processadas com as técnicas de Ritchie e Ziehl Neelsen modificado. Os dados foram analisados usando o SPSS versão 21, tendo sido feitas análises univariadas, bivariadas e multivariadas com base no qui- quadrado de person e em modelo de regressão logística, Odds Ration de modo estabelecer a relação entre a ocorrência Cryptosporidium spp e Cystoisospora belli e as características clinicas dos pacientes e o estadio da infecção por HIV, tendo sido fixado o nível significância de 5%. Resultados: Fizeram parte do estudo 235 pacientes com VIH positivos, dos quais 60.4% (142/235) do sexo feminino. A maioria dos participantes tinha diarreia crónica 80% (188/235), CD4 abaixo de 200 células/µl 91.1% (214/235) e estavam no estádio III e IV da infecção por VIH segundo a OMS 94.9% (223/235). A frequência do Criptosporídium spp foi de 38.3% (90/235) e do Cystoisospora belli foi de 9.4% (22/235). Houve diferenças estatisticamente significativas na ocorrência do Criptosporídium spp entre as diferentes categorias de CD4, diarreia e estadio da infecção por VIH segundo a OMS e na ocorrência do Cystoisospora belli entre pacientes com e sem vómitos e com e sem perda de peso. Conclusão: O Cryptosporidium spp foi o agente mais frequente. A diarreia crónica, a imunodepressão grave (CD4 <200 células/µl) estiveram fortemente associado a presença do Cryptosporidium spp e a perda de peso e vómitos estiveram fortemente associados a presença do Cystoisospora belli

Cryptosporidium spp and Cystoisospora belli infections are important causes of diarrhea in patients with HIV. However, information on these two parasites is scarce in many African countries, including Mozambique. Objectives:To evaluate the relationship between the occurrence of Cryptosporidium spp and Cystoisospora belli with the clinical characteristics and the HIV infection characteristics in patients with diarrhea admitted to HCM Health Services. Methodology:A cross-sectional study was conducted with recourse to a questionnaire, and stool sample collected and processed with Ritchie and modified Ziehl Neelsen techniques. Data were analyzed using SPSS version 21, and univariate, bivariate and multivariate analyzes were performed based on person chi-square and a logistic regression model, Odds Ration in order to establish relationship between the occurrence of Cryptosporidium spp and Cystoisospora bell iand the clinical characteristics of patients and the HIV infection characteristics, have been established a significance level of 5%. Results: The study consisted of 235 HIV positive patients, from which 60.4% (142/235) are female. Most participants had chronic diarrhea 80% (188/235), CD4 below 200 cells/µl 91.1% (214/235) and were in the III and IV stages of AIDS according to WHO 94.9% (223/235). The frequency of Cryptosporidium spp was 38.3% (90/235) and Cytoisospora belli was 9.4% (22/235). There were statistically significant differences in the occurrence of Cryptosporidium spp among different CD4 categories, diarrhea and HIV stage according to WHO, and in the occurrence of Cystoisospora belli among patients with and without vomiting, and with and without weight loss. Conclusion:Cryptosporidium spp was the most frequent agent; Chronic diarrhea, CD4 <200 cells / µl was strongly associated with Cryptosporidium spp and weight loss and vomiting were strongly associated with the presence of Cytoisospora belli.