Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March–April 2019
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
BMC public health
Abstract
Jimsonweed (Datura stramonium) contains toxic alkaloids that cause gastrointestinal and central nervous
system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous
crops, mixing with them during harvesting. On 13 March 2019, more than 200 case-patients were admitted to multiple
health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and
magnitude of the outbreak and recommended evidence-based control and prevention measures.
Methods: We defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea,
or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1
March—30 April 2019. We reviewed medical records and canvassed all villages of the eight affected subcounties to
identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed
211 residents about dietary history during 11–15 March. We used modified Poisson regression to assess suspected
food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic,
DNA, and microbiological testing in one national and three international laboratories.
Results: We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%),
diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12
March, 2–12 h after Batch X of fortified corn-soy blend (CSB +) was distributed. In the retrospective cohort study, 66%
of 134 persons who ate CSB + , compared with 2.2% of 75 who did not developed illness (
RRadj = 22, 95% CI = 6.0–81).
Samples of Batch X distributed 11–15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and
scopolamine (1-10 ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant
laboratory findings were observed.
Conclusion: This was the largest documented outbreak caused by food contamination with tropane alkaloids. Implicated
food was immediately withdrawn. Routine food safety and quality checks could prevent future outbreaks.
Description
Keywords
Jimsonweed, Food poisoning, Outbreak, Humanitarian
Citation
Mutebi, R. R., Ario, A. R., Nabatanzi, M., Kyamwine, I. B., Wibabara, Y., Muwereza, P., ... & Zhu, B. P. (2022). Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March–April 2019. BMC public health, 22(1), 1-10. https://doi.org/10.1186/s12889-022-12854-1