Investigation of an acute neurological outbreak in Eluru, India, 2020.

On 4th December 2020, a sudden outbreak, with neurological symptoms like seizures, loss of consciousness etc., was reported in a town from south India. By 3rd day about 400 people were involved. A multi disciplinary team from our institute visited the site to investigate the outbreak. Based on the c...

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Autores principales:	Mahesh Kumar Mummadi, Raghavendra Pandurangi, J J Babu Geddam, Sukesh Narayan Sinha, Ananthan Rajendran, Sivaperumal P, Naveen K Ramachandrappa, Sree Ramakrishna K, Pagidoju Sreenu
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d27ad8f84c5b42d1b6ff38c327293a6b
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spelling	oai:doaj.org-article:d27ad8f84c5b42d1b6ff38c327293a6b2021-12-02T20:05:59ZInvestigation of an acute neurological outbreak in Eluru, India, 2020.1932-620310.1371/journal.pone.0259192https://doaj.org/article/d27ad8f84c5b42d1b6ff38c327293a6b2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0259192https://doaj.org/toc/1932-6203On 4th December 2020, a sudden outbreak, with neurological symptoms like seizures, loss of consciousness etc., was reported in a town from south India. By 3rd day about 400 people were involved. A multi disciplinary team from our institute visited the site to investigate the outbreak. Based on the case history and clinical examination of the patients, the team suspected a probable diagnosis of an acute pesticide, heavy metal and/or mycotoxin exposure for which, biological samples (blood, urine) were collected from those who reported the symptoms as well as from a few who did not report symptoms (controls). To identify the source, water and food samples were collected. The samples were subjected to ICP-MS for heavy metal analysis, LC-MS/MS for pesticide analysis, microbiological analysis and ELISA-Kit method for aflatoxins if any. Clinical and dietary details were collected from a total of 112 participants, of which, 103 cases (77 active cases at Hospital and 26 recovered cases from community) and 9 were controls. A total of 109 biological samples, 36 water samples and food samples were collected. The mean age of the study participants was 29.2 years. Among cases, Seizures were seen in 84%, loss of consciousness in 66%, mental confusion in 35%, pinpoint pupil in 11%. Triazophos (organophosphate) pesticide was present in 74% of Blood samples and its metabolites were present in 98% of the urine samples collected from the cases. All the ten heavy metals investigated including lead, mercury and nickel were found to be within permissible limits except for a few samples. No presence of mycotoxins was observed in Food samples. Water samples which included Head pump and reservoir were free from pesticides; however, all water samples from households of cases had triazophos pesticide with a mean concentration of 1.00 ug/L. Thus, it was concluded that, the probable cause of outbreak was Triazophos (Organophosphate) pesticide contamination in water at the Household level. Regular surveillance for the presence of residual pesticides in soil, water and food with heightened vigour is recommended to prevent future outbreaks.Mahesh Kumar MummadiRaghavendra PandurangiJ J Babu GeddamSukesh Narayan SinhaAnanthan RajendranSivaperumal PNaveen K RamachandrappaSree Ramakrishna KPagidoju SreenuPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0259192 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mahesh Kumar Mummadi Raghavendra Pandurangi J J Babu Geddam Sukesh Narayan Sinha Ananthan Rajendran Sivaperumal P Naveen K Ramachandrappa Sree Ramakrishna K Pagidoju Sreenu Investigation of an acute neurological outbreak in Eluru, India, 2020.
description	On 4th December 2020, a sudden outbreak, with neurological symptoms like seizures, loss of consciousness etc., was reported in a town from south India. By 3rd day about 400 people were involved. A multi disciplinary team from our institute visited the site to investigate the outbreak. Based on the case history and clinical examination of the patients, the team suspected a probable diagnosis of an acute pesticide, heavy metal and/or mycotoxin exposure for which, biological samples (blood, urine) were collected from those who reported the symptoms as well as from a few who did not report symptoms (controls). To identify the source, water and food samples were collected. The samples were subjected to ICP-MS for heavy metal analysis, LC-MS/MS for pesticide analysis, microbiological analysis and ELISA-Kit method for aflatoxins if any. Clinical and dietary details were collected from a total of 112 participants, of which, 103 cases (77 active cases at Hospital and 26 recovered cases from community) and 9 were controls. A total of 109 biological samples, 36 water samples and food samples were collected. The mean age of the study participants was 29.2 years. Among cases, Seizures were seen in 84%, loss of consciousness in 66%, mental confusion in 35%, pinpoint pupil in 11%. Triazophos (organophosphate) pesticide was present in 74% of Blood samples and its metabolites were present in 98% of the urine samples collected from the cases. All the ten heavy metals investigated including lead, mercury and nickel were found to be within permissible limits except for a few samples. No presence of mycotoxins was observed in Food samples. Water samples which included Head pump and reservoir were free from pesticides; however, all water samples from households of cases had triazophos pesticide with a mean concentration of 1.00 ug/L. Thus, it was concluded that, the probable cause of outbreak was Triazophos (Organophosphate) pesticide contamination in water at the Household level. Regular surveillance for the presence of residual pesticides in soil, water and food with heightened vigour is recommended to prevent future outbreaks.
format	article
author	Mahesh Kumar Mummadi Raghavendra Pandurangi J J Babu Geddam Sukesh Narayan Sinha Ananthan Rajendran Sivaperumal P Naveen K Ramachandrappa Sree Ramakrishna K Pagidoju Sreenu
author_facet	Mahesh Kumar Mummadi Raghavendra Pandurangi J J Babu Geddam Sukesh Narayan Sinha Ananthan Rajendran Sivaperumal P Naveen K Ramachandrappa Sree Ramakrishna K Pagidoju Sreenu
author_sort	Mahesh Kumar Mummadi
title	Investigation of an acute neurological outbreak in Eluru, India, 2020.
title_short	Investigation of an acute neurological outbreak in Eluru, India, 2020.
title_full	Investigation of an acute neurological outbreak in Eluru, India, 2020.
title_fullStr	Investigation of an acute neurological outbreak in Eluru, India, 2020.
title_full_unstemmed	Investigation of an acute neurological outbreak in Eluru, India, 2020.
title_sort	investigation of an acute neurological outbreak in eluru, india, 2020.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/d27ad8f84c5b42d1b6ff38c327293a6b
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Investigation of an acute neurological outbreak in Eluru, India, 2020.

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