Update on research and activities at the Centers for Disease Control and Prevention, and the agency for toxic substances and disease registry.

The true cause of this particular outbreak has yet to be determined, however, outbreaks of PA-associated toxicity are a global public health problem. These outbreaks have caused significant morbidity and mortality in both animals and humans. It is important to consider PA toxicity in the differential for liver disease of unknown origin, and it is probably more important to do so in developing countries. A diagnosis of PA toxicity is mainly accomplished through a proper history and a physical examination of the affected patient. Specialized laboratory and liver biopsy testing, if available, may be helpful in confirming PA-associated toxicity. Local experts in native flora and vegetation should be involved in public health investigations into outbreaks of illness such as these, as they may be able to provide crucial information about specific plants to which a population is exposed. Once PA toxicity is suspected or confirmed, it is important to educate those persons with exposures about the inherent dangers associated with consumption of such plants. More research is needed on possible treatment options for PA-associated hepatotoxicity.