Scientist, National Institute of Nutrition (ICMR-NIN), Indian Council of Medical Research, Hyderabad, India.
National Institute of Occupational Health (ICMR-NIOH), Indian Council of Medical Research, Ahmedabad, India.
PLoS One. 2021 Nov 8;16(11):e0259192. doi: 10.1371/journal.pone.0259192. eCollection 2021.
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.
2020 年 12 月 4 日，印度南部一个城镇突然爆发了一起疫情，患者出现了癫痫发作、意识丧失等神经系统症状。到第 3 天，约有 400 人受到感染。我们研究所的一个多学科小组前往现场调查疫情。根据患者的病史和临床检查，该小组怀疑这可能是急性农药、重金属和/或霉菌毒素暴露引起的，为此，他们从出现症状的人和一些无症状的人（对照组）身上采集了生物样本（血液、尿液）。为了确定源头，还采集了水和食物样本。这些样本接受了 ICP-MS 重金属分析、LC-MS/MS 农药分析、微生物分析和 ELISA 试剂盒法（如果有黄曲霉毒素的话）。共从 112 名参与者中收集了临床和饮食细节，其中包括 103 例病例（77 例在医院的活动病例和 26 例来自社区的康复病例）和 9 例对照。共采集了 109 个生物样本、36 个水样和食物样本。研究参与者的平均年龄为 29.2 岁。在病例中，84%出现了癫痫发作，66%出现了意识丧失，35%出现了精神错乱，11%出现了针尖样瞳孔。血液样本中有 74%存在三唑磷（有机磷）农药，尿液样本中有 98%存在其代谢物。调查的十种重金属（包括铅、汞和镍）除了少数样本外，均在允许范围内。食物样本中未观察到霉菌毒素。包括头泵和储水池的水样中没有农药；然而，所有病例家庭的水样都含有三唑磷农药，平均浓度为 1.00ug/L。因此，结论是，疫情的可能原因是家庭用水中三唑磷（有机磷）农药污染。建议加强力度，定期监测土壤、水和食物中残留农药的存在情况，以防止未来再次爆发。
