Handling toxicoses of unknown origin.
A strategy is presented for investigating toxicoses of unknown origin and following a disease-oriented approach. The strategy is derived from and illustrated by experience of three large scale outbreaks of disease involving aflatoxicosis in India, intoxication by pyrrolizidine alkaloids from Heliotropium spp. in Afghanistan and from Crotalaria spp. in India. Investigation of such cases involves a descriptive phase (case definition, descriptive pattern of disease), hypothesis generation (based on pathologic studies and indications from environmental and epidemiological investigations), hypothesis testing and confirmatory studies. After establishing a causal relationship, steps need to be taken to transmit information to health authorities, to disseminate knowledge to health delivery personnel and the general public, to identify borderline cases and plan management, to identify mechanisms of exposure/contamination and relevant measures to remove or minimize exposure to the causal agent.
National Academy of Medical Sciences, New Delhi, India.
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Tandon
D000346:Afghanistan; D000818:Animals; D004196:Disease Outbreaks; D005517:Foodborne Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007194:India; D015651:Mycotoxicosis / Q000209:etiology / Q000517:prevention & control; D000096702:Aflatoxin Poisoning