Cassia occidentalis poisoning as the probable cause of hepatomyoencephalopathy in children in western Uttar Pradesh.
OBJECTIVE
Recurrent annual outbreaks of acute encephalopathy illness affecting young children have been reported for several years in many districts of western Uttar Pradesh (UP). Our earlier investigations over three consecutive years (2002-2005) proved that these outbreaks were due to a fatal multi-system disease (hepatomyoencephalopathy syndrome) probably caused by some phytotoxin and not due to viral encephalitis as believed so far. We conducted a case-control study to investigate the risk, if any, from various environmental factors and also to identify the putative toxic plant responsible for development of this syndrome.


METHODS
Eighteen cases with acute hepatomyoencephalopathy syndrome admitted in 2005 in a secondary care paediatric hospital of Bijnor district of western UP were included in the study. Three age-matched controls were selected for each case. A semi-structured questionnaire was developed and applied to all 18 cases and 54 controls. All interviews were conducted within one week of discharge or death of each case. Quantitative data were analyzed using the relevant established statistical tests.


RESULTS
Parents of 8 (44.4%) cases gave a definite history of their children eating beans of Cassia occidentalis weed before falling ill, compared with 3 (5.6% controls), the odds ratio being 12.9 (95% CI 2.6-88.8, P<0.001). History of pica was the other associated factor with the disease, odds ratio 5.20 (95% CI 1.4-19.5, P<0.01). No other factor was found significantly associated with the disease.


CONCLUSIONS
Consumption of C. occidentalis beans probably caused these outbreaks, described earlier as hepatomyoencephalopathy syndrome. Public education has the potential to prevent future outbreaks.
Vashishtha
V M
VM
Mangla Hospital, Bijnor (UP), and Christian Medical College, Vellore, India. vmv@manglahospital.org
Kumar
Amod
A
John
T Jacob
TJ
Nayak
N C
NC
D001927:Brain Diseases / Q000139:chemically induced / Q000209:etiology*; D016022:Case-Control Studies; D056486:Chemical and Drug Induced Liver Injury; D002675:Child, Preschool; D004196:Disease Outbreaks; D004777:Environment; D005260:Female; D006801:Humans; D007194:India; D008107:Liver Diseases / Q000209:etiology*; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced / Q000209:etiology*; D016017:Odds Ratio; D010936:Plant Extracts / Q000378:metabolism; D029846:Senna Plant / Q000506:poisoning*; D011795:Surveys and Questionnaires
D010936:Plant Extracts