title: An outbreak of veno-occlusive liver disease in northern Ethiopia, clinical findings.
abstract: BACKGROUND
  Following the emergence of an unidentified fatal disease in Tahtay Koraro, rural farmers' village in Tigray, northern Ethiopia since 2001, a team of experts from Addis Ababa University Medical Faculty was assigned in November 2005, to investigate the problem in the field. The team consisted of an Infectious disease specialist, a Gastroenterologist, an Epidemiologist, a Pathologist, and a Microbiologist. The team was also joined by a group of Tigray Regional Health Bureauprofessionals.
  
  
  OBJECTIVE
  To investigate the nature of unidentified liver disease, identify possible cause(s) and recommend specific interventions/treatment in order to save lives and stop further spread of the disease.
  
  
  METHODS
  Data were collected from Clinical history, clinical evaluation of the affected cases in the area, relevant laboratory investigations, and histopathologic studies.
  
  
  RESULTS
  The team evaluated sixty one of patients in the field (37 males and 24 females) with mean age of 27 years. The disease affected both gender and all age groups. Duration of the illness ranged from 1 month to 3 years with a median of 6 months. The illness was reported to have started with abdominal cramp in 75%, febrile syndrome in 77%, and abdominal distention in 63% of the cases. This was usually followed by jaundice, bleeding tendencies, and edematous states mainly in the form of rapidly filling ascites. Majority of the patients had similarly sick family members and/or lost family member(s) due to the same illness. Moreover, laboratory, sonography, histopathological, and toxicological studies revealed VOLD due to Pyrrolizidine alkaloid (PA) toxicity as described in the other sections of the supplement.
  
  
  CONCLUSIONS
  From a detailed clinical and epidemiological investigation as well as histopathological and toxicological analyses, the disease was found to be fatal toxic hepatitis (veno-occlusive liver disease (VOLD). To our knowledge, this is the first report of VOLD from Ethiopia.
authors.affiliation: Department of Internal medicine, Addis Ababa University, Medical Faculty, Addis Ababa, Ethiopia.
authors.forename: Abate
authors.initials: A
authors.lastname: Bane
authors.forename: Teshale
authors.initials: T
authors.lastname: Seboxa
authors.forename: Gebrekidan
authors.initials: G
authors.lastname: Mesfin
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ali
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Tsegaye
authors.forename: Mihret
authors.initials: M
authors.lastname: W/Tensae
authors.forename: Solomon
authors.initials: S
authors.lastname: G/Selassie
authors.forename: Tewodros
authors.initials: T
authors.lastname: Haile
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D060766:Drinking Water; D004781:Environmental Exposure / Q000009:adverse effects; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011763:Pyrrolizidine Alkaloids / Q000633:toxicity; D012424:Rural Population; D014876:Water Pollution / Q000009:adverse effects; D055815:Young Adult
chemical_list: D060766:Drinking Water; D011763:Pyrrolizidine Alkaloids