title: Outbreak of epidemic dropsy in Ethiopia: the clinical and therapeutic observation.
abstract: BACKGROUND
  Epidemic dropsy results from ingestion of argemone oil contaminated food staffs. The oil from Argemone Mexican seeds contains toxic alkaloids called sanguinarine and dehydrosangunarine. These cause wide spread capillary dilatation, proliferation and leakages. This leads to oedema, hypovolemia and hypotension.
  
  
  OBJECTIVE
  To describe the socio-demographic and clinical manifestations of the patients affected with epidemic dropsy in Tikur Anbessa specialized Hospital (TASH).
  
  
  METHODS
  A case series study was conducted in an outbreak with unusual cases which was later diagnosed to be epidemic dropsy. Clinical evaluation of suspects was done and optimal therapy given for the complications detected and information was filled in structured format by medical residents and medial chart records review was made for occurrence of new complications in the end of 9 months.
  
  
  RESULTS
  A total of 164 patients were seen at TASH from 26 households, in 8 sub-cities of Addis Ababa. A wide range of age group was affected with 70% from 16 to 40 years of age. There was no case among less than 5 years of age. Females were affected more than threefold as compared to males. All the patients manifested with bilateral leg swelling and pitting oedema. It was tender in 50 (30.4%) of them while 43 (26.2%) had erythema. Tachycardia was the next common manifestation occurring in 135 (82.3%), followed by cough in 123 (75%), anaemia in 59 (36%), headache in 58 (35.4%), shortness of breathing in 52 (31.2%), hair loss in 44 (26.8%) and respiratory distress in 35 (21.3%). Abdominal pain, hepatomegally, nausea and vomiting were also seen. There was abnormality in the chest X-ray of 31 (27.2%). Hair loss, tingling and burning extremities, difficulty of standing, hyperpigmentation, pruritic rash and eye symptoms were observed lately during follow up. Five of the patients died while in hospital care due to acute respiratory distress syndrome (ARDS).
  
  
  CONCLUSIONS
  The commonest clinical manifestation in our patients is bilateral leg swelling which is similar to other outbreaks of epidemic dropsy elsewhere. The mortality rate is also comparable with other series but all cases died by ARDS in our series which is unusual in other reports. As this is the first reported epidemics in Ethiopia the findings will create awareness of clinical features of epidemic dropsy among clinicians, and therefore, helps for diagnoses of similar problems in the future.
authors.forename: Aklilu
authors.initials: A
authors.lastname: Azazh
authors.forename: Teshale
authors.initials: T
authors.lastname: Seboxa
authors.forename: Abate
authors.initials: A
authors.lastname: Bane
authors.forename: Mekashu
authors.initials: M
authors.lastname: Habte
authors.forename: Addissu
authors.initials: A
authors.lastname: Melkie
authors.forename: Shiferaw
authors.initials: S
authors.lastname: T/Mariam
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Alebachew
authors.forename: Abraham
authors.initials: A
authors.lastname: Assefa
authors.forename: Kelbesa
authors.initials: K
authors.lastname: Urga
authors.forename: Amha
authors.initials: A
authors.lastname: Kebede
authors.forename: Tsehaynesh
authors.initials: T
authors.lastname: Mesele
authors.forename: Ermias
authors.initials: E
authors.lastname: Diro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053119:Benzophenanthridines / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000009:adverse effects*; D002648:Child; D015331:Cohort Studies; D004196:Disease Outbreaks; D004487:Edema / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005506:Food Contamination; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D020896:Hypovolemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D007546:Isoquinolines / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010938:Plant Oils / Q000009:adverse effects*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D053119:Benzophenanthridines; D002316:Cardiotonic Agents; D007546:Isoquinolines; D010938:Plant Oils; C030610:argemone oil; C005705:sanguinarine