This article is more than 5 years old. Information may no longer be current.
Homemade alcoholic drink causes mass poisoning in Mozambique
Click Here to Manage Email Alerts
On the evening of Jan. 9, 2015, 51 patients arrived at a health center in rural Mozambique with similar symptoms, including sudden weakness, abdominal pain and diarrhea. Over the course of several days, 234 people overall were sickened and 75 died.
The illnesses were caused by drinking pombe, a traditional homemade alcoholic beverage made from corn flour that was sold and consumed at a funeral ceremony, according to investigators. The beverage contained bongkrekic acid (BA), a toxin produced by a strain of the gram-negative bacterium Burkholderia gladioli that was first isolated in 1932 as the cause of a mass poisoning in Indonesia from a type of cake made with fermented coconut. BA can cause death in small doses.
The inadvertent mass poisoning in Mozambique was the first time BA poisoning was reported outside of Asia, although Eduardo Samo Gudo, MD, PhD, of Mozambique’s National Institute of Health, and colleagues said smaller outbreaks could have occurred at other times and gone unreported.
Gudo and colleagues investigated the outbreak in Chitima, a rural community of around 20,000 people located in northwestern Mozambique. They said BA might be an unrecognized cause of toxic outbreaks globally.
“The global presence of this microorganism could have significant public health implications, especially in Sub-Saharan Africa, where consumption of traditional, cereal-based fermented beverages similar to pombe is widespread,” they wrote in Clinical Infectious Diseases. “Strengthening food safety standards and providing guidance to local brewers are prudent steps to decrease the risk of contamination with B. gladioli and other contaminants of concern.”
Gudo and colleagues analyzed the corn flour and pombe consumed at the funeral to confirm the presence of BA. They said the woman who prepared the pombe was one of the first casualties of the outbreak.
“She prepared the pombe in her home before delivering it to a nearby kiosk at 6:00 a.m. to be sold at the funeral ceremony; she was not seen again before being found dead in her home at 2:00 a.m. the following morning,” they wrote.
Burkholderia spp. are common in soil. One species, B. cepacia, is known to cause infections in hospitalized patients. During their investigation, Gudo and colleagues detected B. gladioli pathovar cocovenenans, the bacterium that produces BA, in the flour used to make the pombe.
According to their report, the neighbor who donated the flour said it had been unintentionally soaked by floodwater. Although their investigation did not conclude how the flour was contaminated, Gudo and colleagues said floodwater was the likely cause.
Because BA is heat stable, Gudo and colleagues said it would not have broken down during multiple boils to make the pombe. Their tests showed a toxic level of BA in in the pombe consumed by patients in the outbreak but not in control pombe collected in another village.
Symptoms usually appeared within 1 day, and patients who died drank more pombe per body weight than patients who survived and their symptoms appeared sooner, Gudo and colleagues found. Victims did not widely report abnormal tastes or odors. Following the outbreak, pombe — an important source of income in the community — was banned in Chitima for 3 months, but Gudo and colleagues said residents continued to produce it.
“This investigation contributes to the limited body of knowledge on the occurrence and epidemiology of BA poisoning by describing the first reported outbreak from Africa,” they concluded. “We believe it is possible that unrecognized outbreaks caused by the toxin have occurred elsewhere outside of Asia. Additional research is needed to understand the geographic distribution of B. cocovenenans in order to avoid similar events in the future, particularly in regions where homemade alcoholic beverages are consumed.”– by Gerard Gallagher
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.
Click Here to Manage Email Alerts