An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids
Pyrrolizidine alakloids (PAs) are known to cause hepatic veno-occlusive disease (VOD). Outbreaks have occurred in Western Afghanistan since 1974, the latest in February 2008. We conducted an outbreak investigation using a case-control design. Sixty-seven cases of VOD were compared with 199 community...
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| Format: | Article |
| Language: | English |
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Wiley
2010-01-01
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| Series: | Journal of Toxicology |
| Online Access: | http://dx.doi.org/10.1155/2010/313280 |
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| author | Faizullah Kakar Zarif Akbarian Toby Leslie Mir Lais Mustafa John Watson Hans P. van Egmond Mohammad Fahim Omar Jawad Mofleh |
| author_facet | Faizullah Kakar Zarif Akbarian Toby Leslie Mir Lais Mustafa John Watson Hans P. van Egmond Mohammad Fahim Omar Jawad Mofleh |
| author_sort | Faizullah Kakar |
| collection | DOAJ |
| description | Pyrrolizidine alakloids (PAs) are known to cause hepatic veno-occlusive disease (VOD). Outbreaks have occurred in Western Afghanistan since 1974, the latest in February 2008. We conducted an outbreak investigation using a case-control design. Sixty-seven cases of VOD were compared with 199 community controls. Consumption of bread was strongly associated with disease (adjusted odds ratio: 35.8 [95%CI: 7.6–168.2]). Toxic doses of PA were found in plant extracts and in samples of wheat flour taken from the study area. Compared to wheat flour there was 1000 times less PA in milk and whey and in water samples the PA content was zero. Although direct analysis was not possible, contaminated wheat flour used to make bread was the likely source of PA causing the outbreak. Eating a more varied diet including meat and fruit may be protective. Prevention and control measures will rely on community awareness and agricultural interventions to ensure safety of the food supply. |
| format | Article |
| id | doaj-art-c10d55ba822e4658b4f75904f19c6844 |
| institution | Kabale University |
| issn | 1687-8191 1687-8205 |
| language | English |
| publishDate | 2010-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Toxicology |
| spelling | doaj-art-c10d55ba822e4658b4f75904f19c68442025-02-03T01:23:05ZengWileyJournal of Toxicology1687-81911687-82052010-01-01201010.1155/2010/313280313280An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine AlkaloidsFaizullah Kakar0Zarif Akbarian1Toby Leslie2Mir Lais Mustafa3John Watson4Hans P. van Egmond5Mohammad Fahim Omar6Jawad Mofleh7Ministry of Public Health, Kabul, AfghanistanMinistry of Public Health, Kabul, AfghanistanLondon School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UKMinistry of Public Health, Kabul, AfghanistanWorld Health Organisation, Geneva, SwitzerlandNational Institute for Public Health & the Environment, RIVM, 3720 BA Bilthoven, The NetherlandsMinistry of Public Health, Kabul, AfghanistanMinistry of Public Health, Kabul, AfghanistanPyrrolizidine alakloids (PAs) are known to cause hepatic veno-occlusive disease (VOD). Outbreaks have occurred in Western Afghanistan since 1974, the latest in February 2008. We conducted an outbreak investigation using a case-control design. Sixty-seven cases of VOD were compared with 199 community controls. Consumption of bread was strongly associated with disease (adjusted odds ratio: 35.8 [95%CI: 7.6–168.2]). Toxic doses of PA were found in plant extracts and in samples of wheat flour taken from the study area. Compared to wheat flour there was 1000 times less PA in milk and whey and in water samples the PA content was zero. Although direct analysis was not possible, contaminated wheat flour used to make bread was the likely source of PA causing the outbreak. Eating a more varied diet including meat and fruit may be protective. Prevention and control measures will rely on community awareness and agricultural interventions to ensure safety of the food supply.http://dx.doi.org/10.1155/2010/313280 |
| spellingShingle | Faizullah Kakar Zarif Akbarian Toby Leslie Mir Lais Mustafa John Watson Hans P. van Egmond Mohammad Fahim Omar Jawad Mofleh An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids Journal of Toxicology |
| title | An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids |
| title_full | An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids |
| title_fullStr | An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids |
| title_full_unstemmed | An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids |
| title_short | An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids |
| title_sort | outbreak of hepatic veno occlusive disease in western afghanistan associated with exposure to wheat flour contaminated with pyrrolizidine alkaloids |
| url | http://dx.doi.org/10.1155/2010/313280 |
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