Sanguinarine, Hydroxybutyrate Dehydrogenase and Fatigue in Epidemic Dropsy: A Retrospective Study of an Outbreak and its Control from Gujarat, India

Objective: We report an outbreak of epidemic dropsy following ingestion of cooking groundnut-oil adulterated with Argemone oil. Methods: We describe 40 patients (18 families) from three towns in Gujarat in 1998, affected with epidemic dropsy during an outbreak and its control measures. They were successfully treated with supportive measures and antioxidants. The outbreak control measures used wereactive and passive surveillance, media campaigns, and action against traders. Results: Oedema, erythema, cutaneous flush, fatigue, and tachycardia were present. ESR was high. Hydroxybutyrate dehydrogenase levels (165 U/l in 33 patients), reported for the first time, showed significant rise and persisted at 1-month (128 U/l) indicating long-term cardiac toxicity. We detected in serum and urine of 25 patients, sanguinarine (2.5 and 1.4 mg/dl respectively) which at 1-month had returned to trace levels, thus confirming the consumption of oil contaminated with Argemone oil. Fatigue persisted at one month in 80%, and at six months in 38%. Groundnut oil contamination with Argemone mexicana oil was detected. Conclusion: Groundnut oil (used in cooking) contaminated with Argemone mexicana oil was the cause of epidemic dropsy. The health department controlled the outbreak with surveillance, stopping the mixing of argemone oil, and action against culprits. There were no deaths.