Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March–April 2019

Abstract

Background Jimsonweed (Datura stramonium) contains toxic alkaloids that cause gastrointestinal and central nervous system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous crops, mixing with them during harvesting. On 13 March 2019, more than 200 case-patients were admitted to multiple health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and magnitude of the outbreak and recommended evidence-based control and prevention measures. Methods We defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea, or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1 March—30 April 2019. We reviewed medical records and canvassed all villages of the eight affected subcounties to identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed 211 residents about dietary history during 11–15 March. We used modified Poisson regression to assess suspected food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic, DNA, and microbiological testing in one national and three international laboratories. Results We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2–12 h after Batch X of fortified corn-soy blend (CSB +) was distributed. In the retrospective cohort study, 66% of 134 persons who ate CSB + , compared with 2.2% of 75 who did not developed illness (RRadj = 22, 95% CI = 6.0–81). Samples of Batch X distributed 11–15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and scopolamine (1-10 ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant laboratory findings were observed. Conclusion This was the largest documented outbreak caused by food contamination with tropane alkaloids. Implicated food was immediately withdrawn. Routine food safety and quality checks could prevent future outbreaks.

Comparative chloroplast genomes provided insights into the evolution and species identification on the Datureae plants

“…( Berkov et al., 2006 ; Benítez et al., 2018 ; Petricevich et al., 2020 ; Cinelli and Jones, 2021 ). However, tropane alkaloids also result in insidious toxicity and may cause hallucinations and poisoning outbreaks and even death in high dose ( Doan et al., 2019 ; Mutebi et al., 2022 ). Due to similar appearance, the Chinese crude drugs of these species are frequently misidentified; for example, the dried flowers of D. metel listed in the Chinese Pharmacopeia are always mixed with those of D. stramonium , D. inoxia , and even B. arborea during sale process ( Han et al., 2011 ; Wu et al., 2015 ).…”

Germination Response of Datura stramonium L. to Different pH and Salinity Levels under Different Temperature Conditions

“…There are many reports of the harmful effects of this species if ingested by humans or animals, with potentially fatal outcomes caused by the aforementioned alkaloids [ 17 , 18 ]. Ingestion may be involuntary, as when parts of the plant are mixed with other plants; for example, D. stramonium seeds can contaminate different legumes and enter the diet or they can contaminate cereals that are subsequently ground to flour and used in different meal preparations [ 19 , 20 , 21 , 22 ]. Ingestion may also be voluntary, as this plant was, for centuries, used as a drug due to its hallucinogenic effects [ 19 , 23 ].…”

Unveiling the Dark Side of Datura in Pediatric Poisoning With Insights From Jordanian Experience

“…11 One significant outbreak of jimsonweed poisoning occurred in Uganda between March and April 2019, involving over 200 cases following consumption of humanitarian relief food contaminated with the plant. 12 Traditionally, Datura leaves have been utilized for their narcotic effects and asthma-relieving properties via smoking them in cigarettes or pipes. 13 Although smoking Datura leaves typically involves absorbing low doses of alkaloids, it is considered extremely dangerous.…”

“…Additionally, cases of poisoning due to smoking of jimsonweed and related species have also been reported 11 . One significant outbreak of jimsonweed poisoning occurred in Uganda between March and April 2019, involving over 200 cases following consumption of humanitarian relief food contaminated with the plant 12 …”