Beware of bosses bearing beverages

Abstract

To the Editor We investigated a presumptive food-borne outbreak in Los Angeles County with a surprise ending. On August 27, 1997, an emergency department reported an outbreak of acute illness to the Communicable Disease Control unit in Los Angeles County. The acute illness affected 13 of 16 workers from a night-time construction site. During the night, all 13 workers who had a drink provided by their employer became ill with symptoms that included dizziness, nausea, vomiting, rapid breathing, nervousness, and numbness of the upper body. One worker had fainted; two workers said they had experienced increased strength. Symptoms began 15 minutes to 3 hours after consumption of the drink. No illness occurred in at least two of the three workers who did not consume the drink (risk ratio for drink consumption = indefinite; P < 0.01). Laboratory tests of specimens taken at the emergency department showed that the ill workers had rhabdomyolysis, as verified by a raised creatine kinase concentration with normal MB level, and a urinary screening test result was positive for amphetamines. All the workers recovered without being admitted to the hospital. Immediately before the crew's departure to the construction site, the employer had provided them with thermoses of a drink containing “herbal ingredients” and had advised them “not to drink too much.” A sample of the drink tested negative for amphetamine, but it could not be guaranteed that the sample had not been replaced or tampered with. The symptoms and laboratory test results were consistent with taking amphetamines; the beverage was epidemiologically linked to the illnesses. This is the first reported outbreak of amphetamine poisoning associated with consumption of a contaminated drink. Similar cases may arise, however. Since first quantified in 1995, the number of clandestine methamphetamine laboratories destroyed in California has risen steadily (K Yamada, California Environmental Protection Agency, written communication, April 1999) indicating an increasing use of this drug. Physicians might see other patients presenting with amphetamine overdose, even in unusual settings, and should consider this and other toxic causes in disease outbreaks suspected to be of food-borne or waterborne origin.