Abstract
IntroductionSince the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006–2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms.MethodsWe established surveillance for SUD, defined as follows: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease.ResultsWe identified 33 SUD, a 73% decline from 2002–2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata–exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test).DiscussionEpidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue.
Highlights
Since the late 1970’s, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities
We report the epidemiology of SUD from 2006–2009 which focused subsequent control measures and toxicological studies on heretofore undescribed mushroom known as Trogia venenata [29]
Exposures During the field investigation of the first 2 SUD clusters (July 2006), we found that the victims had eaten a heretofore unspeciated mushroom, named Trogia venenata (Figure 2) (Mycobank registration number MB 561711) [29]
Summary
Since the late 1970’s, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. Since the late 1970’s, clusters of sudden unexplained death (SUD) scattered throughout a 60,000 km area of northwest Yunnan, China [1,2], alarmed the public, health authorities, and local governments. These SUD clusters occurred from late June through early September in remote hamlets most with over 2000 m altitude [1,2] and the overall pattern showed strong timespace clustering [1,2,3,4]. Postmortem examination of 29 cases did not reveal a common lesion; but mild, focal lymphocytic myocarditis, insufficient to explain sudden death, was seen in 38%, arrythymogenic right ventricular cardiomyopathy (ARVC), a chronic inherited condition, was seen in 14% [5]
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