Outbreak Investigation of Unexplained Abdominal Pain, Port Said Governorate, Egypt October 2017

Abstract

Background: On 12 October 2017, three cases of unexplained abdominal pain including one death after eating fresh unknown plant were reported to epidemiology and surveillance unit at directorate health affairs.

Objective: Investigation was done to confirm the outbreak, identify the risk factors, and provide control measures.

Methods: Outbreak investigation team defined a case as abdominal pain, diarrhea and vomiting. Active case finding was done and 3 cases were detected. One case died, and a questionnaire was filled for the two alive cases by surveillance team. One stool sample was collected for microbiological testing. The team collected water sample from occupation place for microbiological testing. The team collected samples from the unknown mushroom.

Results: The dead case consumed the mushroom 1 pm and the case deteriorated rapidly and died at 4.30 pm with acute hepatic and renal failure. Symptoms emerged in one case at 7 pm and active case finding was done for the third case which was hospitalized at 10 pm. Two alive cases had moderate symptoms. No more cases were detected. Age range was 43-55. The 3 cases were male workers in a resort. All sick cases consumed mushroom. The symptoms revealed were 100% vomiting, 100% diarrhea, 100% dyspnea, 33.3% malaise, 100% abdominal pain and 66.67% bitter tongue. Results of water and stool samples were negative microbiologically. The mushroom type was called the death cap (Amanita phalloides).

Conclusions: The outbreak was associated with consuming fresh collected death cap mushroom which is hepatotoxic. Control measures were taken to remove all implanted mushroom in the grass of resort and making announcement that there is a poisonous mushroom implanted in the grass. Follow up done for more cases.