Tuesday, July 3, 2018

PRO/EDR> Undiagnosed illness, fatal - Zimbabwe: (MN) methanol susp.

UNDIAGNOSED ILLNESS, FATAL - ZIMBABWE: (MATABELELAND NORTH) METHANOL
SUSPECTED
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Date: 2 Jul 2108
Source: Ewn.co.za [edited]
<http://ewn.co.za/2018/07/02/1-dead-up-to-70-others-fall-sick-in-zimbabwe-from-tainted-red-wine>


One man has died, and up to 70 others have fallen ill in Victoria
Falls after consuming what they thought was red wine left over by
tourists. It is believed that the tainted drink was found at a local
dumpsite in the resort town.

The state-run Chronicle says the victim died 2 days after consuming
the liquid. He is reported to have shared what he believed to be red
wine with his brother and other curio sellers at Victoria Fall's
Thokozani Craft Market last week.

Local reports say up to 70 people have now fallen ill, although many
can't afford to get treatment.

A government health official told the Chronicle that samples of the
liquid the vendors drank have been taken for tests.

The private News Day paper says the liquid was found in a local
dumpsite, and the vendors thought it was alcohol discarded by
tourists.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[There are no clinical signs listed here. There is no description of
the bottle, although if the victim and others thought it was red wine,
it may have been in a wine bottle and likely had some sort of red
coloring to the liquid within the bottle. However, without clinical
signs, the list of possible diagnoses could be lengthy.

Was there a case of these bottles? I am unsure how 70 people could
become exposed to one bottle of the substance.

Another possibility is that the substance was wine but was
contaminated with some other substance, or it was methanol dyed to
look red?

Methanol can cause blindness and is capable of causing death.

"Methanol toxicity initially lacks severe toxic manifestations. Its
pathophysiology represents a classic example of lethal synthesis in
which toxic metabolites cause fatality after a characteristic latent
period.

Methanol is sometimes used as an ethanol substitute for alcohol.
However, foods such as fresh fruits and vegetables, fruit juices,
fermented beverages, and diet soft drinks containing aspartame are the
primary sources of methanol in the human body, but are in very minute
quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic
organic solvent causing metabolic acidosis, neurologic issues, and
death, when ingested. It is a part of many commercial industrial
solvents and of adulterated alcoholic beverages or is mistaken as
being the same as alcohol for ingestion. Methanol toxicity remains a
common problem in many parts of the developing world, especially among
members of lower socioeconomic classes.

Neurological complications are recognized more frequently, due to
advanced technologies and because of early recognition of the toxicity
and advances in supportive care. Hemodialysis and better management of
acid-base disturbances remain the most important therapeutic
improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular
injury. Funduscopic changes are notable within only a few hours after
methanol ingestion. The mechanism by which the methanol causes
toxicity to the visual system is not well understood. Formic acid, the
toxic metabolite of methanol, is regarded as being responsible for
ocular toxicity and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of
methanol consumed and the subsequent degree of metabolic acidosis;
more severe acidosis confers a poorer prognosis. Methanol has a
relatively low toxicity. The adverse effects are thought to be from
the accumulation of formic acid, a metabolite of methanol metabolism.
The prognosis is further dependent on the amount of formic acid that
has accumulated in the blood, with a direct correlation existing
between the formic acid concentration and morbidity and mortality.
Little long-term improvement can be expected in patients with
neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1
mg/kg of body weight. The exact rates of morbidity and mortality from
methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as
blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the
administration of bicarbonate and assisted ventilation. Bicarbonate
potentially may reverse visual deficits. In addition, bicarbonate may
help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed
towards delaying methanol metabolism until the methanol is eliminated
from the patient's system either naturally or via dialysis. Like
methanol, ethanol is metabolized by ADH, but the enzyme's affinity for
ethanol is 10-20 times higher than it is for methanol. Fomepizole is
also metabolized by ADH; however, its use is limited because of high
cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications
for this procedure include (1) greater than 30 mL of methanol
ingested, (2) serum methanol level greater than 20 mg/dL, (3)
observation of visual complications, and (4) no improvement in
acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10 percent dextrose
solution may be helpful. As ethanol prolongs the elimination half-life
of methanol, the treatment may take several days, and the patient
should be hospitalized. Dialysis may be necessary to prevent kidney
failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from:
<http://emedicine.medscape.com/article/1174890-overview>,
<http://emedicine.medscape.com/article/1174890-treatment>,
<https://www.nap.edu/read/4795/chapter/35>, and
<https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750029.html>.
- Mod.TG

HealthMap/ProMED map available at:
Victoria Falls, Zimbabwe: <http://healthmap.org/promed/p/2957>]

[See Also:
Alcohol poisoning - Canada: (NT) methanol susp.
http://promedmail.org/post/20180331.5720594
2016
----
Alcohol, pesticide poisoning - India: (HR) fatal
http://promedmail.org/post/20160302.4064444
Alcohol poisoning - USA, Sweden: hand sanitizer, consumption
http://promedmail.org/post/20160229.4058927
2015
----
Alcohol poisoning, children - USA: hand sanitizer
http://promedmail.org/post/20150921.3660960
Alcohol poisoning - India http://promedmail.org/post/20150621.3454789
Methanol poisoning, fatal - India: (UP)
http://promedmail.org/post/20150113.3088258
2012
----
Alcohol poisoning - Cambodia: methanol susp
http://promedmail.org/post/20120216.1043285
Alcohol poisoning - India: (AP, WB) methanol susp.
http://promedmail.org/post/20120103.0014
2011
----
Methanol poisoning, fatal - India
http://promedmail.org/post/20111215.3600
Alcohol contamination, fatal - Ecuador: methanol
http://promedmail.org/post/20110830.2667
2010
----
Methanol poisoning, fatal - Uganda
http://promedmail.org/post/20100521.1682
2009
----
Methanol poisoning, fatal - Uganda: (KM)
http://promedmail.org/post/20090829.3039
2007
----
Alcohol contamination, fatal - Russia
http://promedmail.org/post/20070123.0309
2006
----
Methanol poisoning, fatalities - Nicaragua (Leon) (02): followup
http://promedmail.org/post/20061227.3620
Alcohol contamination, fatal - Russia (12): Pskov, Volgograd
http://promedmail.org/post/20061223.3588
Alcohol contamination, fatal - Russia (11)
http://promedmail.org/post/20061214.3518
Alcohol contamination, fatal - Russia (10)
http://promedmail.org/post/20061108.3203
Alcohol contamination, fatal - Russia (09)
http://promedmail.org/post/20061102.3145
Alcohol contamination, fatal - Russia (08)
http://promedmail.org/post/20061030.3111
Alcohol contamination, fatal - Russia, Latvia, Belarus
http://promedmail.org/post/20061029.3104
Alcohol contamination, fatal - Latvia
http://promedmail.org/post/20061027.3062
Alcohol contamination, fatal - Russia (07)
http://promedmail.org/post/20061027.3061
Alcohol contamination, fatal - Russia (06)
http://promedmail.org/post/20061024.3052
Alcohol contamination, fatal - Russia (05)
http://promedmail.org/post/20061020.3010
Alcohol contamination, fatal - Russia (04)
http://promedmail.org/post/20061019.3008
Alcohol contamination, fatal - Russia (03)
http://promedmail.org/post/20061007.2885
Alcohol contamination, fatal - Russia (02): disinfectant
http://promedmail.org/post/20060915.2612
Alcohol contamination, fatal - Russia: methanol suspected
http://promedmail.org/post/20060912.2585
Alcohol contamination, fatal - Russia: methanol suspected
http://promedmail.org/post/20060912.2585
Methanol poisoning, fatalities - Nicaragua (Leon)
http://promedmail.org/post/20060911.2576
2005
----
Methanol poisoning, fatal - Kenya (02)
http://promedmail.org/post/20050627.1817
Methanol poisoning, fatal - Kenya: susp, RFI
http://promedmail.org/post/20050626.1789
Methanol poisoning, fatal, counterfeit raki - Turkey
http://promedmail.org/post/20050310.0708
2004
----
Alcohol poisoning, fatal - Iran (03)
http://promedmail.org/post/20040622.1669
Methanol contamination, vodka - UK: alert (03)
http://promedmail.org/post/20040619.1641
Alcohol poisoning, fatal - Iran
http://promedmail.org/post/20040616.1610
2003
----
Methanol contamination, vodka - UK: alert (02)
http://promedmail.org/post/20030702.1633
Methanol contamination, vodka - UK: alert
http://promedmail.org/post/20030701.1620
2001
----
Methanol poisoning - Estonia (02)
http://promedmail.org/post/20010918.2254
Methanol poisoning - Estonia http://promedmail.org/post/20010912.2199
2000
----
Methanol poisoning, humans - Kenya
http://promedmail.org/post/20001117.2011
1999
----
Unidentified disease - Vietnam: methanol poisoning
http://promedmail.org/post/19990114.0049]
.................................................sb/tg/msp/jh
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