Investigation of a Methemoglobinemia Outbreak Caused by Eating Sausages with High Concentrations of Nitrates and Nitrites in Trang Province, Thailand, January 2022
DOI:
https://doi.org/10.59096/osir.v15i2.262422Keywords:
methemoglobinemia, sausages, nitrates, nitrites, TrangAbstract
In late January 2022, a cluster of methemoglobinemia cases across five provinces of Thailand was notified to the regional public health authorities. A joint investigation was conducted aiming to describe characteristics of the outbreak in one of the provinces, traceback the suspected food, and recommend prevention and control measures. We conducted a cross-sectional descriptive study, interviewing the cases, reviewing their medical records, and interviewing their parents and treating physicians. An active case finding was conducted. A probable case was defined as a person who presented with acute central cyanosis with oxygen saturation less than 92% by pulse oximetry. Suspected food samples were collected for nitrates and nitrites testing. Three cases (2 males, 1 female) were identified and there was no death. Their ages ranged from 8–12 years. The sausages came from the same source and were found to have high concentrations of nitrates (1,270.8–1,690.0 mg/kg) and nitrites (3,554.5–3,776.2 mg/kg). The sausages were identified as a likely cause of the outbreak. Government regulation, product liability laws, and food safety concerns among food retailers and customers are important to reduce the impact of consuming unsafe foods.
References
Prchal JT. Methemoglobinemia and Other Dyshemoglobinemias. In: Kaushansky K, Prchal JT, Burns LJ, Lichtman MA, Levi M, Linch DC. editors. Williams Hematology. 10th ed. New York: McGraw Hill; 2021.
Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med. 1999;34(5):646–56.
Iolascon A, Bianchi P, Andolfo I, Russo R, Barcellini W, Fermo E, et al. Recommendations for diagnosis and treatment of methemoglobinemia. Am J Hematol. 2021 Dec 1;96(12):1666–78.
Skold A, Cosco DL, Klein R. Methemoglobinemia: pathogenesis, diagnosis, and management. South Med J. 2011;104(11):757–61.
McGuigan MA. Benzocaine-induced methemoglobinemia. Can Med Assoc J. 1981 Oct 15;125(8):816.
O’Donohue WJ Jr, Moss LM, Angelillo VA. Acute methemoglobinemia induced by topical benzocaine and lidocaine. Arch Intern Med. 1980 Nov;140(11):1508–9.
Kane GC, Hoehn SM, Behrenbeck TR, Mulvagh SL. Benzocaine induced methemoglobinemia based on the Mayo Clinic experience from 28,478 transesophageal echocardiograms: incidence, outcomes, and predisposing factors. Arch Intern Med. 2007;167(18):1977–82.
Johnson CJ, Kross BC. Continuing importance of nitrate contamination of groundwater and wells in rural areas. Am J Ind Med. 1990;18(4):449–56.
McNulty R, Kuchi N, Xu E, Gunja N. Food-induced methemoglobinemia: A systematic review. J Food Sci [Internet]. 2022 Apr [cited 2022 Jun 11];87(4):1423–48. <https://ift.onlinelibrary.wiley.com/doi/full/10.1111/1750-3841.16090>
Lim SF, Tan IK. Quantitative determination of methaemoglobin and carboxyhaemoglobin by co-oximetry, and effect of anticoagulants. Ann Clin Biochem. 1999 Nov;36:774–6.
Mansouri A, Lurie A. Concise Review: Methemoglobinemia. Am J Hematol 1993; 42(1):7–12.
Sahu KK, Mishra A. Methemoglobinemia: Challenges in Diagnosis and Management. J Assoc Physicians India. 2019 Aug;67(8):94.
Beradai MA, Labib S, Boujraf S, Harandou M.Acute methemoglobinemia due to ingestion of MAHIA wine brandy. Ann Afr Med. 2016 Oct–Dec;15(4):207–9.
Chan T Y. Food-borne nitrates and nitrites as a cause of methemoglobinemia. Southeast Asian J Trop Med Public Health. 1996 Mar;27(1):189–92.
Siripanich S. Toxic effects of ingestion of nitrates and nitrites. Weekly Epidemiological Surveillance Report. 2012 Jun 15;43(23):353–6. Thai.
Greenberg M, Birnkrant WB, Schiftner JJ. Outbreak of sodium nitrite poisoning. Am J Public Health. 1944;35:1217–20.
Kaplan A, Smith C, Promnitz DA, Joffe BI, Seftel HC. Methemoglobinemia due to accidental sodium nitrite poisoning. S Afr med J. 1990 Mar 17;77(6):300–1.
Matteucci O, Diletti G, Prencipe V, Giannatale ED, Marconi MM, Migliorati G. Two case of Methemoglobinemia caused by suspected sodium nitrite poisoning. Vet Ital. 2008; 44(2):447–53.
Centers for Disease Control and Prevention. Severe methemoglobinemia and hemolytic anemia from Aniline purchased as 2C-E (4-ethyl-2,5-dimethoxyphenethylamine), a recreational drug, on the internet—Oregon, 2011. MMWR. 2012 Feb 10;61(5):85–8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
