‘Charmak’ disease still killing people, livestock in west
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Over 270 people have been diagnosed with a hepatic veno-occlusive disease (VOD), locally known as “camel belly” or ‘charmak’ disease, in the western province of Herat — and at least 44 deaths have been confirmed — since November 2007, provincial health officials told IRIN.
The disease — which causes rapidly filling ascites (an accumulation of fluid in the peritoneal cavity), severe abdominal pain, vomiting, and jaundice — killed a 15-year-old boy on 8 Dec 2008, according to local health workers.
“VOD of the liver is a form of toxic liver damage caused by pyrrolizidine alkaloids,” the UN World Health Organization (WHO) has said.
Laboratory tests at the National Institute for Public Health in the Netherlands in May [2008] confirmed the disease is caused by exposure to pyrrolizidine alkaloids found in ‘charmak,’ a poisonous weed believed to be growing mostly alongside cereals in Gulran District of Herat Province, and which often finds its way into locally produced wheat flour.
‘Charmak’ disease was first reported in Gulran District in November 2007, and the Health Ministry said “no new outbreak” had occurred since May 2008, largely owing to increased public awareness.
“Diagnosed cases have increased because patients who were infected 5 or 6 months ago are seeking treatment,” said Abdullah Fahim, a spokesman for the Health Ministry.
But Aziz Noorzai, head of Gulran’s 25-bed hospital, told IRIN at least 8 people had been recently infected. “We diagnosed 22 new cases… of which 8 were infected… within the last month.”
Despite the prevalence of the disease for a long time, there is still no effective medication available in Afghanistan to treat patients, health officials in Kabul and Herat said.
Animal husbandry and agriculture are the 2 main sources of income for people in Gulran District. Local people, however, say they now need emergency food aid because `charmak’ has badly affected their grain harvest and livestock.
The outbreak of `charmak’ disease and awareness messages by health workers have prompted local residents to stop consuming locally produced wheat flour, fearing it could be contaminated by the poisonous weed.
Livestock deaths have reportedly increased in the past several weeks causing fear among herders: The fatally toxic `charmak’ weed is suspected to have killed 1,000 sheep, cows and goats over the past month. Thousands of livestock have perished since November 2007.
The head of Gulran District, Golam Farooq Majroh, warned that people would “abandon everything and move to other areas” if animal deaths were not curbed through the urgent provision of safe fodder.
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Communicated by:
ProMED-mail Rapporteur Mary Marshall
[We are very grateful to Prof Alan Shlosberg, Head, Toxicology department, Kimron Veterinary Institute, Beit Dagan, Israel, for the following background commentary, which he kindly agreed to contribute upon ProMED-mail's request:
"The toxicosis was apparently due to the consumption of wheat contaminated with leaves or seeds of a _Heliotropium_ species, "charmak," one of the many cosmopolitan plants that contain toxic pyrrolizidine alkaloids (PA). There have been several previous instances with high morbidity in humans after similar contamination of food grains. The PA content of plants can vary 100 fold in the same species depending on soil type and differing weather and season.
PA have a bitter taste and this may somewhat preclude ingestion of large doses and acute toxicoses, whereas minor contamination of grains or fodder, where it is impossible to pick out and not eat the bitter components, usually results in chronic toxicoses. In either case, PA are primarily hepatotoxic, with manifestations in humans after acute exposures being reflective of veno-occlusion, liver damage, and subsequent ascites, with chronic exposure culminating in fibrosis and cirrhosis; symptoms of pulmonary lesions may be seen less often.
Sheep are much more resistant to PA toxicosis than cattle and horses and have been used to "clean" contaminated pastures before introducing cattle to graze. PA have caused numerous cases of toxicosis in cattle, often caused by _Senecio_ spp ("seneciosis"), and typically the PA have a chronic anti-mitotic action, resulting in progressive fibrosis and cirrhosis, with a characteristic megalocytosis (liver biopsy can aid diagnosis). In many cases there is a very long period (of several months) after exposure during which cattle show little or no signs of ill-health, which is followed by a sudden onset of central nervous system manifestations and death in a few days, a typical hepato-encephalopathy. This latent period often makes diagnosis of the initial exposure to PA difficult, but the histopathology is pathognomonic. There is no specific treatment regimen."
For the province of Herat in west Afghanistan, see maps at <http://www.lib.utexas.edu/maps/middle_east_and_asia/afghanistan_pol_2003.jpg>
and
<http://upload.wikimedia.org/wikipedia/commons/5/5f/Afghanistan_map_Herat.png>.
- Mod.AS
The HealthMap/ProMED-mail interactive map of Afghanistan is available at <http://healthmap.org/promed/en?g=1140763&v=35.1,61.667,5>
.
Additional information on the common heliotrope is available at <http://www.e-pelion.com/flora_boraginaceae_heuropaeum.html>. - CopyEd.MJ]
[see also:
Toxic wheat - Afghanistan (Gulran) 20080823.2634 Toxic wheat - Afghanistan (Gulran) (02) 19990524.0861] ……………………………..arn/mj/dk
