C14 P49 EPIDEMIC DROPSY Community Medicine.ppt

Community Medicine

1. EPIDEMIC DROPSYEPIDEMIC DROPSY
B. Harini Reddy [2k2]B. Harini Reddy [2k2]

2. History & uses of argemoneHistory & uses of argemone

Argema - Greek word means - cataract. In Argema - Greek word means - cataract. In
the past used to treat cataract, but causes the past used to treat cataract, but causes
blindness. uses of argemone oil-blindness. uses of argemone oil-
1.1.Jute industryJute industry
2.2.Industrial oilIndustrial oil
3.3.Cheap oil in lighting diyas also called prickly Cheap oil in lighting diyas also called prickly
pops. vernacular name - satyanashi.pops. vernacular name - satyanashi.

3. SWELLING OF THE BODY CAUSED BY THE CONSUMPTION OF SWELLING OF THE BODY CAUSED BY THE CONSUMPTION OF
MUSTARD OIL ADULTERATED WITH ARGEMONE OILMUSTARD OIL ADULTERATED WITH ARGEMONE OIL

Argemone plantArgemone plant

Fallow fields Fallow fields

Harvested in May Harvested in May

Blackish brown, wrinkled. Blackish brown, wrinkled.


Mustard plant Mustard plant

Cultivated. canopy does not Cultivated. canopy does not
let anything to grow let anything to grow
underneath it. underneath it.

Harvested in March.Harvested in March.

Blackish brown smooth, Blackish brown smooth,

4. Argemone Seeds
Mustard Seeds
Specific gravity of mustard oil is more than that of argemone oil-so seeds of
argemone will float in normal saline solution.

5. Extent of epidemicExtent of epidemic

First case-west bengal-1872.a few cases of First case-west bengal-1872.a few cases of
dropsy were also reported from - Uttar dropsy were also reported from - Uttar
Pradesh, Haryana, Assam, Jammu & Kashmir. Pradesh, Haryana, Assam, Jammu & Kashmir.
Countries-Mauritius, Fiji, South Africa.Countries-Mauritius, Fiji, South Africa.

6. Extent of epidemicExtent of epidemic

Northern &eastern mustard oil consumption Northern &eastern mustard oil consumption
belt-common. belt-common.

Southern & western areas-coconut, ground nut Southern & western areas-coconut, ground nut
oil is consumed-uncommon.oil is consumed-uncommon.

Last epidemic-delhi-august-Last epidemic-delhi-august-
1998.largest.2200cases reported.66deaths 1998.largest.2200cases reported.66deaths
reported.reported.

7. PathogenesisPathogenesis

SanguinarineSanguinarine -toxic principle. -toxic principle.
1.carbohydrate metabolism – glycogenolysis-1.carbohydrate metabolism – glycogenolysis-
decreased glycogen levels-increased pyruvate decreased glycogen levels-increased pyruvate
levels-uncouples oxidative phosphorylation. levels-uncouples oxidative phosphorylation.

2.inhibition of Na, K, ATPase of heart-degenerative 2.inhibition of Na, K, ATPase of heart-degenerative
changes in heart muscle fibre-cardiac failure. changes in heart muscle fibre-cardiac failure.

3.reactive oxygen species 3.reactive oxygen species

4.inhibition of pyruvate oxd.-blood pyruvate 4.inhibition of pyruvate oxd.-blood pyruvate

8. 
Wide spread capillary dilatation & proliferation & Wide spread capillary dilatation & proliferation &
capillary permeability increases-leakage-EDEMA. capillary permeability increases-leakage-EDEMA.

State of hypovolemia-fluids&salt conservation by State of hypovolemia-fluids&salt conservation by
the kidneys. the kidneys.

Capillary proliferation-SOB, hepatomegaly,Capillary proliferation-SOB, hepatomegaly,

9. Clinical featuresClinical features

Onset-insidious/acute. Onset-insidious/acute.

Illness begins with gastro enteric symptoms Illness begins with gastro enteric symptoms
[nausea, vomiting, diarrhoea, abd:colic,epigastric [nausea, vomiting, diarrhoea, abd:colic,epigastric
discomfort].discomfort].

Cutaneous erythema & pigmentation, Cutaneous erythema & pigmentation,

Swelling of hands & feet,Swelling of hands & feet,

Resp. - cough, SOB, orthopnoea - right Resp. - cough, SOB, orthopnoea - right
sided heart failure.sided heart failure.

Eyes-retinal hemorrhages , glaucoma. Eyes-retinal hemorrhages , glaucoma.

10. Diagnosis & ManagementDiagnosis & Management

Largely by clinical examination-Largely by clinical examination-

all age groups except breast fed infants-all age groups except breast fed infants-

many members of the family simultaneously [common many members of the family simultaneously [common
exposure]exposure]

low socio economic groups [buy oil in small amounts in low socio economic groups [buy oil in small amounts in
unpackaged form] unpackaged form]

Symptomatic ONLY. Symptomatic ONLY.
1.diuretics1.diuretics
2.bio anti oxidants2.bio anti oxidants
3.steroids3.steroids
4.vitamins4.vitamins
5.Ca supplementation5.Ca supplementation
6.protein rich diet 6.protein rich diet

11. Intervention & preventive measuresIntervention & preventive measures

Primary intervention-Primary intervention- prevent continual exposure prevent continual exposure
to offending factor. to offending factor.

Secondary intervention-Secondary intervention- prevent/ameliorate prevent/ameliorate
damage caused by exposure. damage caused by exposure.
Strategy for prevention & controlStrategy for prevention & control

1.immediate step to control out break [destroying 1.immediate step to control out break [destroying
the food material & prevent the community from the food material & prevent the community from
consuming the food]consuming the food]

2.prevention of such out breaks in future [prevent 2.prevention of such out breaks in future [prevent
entry into the food chain]entry into the food chain]

3.health education [mass media*role]3.health education [mass media*role]

13. Govt. actions taken & needed to be takenGovt. actions taken & needed to be taken

Food adulteration act-mustard oil HAS to be free from Food adulteration act-mustard oil HAS to be free from
argemone oil argemone oil

During the epidemic banned the sale of mustard oil in During the epidemic banned the sale of mustard oil in
the affected states. the affected states.

Samples tested-lab tests areSamples tested-lab tests are

1.screening tests1.screening tests

2.confirmatory tests2.confirmatory tests

screening testsscreening tests

confirmatory test confirmatory test

Paper chromatography testPaper chromatography test [most sensitive & specific [most sensitive & specific
test-detects.001%-can also test biological samples like test-detects.001%-can also test biological samples like
blood & urine from patients affected by epidemic blood & urine from patients affected by epidemic
dropsy]dropsy]
1. nitric acid test [non specific]1. nitric acid test [non specific]
2. ferric chloride test [detects.25%]2. ferric chloride test [detects.25%]

14. Screening testScreening test

Nitric acid test-test procedure-1.take 5ml oil-add equal quantity of Nitric acid test-test procedure-1.take 5ml oil-add equal quantity of
pure nitric acid-shake well for a minute-allow acid & oil layers to pure nitric acid-shake well for a minute-allow acid & oil layers to
separate the acid layer shows yellow to orange indicates separate the acid layer shows yellow to orange indicates
adulteration.adulteration.

Ferric chloride test-filter the oil to remove any suspended Ferric chloride test-filter the oil to remove any suspended
impurities-take 4ml of suspected oil&2ml of pure oil as control-add impurities-take 4ml of suspected oil&2ml of pure oil as control-add
2ml of concentrated HCl to each tube-mix thoroughly-warm in a 2ml of concentrated HCl to each tube-mix thoroughly-warm in a
boiling water bath for 4-5min with constant shaking, take out the boiling water bath for 4-5min with constant shaking, take out the
tubes & add 1ml of ferric chloride reagent to each tube, the reagent tubes & add 1ml of ferric chloride reagent to each tube, the reagent
passes into the bottom acid layer-rotate the tubes between the palms passes into the bottom acid layer-rotate the tubes between the palms
in such away that the reagent mixes well with the acid layer without in such away that the reagent mixes well with the acid layer without
disturbing the upper oil layer, heat the tubes again for 10min in a disturbing the upper oil layer, heat the tubes again for 10min in a
boiling water bath a distinct reddish brown precipitate in the acid boiling water bath a distinct reddish brown precipitate in the acid
layer indicates argemone oil is present.layer indicates argemone oil is present.