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Eosinophilia-myalgia syndrome

Eosinophilia-myalgia syndrome is an incurable and sometimes fatal flu-like neurological condition that was caused by contaminated L-tryptophan supplements. Similar to regular eosinophilia, it causes an increase in eosinophil granulocytes in the patient's blood. more...

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In 1989 an outbreak of eosinophilia-myalgia syndrome was traced to an improperly prepared batch of tryptophan. The bacterial culture used to synthesise tryptophan had recently been genetically engineered to increase tryptophan production: unfortunately, with the higher tryptophan concentration in the culture medium, the purification process had also been modified to reduce costs, and a purification step that used charcoal absorption to remove impurities had been modified so that reduced amounts of charcoal were used. It is possible that one or more of these modifications allowed new or greater impurities through the purification. The specific impurity (or impurities) responsible for the toxic effects is still equivocal, although several impurities have been associated with the disease, and their chemical structures determined. Regardless of the origin of the toxicity, tryptophan was banned from sale in the US, and other countries followed suit. In February 2001, the FDA loosened the restrictions on the marketing of tryptophan (though not on importation).

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Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan - United States, as of January 9, 1990
From Morbidity and Mortality Weekly Report, 1/12/90

Update: Eosinophilia-Myalgia Syndrome Associated with Ingestion of L-Tryptophan - United States, as of January 9, 1990

As of January 9, 1046 eosinophilia-myalgia syndrome (EMS) cases have been reported to CDC from 49 states, the District of Columbia, and Puerto Rico (Figure 1) [(1-3)]. Only Alaska has reported no cases (Figure 1). Seven deaths have been reported in patients who met the surveillance case definition and who used L-tryptophan (LT).

As of January 9, CDC has received completed report forms from 38 states and Puerto Rico with information about 429 cases fitting the case definition. Ages of these patients ranged from 11 years to 84 years (median: 48 years); 96% of patients were non-Hispanic white, 2% were Hispanic, and 1% were black. Three hundred sixty (84%) were female. Four hundred nineteen (98%) had histories of LT ingestion preceding onset of symptoms; dosage ranged from 26 mg to 15,000 mg per day (median: 1500 mg per day). Three hundred seventy-two (87%) reported onset of symptoms during or after July 1989 (Figure 2). Of the EMS patients reported thus far, 139 (32%) have required hospitalization.

Physicians report suspected cases to state and local health departments, and information is recorded on a standardized case-report form. Total numbers of EMS cases are telephoned weekly to CDC by health departments, and case-report forms mailed when completed; this results in a timely accumulation of total numbers but a lag in availability of detailed data.

Reported by: State and territorial health departments. Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.

References

[1.] CDC. Eosinophilia-myalgia syndrome - New Mexico. MMWR 1989;38: 765-7. [2.] CDC. Eosinophilia-myalgia syndrome and L-tryptophan-containing products - New Mexico, Minnesota, Oregon, and New York, 1989. MMWR 1989;38:785-8. [3.] CDC. Update: eosinophilia-myalgia syndrome associated with ingestion of L-trytophan - United States. MMWR 1989;38:842-3.

PHOTO : FIGURE 1. Eosinophilia-myalgia syndrome cases, by area - United States, as of January 9, 1990

PHOTO : FIGURE 2. Eosinophilia-myalgia syndrome (EMS) cases, by month of onset(*) - UUnited States, January 1, 1988-January 9, 1990(+) (*) Nine reports did not specify month of onset and are not included here. (+) Six persons had EMS onset before 1988; one case each occurred in August 1982, March 1983, September 1986, and February, July, and November 1987.

COPYRIGHT 1990 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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