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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
From Morbidity and Mortality Weekly Report, 12/8/89

Update: Eosinophilia-Myalgia Syndrome Associated with Ingestion of L-Tryptophan -- United States

On November 9, 1989, CDC contacted all state health departments to inform them of a newly recognized syndrome involving severe, debilitating myalgias and eosinophilia ([is greater than or equal to] 1000 eosinophils per [mm.sup.3]). Eosinophilia-myalgia syndrome (EMS) was reported initially from New Mexico and was associated with ingestion of L-tryptophan-containing products (LTCPs)[1,2]. To better characterize this syndrome and to assess the extent of the problem, CDC and state health departments implemented a national state-based surveillance system using a standardized case-report form. State health departments have telephoned numbers of EMS cases to CDC daily, then mailed completed case report forms; this results in a timely accumulation of total numbers but a lag in availability of detailed data.

As of December 6, 730 EMS cases have been reported to CDC from 48 states, the District of Columbia, and Puerto Rico. Only Alaska and South Dakota have reported no cases (Figure 1). Four deaths have been reported in patients who met the surveillance case definition and who used LT; one death has been confirmed as directly attributable to EMS, and the others are under investigation.

As of December 6, CDC has received completed report forms from 21 states with information about 64 cases fitting the case definition. Ages of these patients ranged from 14 years to 73 years (median: 44 years); 95% of patients were non-Hispanic white, 3% were black, and 2% were Hispanic. Fifty-two (81%) were female. Sixty-three (98%) had histories of LT ingestion preceding onset of symptoms; dosage ranged from 500 mg to 5000 mg per day (median: 1500 mg per day). Fifty-eight (91%) reported onset of symptoms during or after July 1989. Of the EMS patients reported thus far, 21 (33%) have required hospitalization. [Figure 1 Omitted]

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.

State Requirements for Reporting Infectious and Occupational Diseases

Two articles published in the December 1, 1989, issue of the Journal of the American Medical Association contain lists of infectious[1] and occupational [2] diseases required to be reported to each state. These articles are useful references for health practitioners and public health workers. A report on this subject will be published as an MMWR Recommendations and Reports in the near future.

References

[1]Chorba TL, Berkelman RL, Safford SK, Gibbs NP, Hull HF. Mandatory reporting of infectious diseases by clinicians. JAMA 1989;262:3018-26. [2]Freund E, Seligman PJ, Chorba TL, Safford SK, Drachman JG, Hull HF. Mandattory reporting of occupational diseases by clinicians. JAMA 1989;262:3041-4.

COPYRIGHT 1989 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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