Bongkrekic Acid Poisoning

 

SUBSTANCE

  Bongkrekic acid

-          molecular weight of 486 kDa [1]    

-          ever been reported from Indonesia, China, and more recently in Mozambique.[1]

-          test liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) using blood samples. [2].

-          B. cocovenenans is often called Pseudomonas cocovenenans subsp. farinofermentans. [3].

 

 

Common name / Trade name

-          Pathogenic bacteria Burkholderia gladiolus (B. gladiolus) foodborne. Burkholderia cocovenenans [4, 5]

-          Possible related food not well- reserved : wet rice and starch products, Tremella, and Auricularia auricula [6]    

-          Wet rice noodles with 4% soybean oil had a BA concentration of 31.72 ± 9.41 mg/kg, 5.74 times higher than those without soybean oil (5.53 ± 1.23 mg/kg). [6]

-          Mitochondrial toxins: it inhibits adenine nucleotide translocase (ANT)[1]

-          Not-well reserved coconut- or corn-based foods [1]

 

 

Involving SYSTEM

-          Liver :progressive dysfunction of liver function and coagulation function [3]

-      Kidney: Acute kidney injury.  [3]

-          Diffuse changes in the liver, hepatic failure. [3]

-          Brain, CNS.: Collapse and altered mental status.

 

Presentation

-          Altered mental status.

-          Hepatic failure.

-          Acute kidney injury

-          Shock presentation.

-          Collapse, sudden.

-          OHCA, (Out of Hospital Cardiac Arrest).

-          Respiratory failure.

-          Abdominal pain, diarrhea, vomiting, and generalized malaise. [7]

-          Death was preceded by psycho-motor agitation and abnormal posturing.[7]

 

 

Antidote / Treatment

- No specific antidote.

- Fresh frozen plasma.

- Plasma exchange was suggested. [8]

- Molecular Adsorbent Recirculating System (MARS) [9]

- Continuous veno-venous hemodiafiltration (CVVHDF)

- aggressive supportive care.

- ICU, intensive care is mandatory.

 

 

Disposition

 

-          mortality rate of up to 40 % or more [4]

-          The reported case fatality rates averaged 60%, 32%, and 26.5% [3]

-          The median course of disease in 9 cases was 53 hours (range: 20–341 hours).

-          In China a patient had the longest latency period, and he returned home after receiving prescription medication from the OPD. He then died at home with the shortest course of illness, which was only 20 hours. [3]

 

 

REFERENCES

 

[1] Anwar M, Kasper A, Steck AR, Schier JG. Bongkrekic Acid-a Review of a Lesser-Known Mitochondrial Toxin. J Med Toxicol. 2017 Jun;13(2):173-179. doi: 10.1007/s13181-016-0577-1.

 

[2]. Zhou B, Li HL, Ma J, Dong F, Yu Y. [Fast determination of bongkrekic acid in plasma by high performance liquid chromatography-tandem mass spectrometry]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022 Mar 20;40(3):219-221.

 

[3]. Yuan Y, Gao R, Liang Q, Song L, Huang J, Lang N, Zhou J. A Foodborne Bongkrekic Acid Poisoning Incident - Heilongjiang Province, 2020. China CDC Wkly. 2020 Dec 18;2(51):975-978.

 

[4] Wang T, Cheng B, Jiao R, Zhang X, Zhang D, Cheng X, Ling N, Ye Y. Characterization of a novel high-efficiency cracking Burkholderia gladiolus phage vB_BglM_WTB and its application in black fungus. Int J Food Microbiol. 2024 Apr 2;414:110615. doi: 10.1016/j.ijfoodmicro.2024.110615. Epub 2024 Feb 3. PMID: 38325260.

 

[5] Jiao Z, Kawamura Y, Mishima N, Yang R, Li N, Liu X, Ezaki T. Need to differentiate lethal toxin-producing strains of Burkholderia gladioli, which cause severe food poisoning: description of B. gladioli pathovar cocovenenans and an emended description of B. gladioli. Microbiol Immunol. 2003;47(12):915-25.

 

[6]. Yao Y, Zhong X, Zhou Y, Zhang H, Zhao D, Zhang W, Liu Y, Xu J, Xie C, Yu C, Wang Y, Chen Z, Chen K, Yuan J. Exploring the characteristics of Burkholderia gladioli pathovar cocovenenans: Growth, bongkrekic acid production, and potential risks of food contamination in wet rice noodles and vermicelli. Food Microbiol. 2024 Jun;120:104449.

 

[7]. Gudo ES, Cook K, Kasper AM, Vergara A, Salomão C, Oliveira F, Ismael H, Saeze C, Mosse C, Fernandes Q, Viegas SO, Baltazar CS, Doyle TJ, Yard E, Steck A, Serret M, Falconer TM, Kern SE, Brzezinski JL, Turner JA, Boyd BL, Jani IV; Chitima Investigation Group. Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa. Clin Infect Dis. 2018 Apr 17;66(9):1400-1406.

 

[8] Lv R, Zeng W, Zhang P, Chen X, Yuan K, Shen H, Tian J, Li D, Zhao L, Liu Y. The toxicokinetic and extracorporeal removal of bongkrekic acid during blood purification therapies: A case report. Toxicon. 2023 Sep;233:107275.

 

[9]. Saliba F. The Molecular Adsorbent Recirculating System (MARS) in the intensive care unit: a rescue therapy for patients with hepatic failure. Crit Care. 2006 Feb;10(1):118.

 

 

Edited by Yu-Jang Su         April 4, 2024