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
