Bongkrekic acid (BA) food poisoning is a severe and often fatal illness caused by the bacterium Burkholderia cocovenenans. This bacterium thrives in foods like coconut and corn, producing the potent toxin BA. A recent incident highlighted the devastating consequences of BA contamination, where contaminated corn flour used in sour soup resulted in nine deaths. The BA concentration in the flour was significantly higher than the lethal dose, leading to a 100% fatality rate.
Laboratory research confirms that B. cocovenenans favors environments rich in oleic acid, with neutral pH and temperatures between 22-30°C. Under these conditions, the bacteria can produce significant amounts of toxin in a short period. While the exact contamination source in the sour soup incident remains unclear, improper food storage and processing likely played a role. The corn dough used in the soup was potentially contaminated during the drying process, creating an ideal environment for bacterial growth and toxin production. The heat stability of BA means that even cooking contaminated food may not eliminate the danger.
Historically, BA poisoning has shown high fatality rates in regions like Indonesia and Mozambique. While China has seen a decrease in incidents since implementing a public health surveillance system, the case fatality rate remains substantial at 26.47%. Different food types appear to contribute to varying fatality rates. For example, incidents involving contaminated “Diaojiangba” (a type of syrup cake) in Yunnan Province resulted in a 32% fatality rate. The high fatality rate in the sour soup incident likely stemmed from exposure to a significantly higher dose of BA than in previous cases.
Diagnosis of BA poisoning often relies on clinical symptoms and exposure history due to limited testing capabilities. A survey revealed that only a small percentage of medical institutions in China have access to BA detection technology. This lack of readily available diagnostic tools can significantly delay diagnosis and treatment, impacting patient outcomes. In the sour soup incident, obtaining qualitative and quantitative test results took several days.
Furthermore, the lack of specific antidotes and standardized treatment guidelines for BA poisoning hinders effective medical intervention. Treatment primarily focuses on eliminating toxin exposure, removing unabsorbed toxins, and providing supportive care. Prompt treatment at facilities equipped to handle severe poisoning cases could potentially reduce fatality rates.
Investigating BA poisoning incidents often faces challenges, including incomplete information about food preparation and limited clinical records. In the sour soup incident, the death of the individual who prepared the food hampered efforts to gather detailed information. Insufficient biological samples for quantitative BA detection further limited the investigation.
Preventing BA poisoning requires a multifaceted approach. High-risk areas should prioritize safe food handling practices, especially during fermentation and storage. Improved training for healthcare professionals in recognizing and managing BA poisoning, coupled with expanded access to rapid diagnostic testing, is crucial for timely intervention. Scientific research focusing on B. cocovenenans distribution, toxin production, and BA toxicokinetics is essential for developing effective prevention and treatment strategies. The development of commercially available rapid detection kits for foodborne toxins would also significantly enhance food safety efforts.
