Epidemic dropsy in the eastern region of Nepal

Twenty-six persons from five families comprising 34 members residing in dif ferent areas of Saptari district of the eastern region of Nepal developed s ymptoms of epidemic dropsy over 6-8 weeks. Seventeen patients were studied during July-August 1996, The age of affected individuals varied from 3 to 7 5 years. Members who had not consumed food cooked in mustard oil or who wer e not residing with the family were spared. Mustard oil, which was used for cooking, was found to be contaminated with oil of Argemone mexicana seeds. Sanguinarine was detected in all mustard oil samples collected from the ho mes of affected families. Gastrointestinal symptoms were present in 82 per cent of eases a week or so prior to the onset of pedal oedema, Fitting oede ma of the lower limbs, fever, and darkening of the skin were the most consi stent features, found in all cases. Other prominent features such as local erythema (82 per cent) and tenderness (88 per cent) of the lower limbs were present in most cases Two striking features not previously noted were peri anal itching (100 per cent) and severe carditis (35 per cent) with congesti ve cardiac failure (29 per cent), Other unique features noted were 'sarcoid ' skin changes (18 per cent), bilateral pleural effusion, and Roth's spots and subhyloid haemorrhages in the fundus in one patient. Other important fi ndings were anaemia (88 per cent), hepatomegaly (41 per cent), pneumonia (3 5 per cent) and ascites (12 per cent), There were no deaths due to epidemic dropsy, In the majority of eases, oedema, cutaneous changes, and carditis showed a marked improvement in 2-3 weeks and patients were well after 6-8 w eeks of follow-up.