ASSOCIATION OF SAUROPUS-ANDROGYNUS AND BRONCHIOLITIS-OBLITERANS-SYNDROME - A HOSPITAL-BASED CASE-CONTROL STUDY

In late April 1995, an outbreak of a poorly defined respiratory illnes s related to the ingestion of leaves of Sauropus androgynus was observ ed in southern Taiwan, To further evaluate the association between S. androgynus and bronchiolitis obliterans syndrome, a hospital-based cas e-control study was conducted with one case group and three different control groups at Veterans General Hospital-Kaohsiung between April an d September 1995. A total of 54 cases (50 females, 4 males), 54 age- a nd sex-matched neighborhood controls, 54 matched routine physical chec k-up controls, and 54 matched sell-referred patron controls (who had i ngested S. androgynus yet without obstructive physiology) were intervi ewed for clinical symptoms, history of S. androgynus consumption, and potential confounding factors. All 54 cases (100%) ingested S. androgy nus compared with only five (9%) neighborhood controls (matched odds r atio (OR) incalculable, p < 0.001) and two (4%) physical check-up cont rols (matched OR incalculable, p < 0.001). In the univariate analysis of 54 cases and 54 self-referred patron controls, factors associated w ith an increased risk of bronchiolitis obliterans syndrome were method s of food preparation (uncooked juice vs. stir fried or boiled dishes, matched OR 10.3 (95% confidence interval (CI) 1.3-84.4)); preparer of the S. androgynus-containing food (vendor only vs. patient only or pa tient plus vendor, matched OR 2.8 (95% CI 1.1-7.1)); total S. androgyn us consumption quantity (>4,500 vs. 413-2,063 g, matched OR 10.0 (95% CI 1.9-53.0)); duration of consumption (>45 vs. 6-24 days, matched OR 2.1 (95% CI 1.2-3.8)]; and midterm interruption (<2 vs. 2-5 days per w eek, matched OR 2.6 (95% CI 1.1-6.1)). Additionally, multiple conditio nal logistic regression analysis of cases and self-referred patron con trols revealed that a larger total amount of S. androgynus consumption , preparation of S. androgynus food without cooking, and ingesting S. androgynus food prepared by a vendor were the significant risk factors associated with bronchiolitis obliterans syndrome.