Epidemic dropsy is an acute non-infectious disease resulting from use of edible oils adulterated with Argemone mexicana (mexican poppy) seed oils. It occurs as an epidemic (unusual occurrence of disease above what is normally expected in that population in that area) form in places where mustard oil is commonly used as cooking mediums as in North, North-Western and North- Eastern states of India, generally sparing South Indian states where the predominant cooking oil is coconut oil. In Western Rajasthan, India a small outbreak was reported from consumption of contaminated sesame seeds oil with Argemone Mexicana.
Epidemic dropsy was first reported by Lyon in 1877 from Calcutta, India and since then outbreaks/cases were reported from West Bengal, Bihar, Orissa, Madhya Pradesh, Uttar Pradesh, Gujarat, Haryana, Maharashtra, Delhi, Jammu and Kashmir, Assam, Rajasthan and Punjab.
The epidemic in 1998 at New Delhi was the large outbreak in which over 60 persons lost their lives and more than 3000 victims were hospitalized. Even after that the epidemics occurred at Gwalior (2000), Kannauj (2002) and Lucknow (2005), Panchmahal and Dungarpur (2012) districts of India. Usually, epidemics in India have been reported between July and September, but because of enforcement of law and public awareness the mode of presentation has changed from an epidemic to a sporadic pattern.
The main symptom of epidemic dropsy consists of bilateral swelling of legs often associated with erythema, diarrhea, dyspnoea, glaucoma. Persons of all ages and both sexes were affected except breastfed infants and small children who have no mustard oil in their diets.
Epidemic dropsy has been also reported from Fiji Islands, Madagascar, Mauritius and Cape Districts of South Africa. All outbreaks were related to the intake of mustard oil contaminated with argemone oil except in the South African epidemic which occurred because of consumption of wheat flour adulterated with argemone seeds.
The Food Safety and Standards Authority of India (FSSAI) under Ministry of Health and Family Welfare, Government of India has made “The Food Safety and Standards (packaging and labelling) regulations” 2011*, according to this every container of refined vegetable oil should carry the label “free from Argemone Oil” along with other specifications mentioned under FSSAI.
*www.fssai.gov.in (Food Safety and Standards (packaging and labelling) Regulations, 2011, 2.4.2: Labelling of edible oils and fats:4(a))
The disease is mostly reported in epidemic form but sporadic cases were also reported. Both sexes were involved equally. Persons of all ages were affected except breastfed infants and small children who have no mustard oil in their diets.
Epidemic dropsy is a clinical state caused by consuming the edible oil adulterated with Argemone mexicana seed oil that is a native plant of the West Indies, and grows wild in India. It has prickly leaves and bright yellow flowers. In India it is popularly known as Satyanashi.
Seeds of Argemone mexicana are black in colour and closely resemble mustard seeds. Crops of mustard oil are matured during March and at the same time seeds of argemone also mature hence there may be accidental mixing of both seeds. However intentional mixing of Argemone mexicana oil with mustard oil by unscrupulous traders can lead to large scale outbreaks.
Toxic effects of argemone oil are because of two physiologically active (benzophenanthridine) alkaloids-sanguinarine and dihydro-sanguinarine. Sanguinarine interferes with the oxidation of pyruvic acid that accumulates in the blood.
The outbreaks of epidemic dropsy occur usually in months of May to September in India because newly extracted oil is sold during these months in the market. Massage with contaminated mustard oil has also been reported to cause epidemic dropsy.
Park’s Textbook of Preventive and Social Medicine, 22nd edition, 2013: 610.
The diagnosis of epidemic dropsy may be considered during an outbreak of bilateral tender pitting leg oedema in more than one member of a family or community. It should be distinguished from hypoproteinaemic states, filariasis, venous insufficiency, Beriberi, hypothyroidism and nephrotic syndrome. Presence of sanguinarine in blood and urine confirms the diagnosis for epidemic dropsy.
Detection of argemone seed with mustard seed:
Detection of argemone oil adulteration in edible oils:
No specific treatment is there for the epidemic dropsy.
Mortality is seen in about 5% of cases and usually due to heart failure, pneumonia, respiratory distress syndrome or renal failure.
Various preventive measures to prevent outbreaks of epidemic dropsy:
Prior to purchase of refined vegetable oil, make sure that container should bear the label “free from Argemone Oil” along with other specifications mentioned under “The Food Safety and Standards (packaging and labelling) Regulations” by FSSAI*.
Use of unbranded and unpacked edible oil should be discouraged. In case of suspicion local health authorities/Chief Medical Officer may be informed so that unscrupulous dealers may be dealt with the strict enforcement of regulation.
Sensitization of farmers about accidental contamination of edible oil with argemone seeds; its consequences and prevention by de-weeding of argemone plants grown along with mustard plants should be encouraged.
* www.fssai.gov.in - Food Safety and Standards (packaging and labelling) Regulations, 2011, 2.4.2: Labelling of edible oils and fats:4(a)