Endemic ascites

INTRODUCTION:

• Endemic ascites is caused by a hepatotoxin – pyrrolizidine alkaloid found in weed seeds of Crotolaria (Jhunjhunia).

CONTAMINATION:

• Investigation by the National Institute of Nutrition concluded that this outbreak was due to intake of Millet seeds contaminated with Crotalaria seeds which form their main diet. 
• Crotalaria occurred as a weed in areas of millet (Panicum miliare) cultivation. 

PATHOLOGY:

• Crotalaria seeds contain pyrrolizidine alkaloids which are hepatotoxic.

CLINICAL FEATURES:

•  Ascites and jaundice

• Abdominal distension, abdominal heaviness and pressure as well as shortness of breath

• Portal hypertension (perhaps due to cirrhosis or fibrosis of the liver) people may also complain of leg swelling, bruising, gynecomastia, hematemesis, or mental changes due to encephalopathy. 

PREVENTION:

• Preventive measures
• Educating the people
• Deweeding of Jhunjhunia plants which grow along with the staple food-millet.
• Sieving to separate out the Jhunjhunia seeds from millet seeds.

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