Poisoning outbreaks related to food poisoning have been posing challenges in Vietnam in recent decades, especially if the toxins were not documented in the medical literatures or rarely occurred. Cicada flowers are a traditional herb for treatment of some diseases such as detoxification, convulsions, and fever. Cicada nymphs are also a nutritional food source in rural areas of Vietnam. However, there were outbreak of cicada nymph poisoning that occurred in many provinces in the South of Vietnam in the summer every year. The culprit was the poisonous cordyceps fungus (Cordyceps heteropoda), that manifested as neurotoxicity. This fungus contains ibotenic acid.
Litchees are fresh fruit and very popular in Vietnam. Many children were presenting with acute encephalitis that coincided with the litchee harvest (May–July) in Bac Giang, the North of Vietnam. Most of these cases were less than 15 years old. The presenting clinical features were abrupt febrile onset, rapid progression to coma, seizures, hypoglycemia, and a high fatality rate. Hypoglycin A is contained in unripe litchee, and children were consuming a lot of the unripe fruit during the harvesting season.
A botulism outbreak related to vegetarian food recently occurred in Vietnam. There were 20 cases and two fatalities in two outbreaks in one year. A problem was the lack of antitoxin availability for treatment. Antitoxin provided by the WHO was administered after some patients had progressed to respiratory failure, but late administration of the antitoxin provided no benefit. Full recovery in those patients took approximately 6 months.
In the diagnosis of these mass casualty poisoning outbreaks, the use of toxicology laboratory testing was not helpful. The determination of the individual toxic agent by use of the LEWT method helped us find the toxic culprit in all these cases.
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