@article{ref1,
title="Clusters of Sudden Unexplained Death Associated with the Mushroom, Trogia venenata, in Rural Yunnan Province, China",
journal="PLoS one",
year="2012",
author="Shi, Guo-Qing and Huang, Wen-Li and Zhang, Jian and Zhao, Hong and Shen, Tao and Fontaine, Robert E. and Yang, Lin and Zhao, Su and Lu, Bu-Lai and Wang, Yue-Bing and Ma, Lin and Li, Zhao-Xiang and Gao, Yang and Yang, Zhu-Liang and Zeng, Guang",
volume="7",
number="5",
pages="e35894-e35894",
abstract="INTRODUCTION: Since the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006-2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms. METHODS: WE ESTABLISHED SURVEILLANCE FOR SUD, DEFINED AS FOLLOWS: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease. RESULTS: We identified 33 SUD, a 73% decline from 2002-2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata-exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test). DISCUSSION: Epidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue.<p /> <p>Language: en</p>",
language="en",
issn="1932-6203",
doi="10.1371/journal.pone.0035894",
url="http://dx.doi.org/10.1371/journal.pone.0035894"
}