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Watermelon poisoning
  1. T K Pande,
  2. A H Khan,
  3. R Pipersania,
  4. S K Sethi,
  5. Y Rath
  1. Department of Internal Medicine, J L N Hospital and Research Center, Bhilai 490 009, India; pandetk{at}mantraonline.com

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    Food borne diseases are a result of ingestion of foods contaminated by either infectious or toxic agents. These diseases are sometimes inaccurately referred to as “food poisoning”, and they represent one of the most widespread and overwhelming public health problems of the modern world. Infants, children, the elderly, and the immunocompromised are more commonly affected.1 Infection of six members of a family is described here.

    The head of a family (61 years), his wife (59 years), their son (38 years), daughter in law (35 years), and two male grandchildren (14 and 11 years respectively) were admitted to hospital with gastroenteritis. About four hours earlier they had consumed pieces of freshly cut watermelon. During the past seven days they had consumed home cooked food and clear water from the domestic supply. The head of the family, who had received the lion's share of the fruit, was affected the most and was in a state of shock and acute renal failure. It took three days for his urinary output and renal parameters to improve. He was treated with intravenous fluids, ciprofloxacin, metronidazole, and other conservative measures for five days. Other members of the family had an uneventful stay in the hospital and were discharged on the second day after admission. The daughter in law, who had received the smallest share of the fruit, was affected the least and had just two or three loose stools in hospital. Haematology, urinalysis, and chest radiography of all the family members were normal. Blood biochemistry of the head of the family suggested uraemia and acidosis. Stool cultures of all members of the family grew an enteroinvasive variety of Escherichia coli, which was non-motile with non-lactose ferments.

    We asked the fruit seller about the purchase of watermelon and this revealed the fact that watermelons can be made more colourful and sweet without cutting them open. Instead a long needle, into the core, can inject sweetener and colouring agents, three to four hours before sale. The nature of the injected agents was not revealed by the fruit seller for obvious reasons. Culture from the solution that had been injected (which had been prepared and stored in an earthenware bowl), also grew multiple colonies of the enteroinvasive variety of E coli, which were biochemically lactose positive, non-motile, with non-lactose ferments.

    Diarrhoeal diseases have been commonly attributed to a pathogen contaminated water supply, but it is now recognised that food also plays an equally important part in 70% of such illnesses. Besides the usual foods, contamination has been reported in other foods such as raw fish, shellfish, bivalve molluscs (oysters, cockles, mussels), raw shrimp, pork, mixed d'oeuvre, crabs, prawns, rock lobster, cooked squid, turkey, street foods, eggs, egg salad, cold asparagus, aquatic plants, bottle feeds (for infants), ice creams, chocolates, candies, etc. The chief contaminants are bacteria (E coli, shigella, salmonella, Vibrio cholera 01, Campylobacter jejuni, brucella, Bacillus cereus, Staphylococcus aureus, Clostridium perfringens, and Clostridium botulinum), helminthes (Trichinella spiralis, Taenia saginata, Taenia solium, clonorchis, Fasciola opisthorchis, Paragonimus spp), protozoa (Entamoeba hystolitica, Giardia lamblia, Cryptosporidium spp), and enteric viruses (rotavirus hepatitis A&E virus) etc.1

    Infections due to pathogenic strains of E coli are probably the commonest cause of diarrhoea in developing countries. The contamination of food with micro-organisms is caused by:

    • Use of contaminated equipment.

    • Infected food handlers.

    • Use of raw and contaminated ingredients.

    • Cross contamination.

    • Addition of toxic chemicals or use of foods containing natural toxicants like mushrooms etc.1

    Gastroenteritis by Salmonella javiana contamination of watermelon has been described in 26 cases in the USA.2 Contamination of fruit by such a novel method as described here may prove to be a major public health hazard, and hence is noteworthy.

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