Carbon monoxide (CO) poisoning appears with signs and symptoms that mimic other diseases. Diagnosis of carbon monoxide poisoning is frequently overlooked unless a high index of suspicion is present. Twenty females presented at two hospitals with a clinical syndrome within 2-3 hours after attending a wedding party in Saudi Arabia. This study investigated the cause of this outbreak.
Methodology
A Case-control study was conducted with 20 cases and 19 controls. Hospital emergency room records for every patient in the study, and preventive health department records in the region were reviewed. All 39 persons who attended the party were interviewed. Odds ratios and 95% confidence intervals were calculated for association between the illness and potential risk factors.
Results
The most common symptoms were: vomiting, headache, and drowsiness. All of the cases were misdiagnosed as having food poisoning by Emergency room physicians. Most of the victims (55%) had not eaten any food at the wedding, and they came from different houses with no previous exposure to a common food. However, all the victims were inside a party tent and exposed for a variable length of time to a source of carbon monoxide (charcoal burning outside the tent). The party tent was closed from all sides except for one entrance, and was poorly ventilated. The fire was 2-3 meters away from the entrance of the tent and the wind blew in the direction of the entrance. The signs and symptoms were consistent with CO poisoning. All the laboratory results were negative for any pathogen. COHb level was not detected.
Conclusion
The study suggested that the most likely cause of this outbreak was CO poisoning. It also stressed the significance of the misdiagnosis of CO poisoning as food poisoning and the impact on the health of the people. It was recommended to increase awareness of CO poisoning signs and symptoms, which can mimic other diseases. Diagnosis of CO poisoning can be made by finding the source of CO in the presence of risk factors in a patient presenting with compatible clinical picture. In rural areas where wood or charcoal is still used for cooking and other purposes, CO poisoning should top the list of differential diagnosis if a group of people is affected simultaneously and exhibit vague symptoms. Carbon monoxide poisoning should be reported and the annual incidence should be documented.