Five Saudi men complained of haematuria and dysuria after eating wild birds they had hunted and cooked in one pot. Our investigation was carried out to determine the source and etiology of this outbreak.
Methodology
Patients were interviewed and all medical records were reviewed. The hospital staff, experienced citizens, and hunters were questioned. Blood, urine, and stool samples were taken to determine the presence of any micro-organism or toxic materials and to check kidney function. Some birds were dissected and the stomach contents were sent to the entomology department lab.
Results
Eight persons camped in a vernal area where they hunted wild birds. The group cooked 20 birds in one pot immediately after killing them, removing the heads and feathers only and keeping the guts as part of typical hunter rituals. Five developed the symptoms within 3 hours after eating the meal. One patient, who drank a lot of soup while preparing the meal, had severe dysuria and haematuria. Four patients who ate rice and meat and only a small amount of soup had mild symptoms. Three persons who ate only meat had no complaint. One of the patients noticed an insect part in the gut of birds.
Conclusion
This is the first report of indirect food poisoning caused by eating wild birds in the Kingdom of Saudi Arabia. Migrating birds ingest insects that secrete a toxic chemical (cantharidine) as a defense mechanism, but this does not affect the birds' urinary system since some birds have no bladder (Cloacae). Cantharidine dissolves and mixes with food, causing food poisoning in humans. It is an extreme irritant and vesicant, long falsely identified as an aphrodisiac. An adult lethal dose by mouth is 65 mg, but much smaller amounts can be life threatening. It was recommended to remove the internal gut of birds before preparing them for cooking, in addition to minimizing the hunting of birds towards the end of spring. People who use traditional medicine, in which these insects are combined, were warned against using them, since the doses and poison in that combination are not well assembled and may result in renal failure or death. There is a need for a follow-up study to look at other complications of canthardin (renal failure).