Summary of Gulran/Charmak/Camel Belly Disease

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Dear All,

I would like to thank you all for your contributions to the discussion (Gulran/Charmak/Camel Belly Disease in Afghanistan) and your major contributions to the NETRUM.

In nutshell, your contribution provides critical resources that impact every facet of life. The excellent ideas, understandable descriptions and links to more information have brought me to more interesting information regarding charmak/gulran disease, than I can ever assimilate.

Please read the summary report below:

Subject: Summary of Gulran/Charmak/Camel Belly Disease:

Moderator: Dr. Mohammad Bashaar (Afghanistan)

Discussion Participants: Dr. Vijay Thawani, Dr. Geer. M. Ishaq, Dr. Santosh, Dr. Rakesh Biswas, Dr. Anumpa and Dr, Kunda Gharpure.

Discussion Date: 1-7 July 2008

Total Postings: 71

Background:

Hepatic veno-occlusive disease (VOD)/camel belly/charmak’ disease occurred in Gulran District of Herat Province, western Afghanistan.

Disease was caused by exposure to pyrrolizidine alkaloids found in `charmak’, a poisonous weed believed to be growing mostly in grain fields in Gulran District, and which often finds its way into locally produced wheat flour. According to WHO, regular consumption of bread contaminated by alkaloids contained in the weed can cause rapidly filling ascites (also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or abdominal dropsy), severe abdominal pain, vomiting and jaundice.

`Charmak’ has appeared at least three times in the past 50 years - always in Herat Province - and had affected hundreds of people each time, according to local officials. Health experts said the disease cannot be prevented through medical measures only, but that improvements in wheat cultivation, harvesting, threshing and milling - and enabling farmers to eliminate poisonous weeds in their fields - would help avert future outbreaks. The government should focus on agricultural policies that will reduce contamination of grain with Heliotropium [`charmac’] weeds.

Dr. Vijay Thawani

The weed Heliotropium (Greek = leaves turn to sunlight) has been existing in many parts of the world since long.It is there in USA, Australia, Africa, Asia. Many types are there. Epidemics have occured due to consumption of this. The first such epidemic was reported in 1920 from South Africa.The plant is also nursed indoors and outdoor because of its fragrant flowers. The fragrance is closer to vanilla. It contains pyrolizidine alkaloids which if ingested, are responsible for VOD.

Dr.Vijay has sent very useful attached, where it was stated “Substantial contamination of grain commodities has been recorded in various countries due to both contaminations by seeds of PA-containing weeds growing in the crop as well as plant dust fragments from the same plants.

There is currently no data to indicate whether PAs occur in oilseed crops. On the basis of the very limited data available, the major source of dietary exposure to PAs is grains, with eggs, offal and honey minor dietary contributors. However, on the basis of the currently available data, it is not possible to estimate the potential dietary exposure to PA from these food sources”

Dr. Geer. M. Ishaq

Reproduced an article on Hepato veno-occlusive disease (VOD), also known as camel belly disease for information of all members in his very initial posting

Dr. Geer has sent very informative pdf file, where article on VOD describing its Pathology in detail besides its Clinical Features, Diagnosis, Classification, Causes, Prognosis, Therapy, and Prevention.

Dr. Santosh:

At least 161 people were hospitalized with Gulran disease in Herat province, said Graaff, resident representative of the World Health Organization.A toxic weed called charmak grows in the area and contains chemicals that can cause Gulran disease

Dr. Santosh, pointed out the involvement of some environmental hazards of Pyrrolizidine alkaloids. He added, that, Plants containing PAs are likely to grow as weeds among staple food crops and pastures, especially following drought, and consumption of such crops can cause large scale outbreaks of toxic disease in both man and farm animals.

Dr. Kunda Gharpure

In India several years ago, we received aid from USA in the form of wheat. The interesting fact was that the wheat we recd had to be picked( cleaned) before milling because it contained ergot seeds.after a decade it was observed that a peculiar grass is growing in all parts of India which is resistant to weed killers.

We call it congress grass as it is ubiquitous like our political party "congress". And it was the result of the contamination in the wheat imported from USA.

Vijaya Chaudhari

He stated the case study of camel belly, in kusmi block of sarguja district in mp and according to chemical analysis they found that the causative agent was pyrrolizidine alkaloids

Dr. Anumpa sukhlecha

Dr. Anupama suggested the investigation of the possible reasons for the charmak disease and also the following aspects:

a- Weeds which grow along with the crop, animal studies can also be done with the weed to rule out hepatotoxic potential

b- Colouring/ flavouring agents of wheat flour can similarly be tested for hepatotoxicity

c- Packing material of wheat bags/ flour should be checked for

d- Any contamination in transportation can be checked

e- The milk of goats, cows which feed on these plants can also have some percentage of contamination

f- Interaction with alcohol cannot be ruled out

g- Human errors

Dr. Anupama also pointed out, that many of the agencies provided aid (medicince, wheat) to the victims and to gulran district in general.

Though we had very interesting discussion on charmak disease, where we found more about Pyrrolizidine alkaloids (Pas) which are the main cause of charmak disease every where.

We found that even some of the herbs like senna, valerian, lobelia, sarsapariila, ephedra, nutmeg etc that are very frequently used for various ailments are also fraught with such dangerous manifestations

Thanks and Regards

Mohammad Bashaar