Epidemic of toxic hepatitis in India of possible mycotoxic origin

An epidemic of liver disease, characterized by onset with high fever, rapidly progressive jaundice, and ascites occurred in a rural area of India. Several hundred people were affected and mortality was high. The epidemic was heralded by the appearance of similar features in the village dogs. Liver biopsy specimens from eight cases and autopsy material from one human case and two dogs were studied. Characteristic features were centrizonal scarring, hepatic venous occlusion, ductular proliferation and cholestasis, focal syncytial giant-cell tr-nsformation of hepatocytes, and pericellular fibrosis. Toxic quantities of aflatoxin B1 were found in samples of corn, the staple food grain of the people, that was obtained from the domestic food stores. The etiology of the disease could not be unequivocally established, but aflatoxins, perhaps in combination with other factors, may have been the cause.