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Outbreak of Beriberi in an Indian Population of the Upper Amazon Region, Roraima State, Brazil, 2008
Edema, parasthesias, and paresis affected 10 residents of an Indian community in Roraima state; three died. Mining with mercury occurs locally; caxirí, a traditional alcoholic drink, is consumed daily. We conducted a 1:2 unmatched case-control study; a case was an Indian from Uiramutã county (population of 9,127) who presented ≥ 1 of lower extremity edema, paresthesias, paresis, or weakness. Controls were asymptomatic Indians randomly selected from the population. We identified 90 cases (prevalence of 1%) and 180 controls; all were enrolled. Among cases, 79% were male, and the median age was 31 years. Ethnicity was Macuxí, and 49% had income. Cases had lower extremity edema (85%), upper extremity paresthesias (84%), and lower extremity weakness and pain (78%). Risk factors were male sex (odds ratio [OR] = 6.8; P < 0.001), age 31–40 years (OR = 5.63; P < 0.001), and consumption of caxirí (OR = 2.7; P < 0.003). Mercury exposure was not a risk. Thiamine therapy produced complete rapid clinical recovery in all cases, confirming the diagnosis of beriberi. We recommend surveillance, thiamine supplementation, and nutritional intervention.
Author Notes
Authors' addresses: Matheus P. Cerroni, Jean C. S. Barrado, and Aglaer A. Nobrega, Field Epidemiology Training Program, Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil, E-mails: mtcerroni@gmail.com, jean.barrado@gmail.com, and aglaer.nobrega@saude.gov.br. Alysson B. M. Lins, Secretaria Estadual de Saúde de Roraima, Boa Vista, RR, Brazil, E-mail: alyssonlins@hotmail.com. Iolanda P. da Silva, Conselho Indígena do Estado de Roraima, Boa Vista, Roraima, Brasil, E-mail: mtcerroni@gmail.com. Robson R. Mangueira, Fundação Nacional de Saúde do Estado de Roraima, Ministério da Saúde, Boa Vista, Roraima, Brasil, E-mail: robmd34@hotmail.com. Rômulo H. da Cruz, Fundação Nacional de Saúde do Brasil, Ministério da Saúde, Brasília, Distrito Federal, Brasil, E-mail: Romulo.rhc@gmail.com. Sandra M. F. Mendes, Unidade Regional de Saúde de Imperatriz, Maranhão, Brasil, E-mail: mendesmesquita@gmail.com. Jeremy Sobel, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: jsobel@cdc.gov.