Bongkrek acid suspected in deadly Taipei food poisoning outbreak

Taipei, March 28 (CNA) Bongkrek acid was the likely cause of a deadly food poisoning outbreak at Malaysian restaurant chain Polam Kopitiam in Taipei, according to health officials.

The outbreak has killed at least two people while 12 others who dined at the branch in Xinyi District have received medical attention, Health Minister Hsueh Jui-yuan (薛瑞元) told reporters before a legislative hearing Thursday.

On Wednesday evening, Deputy Health Minister Victor Wang (王必勝) said that the sickened diners were likely to have ingested Bongkrek acid, which can be found in rice products contaminated by the rare bacterium Burkholderia gladioli during fermentation.

Update

Q&A/Four things to know about Bongkrekic acid

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This conclusion was reached by an expert panel of toxicology and infectious disease experts, representatives from the Centers for Disease Control (CDC), Taiwan Food and Drug Administration (TFDA), hospitals treating the affected patients, and the Institute of Forensic Medicine, Wang said.

How the food at Polam Kopitiam became contaminated is still under investigation, but Hsueh said that deliberate human intervention has not been ruled out.

According to Wang, the sickened individuals all dined at the Xinyi branch of Polam Kopitiam between March 19 and 22 and consumed dishes such as flat rice noodles and kway teow (a kind of rice noodles) made from the same ingredients.

Clinically, especially among those with severe symptoms requiring hospitalization, the symptoms were similar, with acute liver failure leading to subsequent organ failure, Wang said.

Toxicologist Yen Tzung-Hai (顏宗海), who was part of the expert panel, told CNA that Bongkrek acid was first discovered in Indonesia, where several food poisoning cases occurred due to the consumption of a traditional coconut-fermented cake called Tempe bongkrek.

One milligram of Bongkrek acid can be fatal, Yen said, adding that the toxin directly damages the mitochondria responsible for energy production in human cells, thus affecting cellular respiration.

Symptoms resembling acute gastroenteritis, such as nausea, vomiting, and diarrhea will develop after the ingestion of food contaminated with Bongkrek acid, with the possibility of multiple organ failure within one day and a mortality rate exceeding 40 percent, Yen said.

In terms of treatment, Yen stated that there is no antidote for Bongkrek acid, with only supportive therapies available, such as intubation for respiratory failure or administering inotropic agents for shock.

Meanwhile, Wang said that an investigation is underway, with the TFDA having collected specimens from patients and 35 food samples from the restaurant for testing, while the TFDA, National Taiwan University Hospital, and Taipei Veterans General Hospital have placed orders for standard samples required for testing Bongkrek acid.

While the testing is expected to commence next week, Wang pointed out that the forensic autopsy conducted on Thursday will include tests for pesticides and other toxins, rather than solely focusing on one substance.

If the food poisoning outbreak is confirmed to have been caused by Bongkrek acid, it would be Taiwan's first case of collective food poisoning caused by Bongkrek acid, Wang added.

Update

March 28: 5 people remain in critical condition due to food poisoning in Taipei

March 28: Three staff members at food poisoning restaurant banned from leaving Taiwan

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