It is a case full day, and I have a case to discuss today. Today, I will be discussing a case published in a literature on January 27, 2021 and it is a case of Coconut water gone wrong.
The story revolves around a young man who believed he was indulging in a refreshing sip of coconut water. However, the seemingly innocent drink quickly metamorphosed into a harbinger of distress. After consuming it, an unsettling cascade of symptoms unfolded. Profuse sweating, unrelenting nausea, and an unsettling sensation of dizziness gripped him, ultimately culminating in his collapse to the ground. His skin, once vibrant and healthy, grew pallid as an ominous pallor spread across his complexion.
He saw a coconut on his kitchen cabinet, but this wasn't like the regular coconut with hairs, this coconut was clean shaved, and colored. It was the kind one might encounter in the refrigerated section of a grocery store, intended to deliver the delight of pure, hydrating coconut water.
This particular coconut, however, had been languishing in the man's home for weeks, perched casually on the cabinet. As he partook of its contents, an unsettling realization dawned upon him—the coconut water had gone awry. A rancid, slimy quality had usurped the purity of the beverage, sending an alarm through his senses. Despite this distasteful encounter, he swallowed the offending liquid, albeit with reluctance. The taste lingered on his tongue, a lingering reminder of the tainted refreshment.
He was rushed to the emergency room and although he can still respond, he response was slow before he became unresponsive. Early examinations showed that his blood pressure was increasing, although his heartbeat was still normal. His pupils were still responsive to light showing that his brain was responsive but upon blood test, he had metabolic acidosis (a condition where excess acid waste product is produced from metabolism) also, high level of lactate, 3-hydroxybutyrate and glucose were also found in his blood which indicates metabolic derangement. His forearms and calves began to twitch and jerk, and his temperature began to increase.
The symptoms and test showed that he was likely suffering from an infection that is affecting his brain known as meningitis which is an inflammation of the meninges which is the membrane surrounding the brain. Acidosis can be a reaction to bacteria growing in his nerves and brain but to be sure, Cerebrospinal fluid was taken for test.
In an attempt to address potential bacterial involvement, antibiotics were administered. Intriguingly, the attending medical professionals remained unaware of his prior consumption of the tainted coconut water. It was only through the account provided by his wife, who had observed the rotten coconut, that they received a crucial lead.
Laboratory results soon returned, revealing that his brain bore no trace of infection. Now, the focus shifted toward the peculiar properties of rotten coconuts, which have been linked to Bongkrekic acid, a mitochondrial toxin produced by Burkholderia bacteria as a result of incomplete fermentation. Such a toxin could account for his symptoms. However, examinations of the coconut in question failed to detect the presence of Burkholderia bacteria or Bongkrekic acid.
Upon MRI, the patient's brain showed fluid getting into the part of his brain that controls movement, learning , and memory, and a blood test then showed that he had Hyporammonemia which means high ammonia present in blood. Ammonia is a waste product of proteins and protein is a long chain of amino acid which is digested by gut bacteria and this was as a result of his liver shutting down. The blood test also showed that part of his muscle tissue because the brain was unable to control the contraction and relaxation of the muscles and the energy lacked energy.
It is important to know that the patient doesn't suffer from any bacteria infection from tests done at the hospital and didn't suffer from the Bongkrekic acid toxin. So what could be the problem?
His kidneys began to shutdown, and the liver also shut down, but then examination of the coconut showed Arthrinium Saccharicola which is a fungi that produces the toxin 3-Nitropropionic acid and the toxin is similar to the chemical Succunic acid present in the mitochondria which is used to produce ATP for energy. This toxic acid gets into the mitochondria, taking over the Succunic acid and preventing the production of ATP which is energy needed by the body.
The repercussions were dire as brain tissues and cells began to perish due to energy depletion, mirroring the fate of liver cells, which prompted the accumulation of excess ammonia in the bloodstream. As the brain swelled, the kidney cells also faced demise. Consequently, the patient's pupils ceased to react to light, and the shutdown of his vital organs left him incapable of autonomous respiration.
This case serves as a stark reminder of the importance of food safety and the significance of promptly refrigerating items that require it. The incident underlines that while microbes themselves may not always pose an immediate threat, the toxins they generate can have severe consequences.
Read More
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774558/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3471735/
https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/jat.4259
https://pubmed.ncbi.nlm.nih.gov/16300642/
https://www.cambridge.org/core/services/aop-cambridge-core/content
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1482830/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856542/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201847/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440313/
Image Reference
Image 1 || Pickpik || Female holding a fresh coconut
Image 2 || Picryl || Emergency Department staff members assess the injuries