Lobster-Induced Rhabdomyolysis Raises Questions, Nanjing Launches Emergency Investigation
Yesterday, media reports on "muscle dissolution" caused by delicious lobsters sparked widespread public concern. It was reported that patients with muscle dissolution from eating lobsters have frequently appeared in major hospitals in Nanjing in recent days. Yesterday, a reporter learned from relevant departments that the Nanjing Municipal Health Bureau specifically convened all relevant units for deployment around 6 PM yesterday evening and will begin to investigate the lobster incident from today.
Wang Zhenqiu, director of the Nanjing Municipal Health Inspection Institute, told reporters that they had already proactively intervened in the investigation based on clues from media reports, and had also visited some agricultural markets and catering enterprises. "But from now on, we will conduct targeted investigations and demonstrations in accordance with the unified deployment of the bureau," he said.
What Caused the Illness?
Nanjing Center for Disease Control and Prevention: It's Impossible to be Caused by "Lobster Washing Powder"
A person in charge of the Nanjing CDC revealed that the CDC department will summon relevant epidemiologists and nutritionists to conduct an investigation. Different from previous CDC investigations into food poisoning incidents, the cases of "rhabdomyolysis" caused by lobsters are relatively scattered. They were reported by various hospitals to district and county CDCs, and about 20 cases have been summarized to the Nanjing CDC. The sources of the lobsters are also scattered; some were cooked at home, and some were eaten in restaurants. There is no certain correlation between them. "If all 20 cases came from the same restaurant and occurred in the same period, the investigation and confirmation would be relatively simple," the person in charge frankly admitted, but with such scattered cases, investigation and sampling are certain to be difficult. "If we can identify a specific substance, it can be detected quickly, but now we don't know which substance it is, such as testing all suspected objects one by one after eliminating them." This person in charge stated that it is also necessary to cooperate with the agriculture and drug supervision departments to test suspicious substances when necessary.
"It is impossible that 'lobster washing powder' caused the rhabdomyolysis," said Li Jiequan, director of the Nanjing Center for Disease Control and Prevention. After the news was reported, they immediately organized relevant experts to conduct an epidemiological investigation and analysis, and the results basically negated the statement that "lobster washing powder" caused the disease. The main component of "lobster washing powder" is oxalic acid, an oxidant that mainly cleans dirt. Although oxalic acid decomposes after being soaked in clear water and cooked at high temperatures, it is a chemical substance and should not be used in food processing.
Expert from Provincial Freshwater Fisheries Research Institute: Disagrees with the Link Between Cases and Lobsters
Are so many cases really related to lobsters? Tang Jianxin, an expert from the Jiangsu Provincial Freshwater Fisheries Research Institute, does not agree. He said that current lobsters are mainly fed with ecological food during their rearing process, with a wide and complex diet, and basically do not need artificial feed or any drugs. The US food safety inspection is the strictest in the world, and our province exports a large number of lobsters to the United States every year, which fully shows that lobsters are not as "dirty" as the public believes.
Wu Jianzhong, deputy director of the Expert Committee for Public Health Emergencies of Nanjing Municipality, repeatedly emphasized to reporters that it is not yet certain that it is lobster poisoning. "Because lobsters themselves do not synthesize toxins, they are different from pufferfish." Wu Jianzhong said that the specific cause is still inconclusive, and finding the cause is a scientific process that cannot be based on impression or experience. If a chemical substance is suspected to have caused the poisoning, experiments must be conducted for toxicological analysis.
Three Major Points of Doubt
Reporters learned that as the number of cases admitted to major hospitals in Nanjing continues to increase, the fact that "how you eat and how much you eat can both lead to illness" has puzzled many experts in epidemiology. From the current medical records, there is not much clear direction, making it difficult to find a pattern. Experts pointed out that the exploration of the cause of this newly discovered group illness cannot be based on experience or come to a hasty conclusion. Instead, laboratory demonstration is needed to scientifically explore the cause of the illness. And from the cases reported to the CDC by Gulou Hospital and Jiangsu Provincial People's Hospital, there are still the following three major points of doubt.
- Point of Doubt One
More Cases from Home Cooking Than from Eating Out
From the cases reported to the CDC, the number of people who induced "rhabdomyolysis" by cooking and eating lobsters at home was more than those who ate in restaurants. Gulou Hospital was the first hospital in Nanjing to admit such patients. From July 20th to July 28th, it admitted 11 patients with muscle dissolution from eating lobsters, all of whom bought lobsters from agricultural markets and processed them themselves. They unanimously stated that the lobsters looked fresh and clean, and they were washed very clean after buying, with gills and other parts removed. Last week, Gulou Hospital admitted another family, whose young daughter was admitted to the nephrology ward, and this family also bought lobsters from the Huimin Bridge Aquatic Wholesale Market themselves. During the interview, reporters also learned that some families buy from roadside vendors and then can't find them anymore.
Of course, some citizens also became ill after eating lobsters in restaurants. In mid-August, Jiangsu Provincial People's Hospital admitted a batch of patients in succession, basically eating lobsters from a certain lobster restaurant in Nanjing at the same time. On the day the incident was disclosed by the media, the Baixia District Health Inspection Institute led a team to inspect the involved restaurant. It is reported that this restaurant has been open in Nanjing for many years, and all its health certificates meet the standards. It is also the first time such a "poisoning incident" has occurred. The source of the lobsters was a storefront at Huimin Bridge.
An expert said that lobsters must be steamed or boiled for 30-40 minutes, but many families do not cook for that long. It is not ruled out that some restaurants have repeatedly steamed or boiled their lobsters. However, generally, popular restaurants sell a large number of lobsters every day and, to maintain the taste, will not cook for too long.
- Point of Doubt Two
Related to Allergic Constitution
"Why do only a few people get sick in this lobster restaurant when so many people eat lobsters here every day?" an expert from the CDC questioned. Judging from the amount of lobsters Nanjing residents eat every day, the current number of 20-30 sick people is still relatively small, which is considered sporadic. He suspects it is still related to a person's constitution. From the analysis of these cases, some were mild and got better after intravenous drip, while others were severe and required hospitalization. Therefore, some experts suspect that it may still be related to allergic constitution. Some people with special allergic constitutions may have abnormal immune reactions after drug stimulation. And allergic constitution is related to genetics, so if one parent has an allergic constitution, the child has a high probability of also having an allergic constitution.
Shi Hongqiao, director of the dermatology department of Nanjing Hospital of Traditional Chinese Medicine, said that lobsters are a high-protein food that can easily cause heterologous protein reactions. From the perspective of TCM, lobsters are "hair-trigger foods" (foods that can trigger or exacerbate certain illnesses), and for people with allergic constitutions, they are an allergen. Many citizens, due to their love of eating crayfish, are covered in small red rashes, which are unbearably itchy, and in severe cases, accompanied by gout attacks. Director Shi reminded the general public, especially those with allergic constitutions, to be cautious when eating crayfish.
- Point of Doubt Three
Those Who Eat More Are Not Necessarily More Severely Affected
Among some of the cases admitted to the hospital, people who ate more lobsters had more severe symptoms, but subsequent cases did not continue to "verify" this pattern. For example, two days ago, Jiangsu Provincial People's Hospital admitted a patient named Xiao Gong. Her father ate the most but did not get sick, while she and her mother each ate less than 10 lobsters and suffered kidney damage. A girl admitted to Gulou Hospital last week, who claimed to be a "crayfish killer" normally, was hospitalized after eating only eight or nine lobsters this time.
Some experts even suspect that some feed additives can also cause rhabdomyolysis, or whether there are any ingredients in the seasonings added during the cooking process that induce the disease. All of this needs to be tested.
- Shanghai's Rapid Response
Shanghai's Emergency Risk Assessment of Crayfish May Investigate the Farming Link
In response to multiple cases in Nanjing suspected of being caused by eating crayfish leading to rhabdomyolysis and "soy sauce urine," the Shanghai Food and Drug Administration yesterday launched a special risk assessment for crayfish. Gu Zhenhua, a person in charge of the Shanghai FDA, revealed that since last year, Shanghai has banned the use of so-called "crayfish washing powder," but it is necessary to further investigate whether any substances have been added during the crayfish farming process. However, Shanghai has not yet received any similar cases of suspected muscle dissolution from eating crayfish, but improper consumption of crayfish may cause diarrhea or allergies.
Yesterday morning, food experts from the Shanghai FDA urgently launched a special study on crayfish. Gu Zhenhua, director of the Shanghai Food and Drug Supervision Institute, said that so far, Shanghai has not found any cases related to "suspected muscle dissolution from eating crayfish." In fact, "crayfish washing powder" is not edible alkali. Its main components are citric acid and sulfites. These two components are legal food additives, but relevant regulations clearly define their scope of use. Using them to wash crayfish is a violation. "However, these two components will not cause muscle dissolution."
"However, 'crayfish washing powder' also contains many other unseparated components, and new formulas may have emerged," related food experts believe. It is still inconclusive what these components are and whether they cause muscle dissolution, and further research is needed. Some experts also believe it is necessary to investigate the crayfish farming process. At present, the vast majority of crayfish are not wild but are artificially farmed. During the farming process, in order for crayfish to grow faster, some farmers may "medicate" the crayfish.