Epidemiologic Notes and Reports
Update: Eosinophilia-Myalgia Syndrome Associated
with Ingestion of L-Tryptophan -- United States
On November 9, 1989, CDC contacted all state health departments
to inform them of a newly recognized syndrome involving severe,
debilitating myalgias and eosinophilia (greater than or equal to
1000 eosinophils per mm3). Eosinophilia-myalgia syndrome (EMS)
was reported initially from New Mexico and was associated with
ingestion of L-tryptophan-containing products (LTCPs) (1,2). To
better characterize this syndrome and to assess the extent of the
problem, CDC and state health departments implemented a national
state-based surveillance system using a standardized case-report
form. State health departments have telephoned numbers of EMS
cases to CDC daily, then mailed completed case report forms; this
results in a timely accumulation of total numbers but a lag in
availability of detailed data.
As of December 6, 730 EMS cases have been reported to CDC from
48 states, the District of Columbia, and Puerto Rico. Only Alaska
and South Dakota have reported no cases (Figure 1). Four deaths
have been reported in patients who met the surveillance case
definition and who used LT; one death has been confirmed as
directly attributable to EMS, and the others are under
investigation.
As of December 6, CDC has received completed report forms from
21 states with information about 64 cases fitting the case
definition. Ages of these patients ranged from 14 years to 73
years (median: 44 years); 95% of patients were non-Hispanic
white, 3% were black, and 2% were Hispanic. Fifty-two (81%) were
female. Sixty-three (98%) had histories of LT ingestion preceding
onset of symptoms; dosage ranged from 500 mg to 5000 mg per day
(median: 1500 mg per day). Fifty-eight (91%) reported onset of
symptoms during or after July 1989. Of the EMS patients reported
thus far, 21 (33%) have required hospitalization.
Reported by: State and territorial health departments. Div of
Environmental Hazards and Health Effects, Center for
Environmental Health and Injury Control, CDC.
CDC. Eosinophilia-myalgia syndrome and L-tryptophan-containing
products--New Mexico, Minnesota, Oregon, and New York, 1989. MMWR
1989;38:785-8.
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