I have a kinda confusing scenario to analyze in which am not able to make a concrete decision. Can anyone help me with this? I need your help to determine the cause of this outbreak was and to make suggestions as to how such a terrible episode can be avoided in the future, am so confused by the four different opinions I received that I don’t know where to start. Outline the kinds of experimental and epidemiological questions I can ask to find out the cause of the outbreak was? How to determine the etiology of this? THE SCENARIO: Outbreak of acute liver failure in several villages in the Amazon River basin in northeastern Peru. More than a hundred children died within a two –week period in a cluster of 19 villages. A provincial health officer and midwife from the small clinic in Iquitos (the only town within 200 miles of villages) traveled to each of the 19 villages to examine the sick, dying and dead children. They found what appeared to be well-nourished children of Incan descent who had recently suffered a mild bout of what seemed to be influenza and were treated by family members and /or medicine men with a special gruel. All sick children received the same gruel. A single preparation of gruel was made to treat all children. The gruel was prepared from peanuts; plant leaves, chilies, cassava, fish entrails, mushrooms, and berries, and was fermented in air tight clay pots for 1-2 days. The gruel was strained and without further processing, given to ailing children orally and within 24 hours the symptoms of influenza receded completely. However, within the next 1-4 days the children who had received the gruel began to vomit, sometimes with blood; they developed convulsions and Jaundice. Some had diarrhea with blood, sore abdomens and feeling of panic. Several of the children had feeble heart beats and an intense thirst. Cases with a fatal outcome went into coma for several hours before death; none of the surviving children experienced coma. The health officer put four of the sickest children in his Land Rover and returned to his clinic in Iquitos, but the children soon died. Autopsy showed hemorrhagic degeneration of jaundice and intestinal hemorrhaging. Tissues were frozen for record, as was some of the gruel that had been given to the children; the gruel, however, had continued to ferment before it was frozen b the health officer. The health officer reported the outbreak to the ministry of public health in Lima and over a period of two weeks received individual comments from four prominent specialists in tropical medicine. One physician indicated that the outbreak was most likely due to aflatoxins and recommended collection of peanuts from the area for chemical analysis to confirm the presence f the causative factor. A second physician indicated that the outbreak was undoubtedly the result of inclusion of amanita mushrooms in the gruel and requested that the gruel be examined by a mycologist to confirm the diagnosis. A third physician suggested that he outbreak was due to hypoglycin poisoning because he knew that certain un ripe berries contain high concentrations of hypoglycin and the symptoms described by the provincial health officer are the same as seen in Jamaican vomiting sickness. The last opinion came from Dr. Verde who rather dogmatically stated that there was no question that this was an outbreak of pyrrolizidine alkaloid poisoning, most likely retrorsine, and that the survivors were at high risk for developing liver cancer in the next several years.