News
Getting drunk on food not drink; Lankan doctors unravel medical mystery
View(s):NEW YORK – The lead story in last Sunday’s Staten Island Advance recounted the unravelling of a medical mystery: How can you get drunk without imbibing even a drop of hard liquor? Described as “auto-brewery yeast syndrome” – a rare illness with symptoms that mimic intoxication — the medical condition has been identified by a team of four doctors, two of whom are Sri Lankans.
Once diagnosed, it took a nationwide search to find doctors to treat the patient – and most doctors had never heard of the condition, and those who had, had no idea to treat it. The doctors discovered that the digestive system of the patient, Donato Giannotto, was turning food into alcohol.
Mr. Giannotto hasn’t had an alcoholic beverage in more than 20 years because of his diabetes, yet he was intoxicated for more than a year straight, according to the news story. The four doctors who succeeded in unravelling the mystery were: Dr. Jessie Saverimuttu, an attending infectious disease specialist at Richmond University Medical Centre (RUMC);
Dr. Prasanna Wickremesinghe, gastroenterologist at RUMC (both from Sri Lanka); Dr. Seshadri Das, endocrinologist at Mount Sinai Hospital, and Dr. Christopher Napoli, a chiropractic and a licensed nutritionist on Staten Island, a neighbouring borough in New York city.
Mr. Giannotto’s wife Michelle was quoted as saying: “We would be sitting at the table having dinner and he’d be fine and then an hour after we ate, he would start slurring his speech and would be talking gibberish and sometimes he would just pass out and I’m like ‘What the hell just happened in front of my eyes?’” she recalled, of the “hell” they went through.
He suffered from diarrhoea, swelling, seizures, constant vomiting, blackouts, hallucinations, and intermittent fevers and chills. His health issues caused him to gain so much weight from swelling, he was required to be on constant oxygen, according to the newspaper report.
After several consultations, the Giannottos reached out to Dr Mitchell Fogel, RUMC’s chief medical officer, who said: “How can excessive belching, dizziness, dry mouth, hangovers, disorientation, irritable bowel syndrome, and chronic fatigue syndrome be related? Add random and seemingly spontaneous episodes of intoxication, and soon you have a rare syndrome that is difficult to diagnose and even more challenging to treat.”
Enter the four member “doctor dream team”. Dr Saverimuttu recognised that Giannotto’s symptoms developed after receiving a course of antibiotics and came to the conclusion that “perhaps the antibiotics had killed the good bacteria in Mr. Giannotto’s intestines. This allowed other organisms to grow there instead,” he stated.
“The thing that wasn’t a surprise is that he had been on multiple courses of powerful antibiotics and they’re like a wrecking ball on the effect they have on the gut,” said Dr Napoli. Dr Wickremesinghe was able to identify the strain of yeast that was in his system, and, in conjunction with Dr Saverimuttu, figured out that the particular strain of yeast was resistant to the anti-fungal he was given earlier at Robert Wood Johnson University Hospital.
The doctors then gave him a powerful anti-fungal agent intravenously through a Peripherally Inserted Central Catheter (PICC) line, something that has never been done before, for one month—and it cured him. Dr Fogel said the team is evaluating and treating other patients and a publication is being prepared in conjunction with Richmond University’s medical residents. This will inform other clinicians of the new methods of evaluation and treatment for the uncommon syndrome.
Dr. Wickremesinghe, an old Thomian, is affiliated with multiple hospitals, including Mount Sinai Hospital and RUMC. He received his medical degree from the University of Colombo, and has been in practice for more than 20 years. He is one of 148 doctors at Mount Sinai Hospital and one of 13 RUMC doctors who specialise in gastroenterology.
Dr. Saverimuttu received her medical degree from the University of Jaffna and has been in practice for more than 20 years. She is one of four Richmond University Medical Center doctors who specialise in Infectious Disease.