It can be incredibly frustrating being constantly told that you have a drinking problem when you've never had a drop but for this 61-year-old Pennsylvania woman, each and every effort to become eligible for a life-saving liver transplant was thwarted by an insurmountable hurdle—she kept testing positive for alcohol. No matter how many times she asserted that she had not been drinking, her urine drug screens read otherwise. Accordingly, she was refused entry on the liver transplant waiting list numerous times, the doctors presuming she was struggling with alcohol addiction.

But the reality was much stranger than anyone might have dreamed. In what seems to be a first in medical history, physicians found that her own bladder was secreting alcohol—a process so unusual that it had not been given an official name yet. Her case sheds new light on how the human body, under abnormal circumstances, can simulate effects of alcohol use without ingestion.

The patient had severe liver cirrhosis, a scarring and liver function loss that requires a transplant to save her life. She also had diabetes that was uncontrolled, leading to high levels of glucose (sugar) in her urine.

Initially, physicians at one hospital brushed off her assertion that she was sober, believing that she was denying alcohol addiction. When she subsequently reported for assistance at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital, the same problem persisted. Her urine samples consistently registered the presence of ethanol, the beverage type of alcohol, further increasing the medical staff's suspicion. Yet there was a critical discrepancy: whereas her urine tested positive for ethanol, it was free of the usual metabolic byproducts—ethyl glucuronide and ethyl sulfate—seen days after drinking.

This contradiction interested Dr. Kenichi Tamama, a senior researcher on the study and an associate professor of pathology and medical director of UPMC's Clinical Toxicology Laboratory. If the woman was consuming alcohol, the metabolites should have been found in her urine. Also, her blood alcohol tests were negative, and she never showed any symptoms of being intoxicated.

Following more research, the doctors discovered a surprising cause: yeast in the woman's bladder was fermenting sugar into alcohol. The process, normally related to making beer or wine, was occurring within her body. Consequently, they suggested calling her condition "urinary auto-brewery syndrome" or "bladder fermentation syndrome."

This condition is similar to, but different from, a rare disorder called auto-brewery syndrome (ABS), also referred to as gut fermentation syndrome. ABS happens when some microbes in the gut ferment carbohydrates into alcohol, leading to people with the condition becoming intoxicated without consuming alcohol. In the case of the Pennsylvania woman, however, her condition was confined to her bladder, so the alcohol did not reach her bloodstream. She therefore never seemed drunk, although her urine was ethanol-positive.

To be sure about their suspicion, scientists performed an experiment. The researchers took a fresh urine specimen from the patient and incubated it at a temperature of the human body (98.6°F or 37°C). Ethanol in the sample zoomed within no time. The sample did not yield any alcohol, however, if it were incubated below normal temperature (39°F or 4°C) or after the addition of a chemical for stopping fermentation. This test conclusively established that the yeast in her bladder was the cause of the alcohol production.

Additional lab tests determined the offender—Candida glabrata, a yeast that is normally present in the human microbiome. Candida glabrata is closely related to brewer's yeast, which is employed in alcoholic fermentation. Under conditions of excess sugar, as in the case of the woman with uncontrolled diabetes, Candida glabrata metabolized the glucose in her bladder to ethanol.

Due to these observations, the woman was finally reevaluated for liver transplant, a move that could turn around her condition and save her life. Her case highlights the need to cast aside standard assumptions of diagnosis and to explore infrequent metabolic phenomena.

Although sporadic reports of such cases have appeared, they were usually considered postmortem changes or laboratory artifacts due to the improper storage of urine samples. This case presents tangible evidence that bladder fermentation is possible in living patients and serves to increase awareness among medical professionals regarding distinguishing between true alcohol intake and endogenously produced alcohol.

What Is Auto-Brewery Syndrome?

Auto-brewery syndrome, or gut fermentation syndrome, is a rare condition where carbohydrates ferment to alcohol within the gastrointestinal tract. Patients can present with signs of intoxication, such as dizziness, slurred speech, and coordination impairment, without alcohol consumption. This results from an imbalance in gut microbiota, typically yeasts such as Candida.

The syndrome is well-documented in medical literature for more than 50 years, yet it remains significantly underdiagnosed. A study published in 2021 estimated that fewer than 100 cases had been reported globally. Experts, however, estimate that numerous other people might be suffering from the condition unknowingly, as the symptoms might be confused with alcohol intake, metabolic conditions, or psychiatric issues. In severe instances, people with ABS have been charged with DUI, even though they consumed no alcohol.

How Is Urinary Auto-Brewery Syndrome Different From Typical Auto-Brewery Syndrome?

Urinary auto-brewery syndrome (bladder fermentation syndrome) and conventional auto-brewery syndrome (gut fermentation syndrome) are similar but differ significantly.

In urinary auto-brewery syndrome, alcohol is synthesized in the bladder because of microbial fermentation of sugar. It may also happen in an open sample of urine outside the refrigerator. But as the alcohol is contained within the bladder and does not get into the bloodstream, individuals who have it do not have symptoms of being intoxicated.

In contrast, classical auto-brewery syndrome happens within the gastrointestinal tract, where fermentative microbes metabolize carbohydrates into alcohol. This alcohol is absorbed into the bloodstream, resulting in a positive plasma ethanol reading and creating symptoms of intoxication similar to that following alcohol intake.

The Multnomah County Health Department (MCHD) on Thursday confirmed one case of tuberculosis at Portland's Lane Middle School. As per the Oregon Health Authority data, in 2024, 87 cases of tuberculosis were reported in Oregon, which meant it was spreading at the rate of 2.1 cases for ever 100,000 Oregon residents.

“Tuberculosis is a bacteria that spreads through close face-to-face contact with an infectious individual. It is curable with medication. Because the infection progresses slowly, it’s important to be treated to prevent serious illness,” the health department said in a statement.

The person who is reported to have tuberculosis may have been contagious between September 3, 2024 to May 1, 2025. The person may also have exposed others to TB, said the MCHD.

“This particular individual had symptoms that were kind of mild for a while and got worse. It was eventually diagnosed like a week ago, said Dr. Richard Bruno, Health Officer with the Multnomah County Health Department.

What Is Happening Now?

The Health Department's Communicable Disease Team is now looking to start for a contact investigation that will help them identify individuals who may have come to contact with the person infected. The exposed individuals have also been contacted by the Health Department via an email letter.

For now, the Health Department has also recommended Lane Middle School parents to be lookout for TB symptoms and report if any. The symptoms include:

• Persistent cough lasting 3+ weeks
• Chest pain
• Blood
• Phlegm
• Unexplained weight loss

The Health Department has also said that it will provide free blood tests to the school community in the coming weeks. Their efforts have made them optimistic that this will prevent a community spread.

What Is Tuberculosis?

As per the World Health Organization (WHO), TB is an infectious disease caused by bacteria that most often affects the lungs. It spreads through the air when people with TB cough, sneeze or spit.

As per the 2017 study, titled The History of Tuberculosis: from the first historical records to the isolation of Koch's bacillus published in the Journal of Preventive Medicine and Hygiene, TB happens due to Mycobacterium tuberculosis (MT), which lasts throughout the life course and determines the formation of tubercles in different parts of the body. MT has ancient origins and have survived over 70,000 years. This also infects 2 billion people worldwide, with 10.4 million new cases each year. It is also responsible for 1.4 million deaths.

Common Symptoms Include:

• A cough that lasts more than three weeks
• Coughing up blood or phlegm
• Chest pain
• Fever
• Chills
• Night sweats
• Weight loss
• Loss of appetite
• Weakness or fatigue
• Feeling generally unwell

Severe Symptoms may also include:

• Swollen glands
• Body aches and pains
• Swollen joints or ankles
• Tummy or pelvic pain
• Constipation
• Dark or cloudy urine
• Headache
• Being sick
• Feeling confused
• A stiff neck

Every year on May 16, India observes National Dengue Day. This day raises awareness about the growing threat of dengue fever, especially during the monsoon season. Usually, it is during the monsoon that due to stagnant water, mosquito breeding increases. The government also aims to highlight the importance of prevention, public participation for awareness, as well as timely medical care to control the spread of the disease.

National Dengue Day 2025 Theme:

Each year, a unique theme is observed in order to raise awareness. This year, the main theme is people-led prevention. The theme is : Act Early, Prevent Dengue: Clean Surroundings, Healthy Living.

Origin of National Dengue Day

The Ministry of Health designated May 16 as National Dengue Day in 2010. This was done to intervene when dengue cases increased throughout the pre-monsoon and monsoon seasons.

As per the World Health Organization (WHO), "Dengue epidemics tend to have seasonal patterns, with transmission often peaking during and after rainy seasons. There are several factors contributing to this increase, and they include high mosquito population levels, susceptibility to circulating serotypes, favourable air temperatures, precipitation and humidity, all of which affect the reproduction and feeding patterns of mosquito populations, as well as the dengue virus incubation period. Lack of proactive control interventions and staff are some of the other challenges."

Dengue And India: Significance

Due to climate change, monsoon has arrived early, thus the Union Health Ministry has directed all air, sea, and land ports across the country to step up surveillance for vector-borne diseases. Authorities have been asked to strengthen preventive and control measures to curb the spread of infections such as dengue, chikungunya, Zika, and yellow fever.

The advisory comes amid concerns over rising cases during the rainy season, a period that typically sees a surge in mosquito breeding and transmission. India continues to report a significant number of cases and deaths linked to vector-borne illnesses each year, making early intervention and preparedness critical.

Dengue and India: History

As per a 2012 study published in the Indian Journal of Medical Research, the official journal of the Indian Council of Medical Research, titled Dengue in India, notes that it was in 1780 when the first epidemic of clinical dengue-like illness was recorded in Madras (now Chennai). The first virologically proved epidemic of dengue fever occurred in Calcutta (now Kolkata) and the Eastern Coast of India in 1963-64.

However, during the last 50 years, notes the study, a large number of physicians have treated and described dengue diseases in India, but the scientific studies which address problems with regard to the disease may have been limited.

What is Dengue?

The study notes that Dengue is an acute viral infection with potential fatal complications. It was first referred to as "water poison" associated with flying insects in a Chinese medical encyclopedia in 992 from the Jin Dynasty.

The word "dengue" is derived from the Swahili phrase Ka-dinga pepo, which means "cramp-like seizure". The first clinically recognized dengue epidemics occurred simultaneously in Asia, Africa, and North America in the 1780s.

As per Global Medicine, the first clinical case report dates from 1789 of 1780 epidemic in Philadelphia is by Benjamin Rush, who coined the term “break bone fever” because of the symptoms of myalgia and arthralgia.

How Does Dengue Happen?

As per the Centers for Disease Control and Prevention (CDC), dengue viruses usually spread to people through the bites of infected Aedes species mosquitoes. This mosquito bites a person infected with the dengue virus and then becomes infected. The infected mosquito then bites people and infects them with the dengue virus.

Every year, May 16 is National Dengue Day, a public health initiative that aims to bring attention to one of the globe's most rapidly spreading mosquito-borne viral diseases. But as the limelight is once again back on dengue prevention and control, a new study is changing the conversation from the short-term risk of dengue to the insidious, long-term damage it can inflict on the future generation.

A recent study published has highlighted an underemphasized but very important issue of maternal health: the long-term effect of dengue fever in pregnancy on newborns. Although dengue fever is a well-documented mosquito-transmitted disease endemic to tropical and subtropical parts of the world, the novel evidence points toward its long-lasting effects on pregnancy outcomes and children's health till the age of three years.

As the world fights rising dengue epidemics fueled in part by climate change and urbanization—knowing how this virus impacts pregnant women and their unborn babies is more critical than ever.

Dengue fever infects almost half of the world's population. In 2023 alone, over three million cases were reported in the Americas, triggering alarms over its explosive growth. Notwithstanding its ubiquity, risks of dengue fever in pregnancy have not been given sufficient attentionuntil now.

Scientists from the UK's Universities of Birmingham and Surrey, employing a huge data set from Brazil's Minas Gerais state, have presented a strong argument for the long-term effect of the virus. The study, published in the American Economic Journal: Applied Economics, points out how even uncomplicated dengue infection in pregnancy has significantly affected the course of a child's life.

The research followed more than 300,000 mother-child pairs from 2011 to 2017. Researchers matched birth certificates, hospitalization rates, and reports of dengue infection to determine how maternal infection influenced early childhood health outcomes.

The study’s findings draw a sharp line between maternal dengue infection and significant early-life health risks for children. Researchers discovered that children born to mothers who contracted dengue during pregnancy faced a 27% higher risk of hospitalization from birth to age three. Alarmingly, this risk peaked in the second year of life, with a 76% increase in hospitalization during that period alone — a stage critical for early development. In addition to hospitalization risks, birth weight outcomes were notably affected. Babies born to infected mothers were 15% more likely to have low birth weight, with more severe outcomes indicating a 67% higher chance of very low birth weight and a staggering 133% increased risk of extremely low birth weight.

These outcomes are medically significant, as birth weight is a well-established predictor of both immediate neonatal health and long-term developmental and socioeconomic trajectories.

These staggering statistics highlight not only the immediate health consequences for newborns but also the possibility of long-term developmental and socio-economic issues.

Why Low Birth Weight Is A Sign Of Something Serious?

Low birth weight is a documented risk factor for many health complications throughout an individual's lifetime. Underweight babies are at higher risk of:

• Delayed physical and intellectual development
• Increased susceptibility to infections and chronic diseases
• Greater risk of metabolic disorders in adulthood

Dr. Livia Menezes, co-author of the University of Birmingham study, underscored this association, adding, "These birth outcomes can have longer-term impacts—for example, previous research has shown that low birth weight can negatively affect socio-economic outcomes and health in adulthood."

Dengue Transmission and Symptoms During Pregnancy

Dengue fever is due to the dengue virus and spread by the bite of an infected Aedes mosquito, predominantly Aedes aegypti. Pregnant women, particularly in the third trimester, are highly susceptible as they can vertically transmit the virus to their fetus.

The signs of dengue fever during pregnancy vary from mild to severe and can include:

• Fever
• Headache and orbital pain
• Nausea and vomiting
• Rash, particularly on palms and soles
• Muscle and joint ache
• Enlarged glands

Severe dengue (dengue hemorrhagic fever) may cause internal bleeding, organ failure, and death when left untreated. Warning signs of severe dengue are persistent vomiting, severe stomach pain, bleeding gums, and inability to breathe.

Historically limited to the tropics, dengue fever is increasingly spreading thanks to global warming. Increasing temperatures and urbanisation have enabled the Aedes mosquito to flourish in southern Europe and even US states.

As economist and co-author Dr. Martin Foureaux Koppensteiner of the University of Surrey describes, the consequences extend beyond personal health: "These adverse birth outcomes… have a much broader effect on communities where dengue is endemic. Hospitalization and long-term health problems caused by maternal infection all cost something—one that might be avoided or at least reduced with greater awareness and better policy."

Furthermore, healthcare systems need to plan for long-term pediatric care in children who were exposed to dengue in utero. These include monitoring for birth weights, developmental milestones, and providing access to early interventions when necessary.

These research findings present the global health community with a urgent wake-up call. Dengue fever is no mere seasonal plague—it is an interrupter of a child's life from an early age. With its spread and underemphasized consequences, especially among pregnant women, dengue needs to gain a greater space on the agenda of maternal health.