The genip is an ovoid tropical fruit with thick green skin and rather gummy yellowish or pinkish flesh. It contains either one or two seeds and its flavour is said to be similar to that of grapes. Between 1980 and 1989 271 cases of toxic hypoglycaemic syndrome were reported as a result of the consumption of this fruit.
An association between ackee poisoning and Jamaican vomiting sickness was first noted in 1875 and documented in 1904. Ackee, the national fruit of Jamaica, is a food staple in many Jamaican diets. The ackee tree was imported from West Africa to Jamaica in 1778; ubiquitous in Jamaica, it is also found in the Antilles, Central America, and southern Florida. In Jamaica, fresh ackee are consumed directly following harvesting or can be obtained in markets when in season (December-March) . Canned ackee fruit is available throughout the year.
Unripe ackee contains hypoglycin A, a water-soluble liver toxin that induces hypoglycemia by inhibiting gluconeogenesis secondary to its limiting of cofactors (CoA and carnitine) essential for oxidation of long-chain fatty acids. Potential risk behaviors for ackee poisoning include 1) selection and cooking of unripe ackee; 2) purchase of tampered, forcibly opened ackee; and 3) re-use of the water in which unripe ackee has been cooked. Undernutrition is also thought to be associated with both susceptibility to and severity of THS, particularly among children in Jamaica.
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