The mysterious deaths of 22 people in Panama have now been linked to a contaminated cough syrup.
The latest fatality in a Panamanian woman who died this weekend of kidney failure, takes the death toll from drinking the tainted product to 22.
According to the Panamanian Health Department another 49 people have been treated for kidney and central nervous system damage after drinking the medicine and 23 of them are still in hospital.
It was the U.S. Centers for Disease Control and Prevention (CDC) who finally resolved the mystery when they traced the cause to an industrial chemical in a red, sugarless cough syrup made by a government-run pharmaceutical factory.
The CDC were called in by Panamanian authorities after victims suffered mysterious kidney failure, paralysis and sagging of the facial muscles and victims also experienced symptoms including nausea and diarrhea.
Most of those affected were patients over 60 with a history of diabetes or high blood pressure and initially the medication they were taking for such conditions came under suspicion.
Many of the patients were taking lisinopril, a blood pressure medication, but last weekend an FDA lab ruled that out as the cause.
Panamanian health officials are concerned that others could have unwittingly have been affected and have urged anyone who has taken cough syrup in recent months to seek medical attention.
Investigations are now underway as to how the medicine became contaminated and the government has ordered the syrup and a number of other cold remedies to be removed from store shelves; it has closed the factory which manufactured the cough medicine.
Dr. Scott Dowell, who leads the Global Disease Protection program at the Atlanta-based U.S. Centers for Disease Control and Prevention says the mystery illness had everybody stumped.
The CDC investigators found diethylene glycol, a chemical cousin of antifreeze, in four white plastic cough syrup bottles flown in from Panama City.
Diethylene glycol is used to keep products such as glue and cosmetics moist and was discovered to be dangerous in 1937, when at least 105 people died after taking a DEG-containing antibacterial medicine.
The incident resulted in the Food and Drug Administration being awarded the power to certify the safety of drugs before they are sold to the public.
Panamanian officials have an antidote for the chemical which they say will be given to the affected patients.
The CDC now has 200 full-time employees in 45 countries and is able to respond quickly to unusual outbreaks of illness around the world.
It established response centers in Thailand in 2001 and in Kenya in 2004 and this year three more, in China, Egypt and Guatemala.
Four investigators from the Guatemala center traveled to Panama to assist in the CDC investigation.