updated 10/13/2006 8:51:02 PM ET 2006-10-14T00:51:02

U.S. health officials this week cracked the case of what caused the mysterious deaths of 21 people in Panama since midsummer — an industrial chemical in red cough syrup.

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Officials continue to investigate how the medicine became contaminated. The Panamanian government has ordered the syrup removed from store shelves and the government factory that manufactured it shut down.

But U.S. health officials are tentatively counting the investigation as a success story in rapid investigation and international collaboration that may have prevented additional deaths.

“It was really a mystery illness that had everybody stumped,” said Dr. Scott Dowell, who leads the Global Disease Protection program at the Atlanta-based U.S. Centers for Disease Control and Prevention.

Many of the victims suffered kidney failure, paralysis and sagging of the facial muscles and other symptoms. Last week, Panama’s Ministry of Health asked the CDC to send help. By that point more than a dozen deaths had been reported.

Early Wednesday, CDC investigators found diethylene glycol in four white plastic cough syrup bottles flown in from Panama City. Diethylene glycol is a chemical cousin of antifreeze and is used to keep products like glue and cosmetics moist.

“I think everybody’s feeling pretty confident” that the chemical’s presence explains the illnesses, said Eric Sampson, director of the CDC environmental health lab that made the find.

U.S. scientists discovered the chemical’s dangers in 1937, when at least 105 people died after taking a DEG-containing antibacterial medicine made by the S.E. Massengill Co. of Bristol, Tenn.

The disaster became a turning point in U.S. regulatory history, influencing Congress to give the Food and Drug Administration the power to certify the safety of drugs before they are sold to the public.

DEG poisonings have erupted occasionally since then in other parts of the world. In late 1995 and early 1996, more than 30 children were admitted to a hospital in Port-au-Prince, Haiti, with sudden kidney failure. An investigation by Haitian health officials, the CDC and others discovered diethylene glycol in acetaminophen syrup manufactured in Haiti.

As of Friday afternoon, the investigation had identified 47 illnesses in the outbreak, including the 21 deaths, CDC officials said, and another 11 illnesses were being investigated. Panamanian officials said they have an antidote for the chemical and planned to administer it immediately to the sick.

CDC officials are trying to position themselves to more quickly react to unusual outbreaks of illness around the world. The agency has 200 full-time employees in 45 countries, up from the 87 employees in 38 countries it had in 2000.

The agency established response centers in Thailand in 2001 and in Kenya in 2004. This year, it also established three more, in China, Egypt and Guatemala.

Four investigators from the Guatemala center traveled to Panama to assist in the CDC investigation.

Investigators noted many of the patients were taking lisinopril, a blood pressure medication, but last weekend an FDA lab ruled that out as the cause. Tests of blood, urine and tissue from autopsies found no contagious diseases, either.

Some of the people who grew ill had been taking a sugarless cough medicine that was made in a pharmaceutical factory operated by Caja de Seguro Social, a government hospital system. That led investigators to test the medicine.

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