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At least 12 people became seriously ill and four of them were admitted to the intensive care unit after a suspected poisoning incident at a restaurant in the Toronto area, public health officials confirmed.

All had eaten at Delight Restaurant & BBQ on Castlemore Avenue in Markham on the evening of Sunday, August 28, according to Barry Pakes, MD, PhD, MPH, the York Region Medical Officer of Health.

In an emailed statement, Pakes said York Region Public Health "responded immediately by launching an investigation and closing the restaurant," which has since been permitted to re-open following a satisfactory inspection by local health authorities.

Most of the 12 people have recovered and are no longer in the hospital, but several remain severely ill in the hospital, though their condition is improving, Pakes said.

On Thursday, Pakes said in an updated statement that the source of the illnesses was likely a spice product contaminated with aconite. He named two products, both from the Mr. Right brand: Kaempferia Galanga Powder and Radix Aconiti Kusnezoffii Powder.

These products should be thrown out immediately, Pakes said, adding that they have been removed from known retail locations across the York region.

CP24 that the incident appeared to be due to aconite toxicity.

"Certainly from the number of people, the effects, how quickly they were affected, and most importantly, from the symptoms that they have, we do suspect that it was ... aconite," Pakes said.

Medical toxicologist David Juurlink, MD, PhD, of the University of Toronto, agreed that the incident sounds like aconite poisoning.

"Aconitine is a highly toxic alkaloid derived from the genus Aconitum," which includes plants such as monkshood and wolfsbane, .

He said its effects "occur quickly and are chiefly [gastrointestinal], neurologic, and cardiac." GI effects include nausea, vomiting, and cramping; neurologic effects include numbness of the face and mouth, progressing to the limbs, with muscle weakness and eventually coma; cardiac effects include hypotension and life-threatening arrhythmias.

Management is mostly supportive, he said, as there is no specific antidote. Treatment includes atropine for bradycardia, magnesium ion (Mg²⁺) for long QT/TdP, cardioversion, and early extracorporeal membrane oxygenation.

Juurlink noted that Canadian health officials about a ginger powder product called Wing Hing that accidentally contained monkshood powder. Monkshood root looks similar to ginger root.

Health authorities discovered that contamination during an investigation following two people being hospitalized in early February with heart irregularities after eating the product, .

In the emailed statement, Pakes said the restaurant remains closed and the investigation is ongoing. The restaurant is cooperating with the investigation, he added.

"We have no reason to think this is intentional in any way," Pakes told CP24.

Health officials warned that anyone who ate at the restaurant on Sunday August 28 and is experiencing symptoms should seek medical attention immediately. People should also throw away any leftovers from the restaurant, Pakes added.

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