Bongkrekic acid poisoning: a neglected toxin at the edge of global food safety.

Bongkrekic acid (BA) poisoning is a rare but highly lethal foodborne intoxication caused by Burkholderia gladioli pathovar cocovenenans. This heat-stable mitochondrial toxin irreversibly inhibits the adenine nucleotide translocator, leading to abrupt energy failure, metabolic collapse, and high case fatality rates. Although historically confined to specific regions and traditional fermented foods, recent outbreaks, particularly in Asia, suggest an expanding and underrecognized global risk. The first documented outbreak in Taiwan in 2024 highlights a shift from household fermentation to modern food service settings, indicating evolving exposure pathways. Detection remains a major challenge due to the toxin's organoleptic invisibility and the lack of rapid, field-deployable diagnostic tools. Meanwhile, globalization of food systems, increased consumption of fermented products, and climate-driven environmental changes may broaden the ecological conditions favorable for toxin production. In the absence of an effective antidote, prevention remains the primary strategy, requiring targeted food safety interventions and culturally informed risk communication. We argue that bongkrekic acid poisoning should be reframed as an emerging global food safety threat, warranting enhanced surveillance, improved detection technologies, and greater clinical and public health awareness.