Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addicts and food poisoning: research on the influence of aflatoxins on child health in the tropics

Micro-climatic variations across Malawi have a greater influence on contamination of maize with aflatoxins than with fumonisins

This study reports levels of aflatoxin and fumonisin in maize samples (n = 1294) from all agroecological zones (AEZs) in Malawi. Most maize samples (> 75%) were contaminated with aflatoxins and 45% with fumonisins, which co-occurred in 38% of the samples. Total aflatoxins varied across the AEZs, according to mean annual temperature (P < 0.05) of the AEZs. Samples from the lower Shire AEZ (median = 20.8 µg/kg) had higher levels of aflatoxins (P < 0.05) than those from the other AEZs (median = 3.0 µg/kg). Additionally, the majority (75%) of the positive samples from the lower Shire AEZ had aflatoxin levels exceeding the EU regulatory limit (4 µg/kg), whereas 25%, 37%, and 39% of positive samples exceeded the threshold in the mid-elevation, Lake Shore and upper and middle Shire, and highlands AEZs, respectively. The lower Shire AEZ is characterised by higher mean temperatures throughout the year and low erratic rainfall. However, total fumonisins did not show significant variation across AEZs, but all positive samples exceeded 150 µg/kg, required for tolerable daily intake of 1.0 µg/kg body weight per day, established by the European Food Safety Authority Panel on Contaminants in the Food Chain. Therefore, results of this study suggest that contamination of maize with aflatoxin responds to micro-climate more than with fumonisins. In addition, the data will be useful to public health policy-makers and stakeholders to articulate and implement monitoring and mitigation programs.

The Scourge of Aflatoxins in Kenya: A 60-Year Review (1960 to 2020)

Aflatoxins are endemic in Kenya. The 2004 outbreak of acute aflatoxicosis in the country was one of the unprecedented epidemics of human aflatoxin poisoning recorded in mycotoxin history. In this study, an elaborate review was performed to synthesize Kenya’s major findings in relation to aflatoxins, their prevalence, detection, quantification, exposure assessment, prevention, and management in various matrices. Data retrieved indicate that the toxins are primarily biosynthesized by Aspergillus flavus and A. parasiticus, with the eastern part of the country reportedly more aflatoxin-prone. Aflatoxins have been reported in maize and maize products (Busaa, chan’gaa, githeri, irio, muthokoi, uji, and ugali), peanuts and its products, rice, cassava, sorghum, millet, yams, beers, dried fish, animal feeds, dairy and herbal products, and sometimes in tandem with other mycotoxins. The highest total aflatoxin concentration of 58,000 μg/kg has been reported in maize. At least 500 acute human illnesses and 200 deaths due to aflatoxins have been reported. The causes and prevalence of aflatoxins have been grossly ascribed to poor agronomic practices, low education levels, and inadequate statutory regulation and sensitization. Low diet diversity has aggravated exposure to aflatoxins in Kenya because maize as a dietetic staple is aflatoxin-prone. Detection and surveillance are only barely adequate, though some exposure assessments have been conducted. There is a need to widen diet diversity as a measure of reducing exposure due to consumption of aflatoxin-contaminated foods.

Chronic and Acute Toxicities of Aflatoxins: Mechanisms of Action

There are presently more than 18 known aflatoxins most of which have been insufficiently studied for their incidence, health-risk, and mechanisms of toxicity to allow effective intervention and control means that would significantly and sustainably reduce their incidence and adverse effects on health and economy. Among these, aflatoxin B1 (AFB1) has been by far the most studied; yet, many aspects of the range and mechanisms of the diseases it causes remain to be elucidated. Its mutagenicity, tumorigenicity, and carcinogenicity-which are the best known-still suffer from limitations regarding the relative contribution of the oxidative stress and the reactive epoxide derivative (Aflatoxin-exo 8,9-epoxide) in the induction of the diseases, as well as its metabolic and synthesis pathways. Additionally, despite the well-established additive effects for carcinogenicity between AFB1 and other risk factors, e.g., hepatitis viruses B and C, and the hepatotoxic algal microcystins, the mechanisms of this synergy remain unclear. This study reviews the most recent advances in the field of the mechanisms of toxicity of aflatoxins and the adverse health effects that they cause in humans and animals.

A Critical Review of Aflatoxin Contamination of Peanuts in Malawi and Zambia: The Past, Present, and Future

Peanut (Arachis hypogaea L.) is an important crop in Malawi and Zambia. The crop is valued for soil improvement in cereal-based cropping systems, for improving the livelihoods of farming households who consume it and also sell it for cash, and for earning foreign exchange when exported. Research and development efforts have resulted in an increase in both peanut production area and productivity. However, a key challenge that still needs to be solved in these countries is how to produce peanuts with acceptable levels of aflatoxin contamination. Data continues to show that aflatoxin continues to be a problem in both formal and informal trade. As a result, unlike 30 years ago, most of the peanut trade has now shifted to domestic and regional markets that do not restrict the sale of aflatoxin-contaminated peanuts. Impacts of aflatoxin contamination on health and also on the full cost burden of control are not well documented. Technologies are available for mitigating against aflatoxin contamination. The advantages, disadvantages, and gaps associated with these technologies are discussed. Considerable money and effort continues to be invested in Malawi and Zambia into mitigating aflatoxin contamination, but evidence of long-term success is limited. Based on past and current initiatives, the prospects of eliminating aflatoxin in the near future at the household level and in trade are not promising.

Mycotoxin Contamination of Foods in Africa: Antinutritional Factors

Mycotoxins are regulated in foods and feeds because of carcinogenic (aflatoxin), immunotoxic (deoxynivalenol), or environmental estrogenic (zearalenone) properties. In addition to having tumorigenic properties, many mycotoxins are antinutritional factors that cause unthrifty growth and immune suppression in young animals. In the developed world, human exposure, and particularly exposure of children, to dietary mycotoxins is virtually nonexistent because of regulatory standards. In developing countries, monitoring and enforcement of standards is rare, and mycotoxin-susceptible foods are often the primary staples in rather undiversified diets. In sub-Saharan Africa, people are exposed to unsafe levels of various mycotoxins, often in mixtures, and the consequences in terms of public health burden have been ignored. This paper presents information on the health effects that have been attributed to mycotoxin exposure from the medical research literature and data on existing mycotoxin levels in maize in West and Central Africa. The International Institute of Tropical Agriculture (IITA), in its Maize Integrated Pest Management Project, has recognized mycotoxins as one of the most important constraints to the goal of improving human health and well-being through agriculture. An overview of various research and development activities at the Institute is given.

Housing and child health

The connection between housing and health is well established. Physical, chemical, and biological aspects of the child's home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced household crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in children's health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in children's homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in children's lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/thirdhand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domestic violence all affect children's health.

Perinatal pathology: practice suggestions for limited-resource settings

The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

Mycotoxins in animal and human patients

The majority of human food and animal feed production occurs in a highly managed agroecosystem. Management decisions include variety grown, tillage and irrigation methods and practices, fertilization, pest and disease control, harvesting methods, and storage and transportation practices. This system is generally managed for optimum returns to labor and capital investments. The spores of toxigenic fungi have ubiquitous distribution and toxigenic fungi exploit food sources when conditions of moisture and temperature are above minimums for growth. The safety margins in the agroecosystem are close and are influenced by extrinsic factors such as climatic events. Control of fungal growth is important in management of raw feedstuffs, foodstuffs, condiments-spices, botanicals, and other consumable substances as they are grown, harvested, stored, and transported. The risk factors for mycotoxin production are weather conditions during crop growth and when the crop is mature, damage to seeds before, during, and after harvest, how commodities are physically handled, the presence of weed seeds and other foreign material in grain, and how commodity moisture and temperature are managed during storage and transportation. Diversion of commodities and by-products from human consumption to animal feedstuffs can increase the risk of mycotoxicoses in animals. The toxicology of selected toxigenic fungi and the mycotoxins they produce are reviewed.

Reduced production of sulfated glycosaminoglycans occurs in Zambian children with kwashiorkor but not marasmus

BACKGROUND

Kwashiorkor, a form of severe malnutrition with high mortality, is characterized by edema and systemic abnormalities. Although extremely common, its pathophysiology remains poorly understood, and its characteristic physical signs are unexplained.

OBJECTIVE

Because kwashiorkor can develop in protein-losing enteropathy, which is caused by a loss of enterocyte heparan sulfate proteoglycan (HSPG), and previous observations suggest abnormal sulfated glycosaminoglycan (GAG) metabolism, we examined whether intestinal GAG and HSPG are abnormal in children with kwashiorkor.

DESIGN

Duodenal biopsy samples collected from Zambian children with marasmus (n = 18), marasmic kwashiorkor (n = 8), and kwashiorkor (n = 15) were examined for expression of HSPG, GAGs, and immunologic markers and compared against reference samples from healthy UK control children. GAG and HSPG expression density and inflammatory cell populations were quantitated by computerized analysis.

RESULTS

The kwashiorkor group was less wasted and had a lower HIV incidence than did the other groups. All duodenal biopsy samples showed inflammation compared with the histologically uninflamed control samples. Biopsy samples from marasmic children had greater inflammation and greater CD3+ and HLA-DR (human leukocyte antigen DR)-positive cell densities than did samples from children with kwashiorkor. Expression of both HSPG and GAGs was similar between marasmic and well-nourished UK children but was markedly lower in children with kwashiorkor in both the epithelium and lamina propria. Although underglycosylated and undersulfated, epithelial syndecan-1 protein was normally expressed in kwashiorkor, which confirmed that abnormalities arise after core protein synthesis.

CONCLUSIONS

Intestinal HSPG loss occurs in kwashiorkor, which may precipitate protein-losing enteropathy to cause edema. If occurring systemically, impaired HSPG expression could cause several previously unexplained features of kwashiorkor. We speculate that a genetic predisposition to reduced HSPG biosynthesis may offer a contrasting selective advantage, by both diminishing protein catabolism during transient undernutrition and protecting against specific infectious diseases.

Does aflatoxin as an environmental mycotoxin adversely affect the renal and hepatic functions of Egyptian lactating mothers and their infants? A preliminary report

BACKGROUNDS/AIMS

Aflatoxin as a mycotoxin constitutes a real human threat. Its presence in human milk was previously reported in different countries. This work is the first Egyptian report that aimed to assess the presence of aflatoxin in both mothers' milk and the infants' sera and studied its correlation with infants' kidney functions.

METHODS

Fifty healthy breast lactating mothers and their infants who were exclusively breast fed for at least 4 months were included. All of them were subjected to thorough laboratory evaluation including determination of aflatoxin concentration by high performance liquid chromatography.

RESULTS

Twenty-four mothers (48%) and their infants had been contaminated with aflatoxin with the following mean contamination levels (ng/ml); mothers' serum of 8.9+/-4.2, mothers' milk of 1.9+/-0.6 and infants' serum of 1.8+/-0.9. The presence of this contamination level is not associated with renal or hepatic dysfunction.

CONCLUSION

Mothers and their infants in our locality showed a relatively high aflatoxin contamination rate. We did not find a correlation of this contamination level and either renal or hepatic dysfunction.

Prevalence of Aflatoxins in Blood and Urine of Egyptian Infants with Protein–Energy Malnutrition

The aim of the present work was to study the presence of aflatoxins in blood and urine of infants with protein–energy malnutrition (PEM). The study was conducted on 60 infants, 30 with kwashiorkor and 30 with marasmus, with 10 age-matched healthy infants studied as a control group. Complete blood count, liver function tests, and determination of the level of aflatoxins (B1, B2, G1, G2, M1, M2, G2a, B3, GM1, P, and aflatoxicol R0) in blood and urine were carried out in all studied infants. Serum aflatoxins were detected in more infants with kwashiorkor (80%) than in those with marasmus (46.7%). The mean serum levels of total aflatoxins, AFB1, AFG1, and AFB2a, were significantly higher in infants with kwashiorkor (p <.001). Aflatoxin B1 (AFB1) was the most commonly detected type. The prevalence of aflatoxin excretion in the urine of infants with kwashiorkor was 80%, a higher value than that in infants with marasmus (46.7%). The mean urinary concentration of total aflatoxins followed the same pattern of distribution (p < .052). There were no significant differences between groups in the mean urinary concentrations of AFB1, AFG1, AFB2a, AFM1, and AFG2a. Aflatoxins were not detected in any of the serum or urine samples of the control group. Aflatoxins are highly prevalent in this study population and show a high degree of correlation with severe PEM.

Analysis of aflatoxin B1-lysine adduct in serum using isotope-dilution liquid chromatography/tandem mass spectrometry

A method for quantitative analysis of aflatoxin B1-lysine adduct (B1-Lys) in serum by liquid chromatography using tandem mass spectrometry (LC/MS/MS) is presented. The protein in a 250-microL sample was digested in the presence of a stable-isotope internal standard during a 4-h incubation at 37 degrees C with Pronasetrade mark. B1-Lys and the internal standard were extracted using mixed-mode solid-phase extraction cartridges and eluted with 2% formic acid in methanol. Following evaporation and reconstitution, extracts were injected onto a Luna C-18(2) column and eluted with a step gradient of acetonitrile and 0.06% formic acid. The B1-Lys and the internal standard were detected in a positive ionization selective reaction monitoring mode with a ThermoFinnigan TSQ Quantum triple quadrupole mass spectrometer. Calibration curves were linear for concentrations from 0.05-8.0 ng/mL. The method was validated with aflatoxin B1 dosed rat serum diluted to anticipated high and low concentrations. Total imprecision determined from 30 measurements over 15 days was 5.6% and 9.1%, respectively. Recoveries of 78.8 +/- 6.4% for B1-Lys and 85.4 +/- 12.4% for the internal standard were based on the full extraction and reconstitution processes. The method can be used to quantitate B1-Lys at the 0.5 pg/mg albumin level and is suitable for routine analysis.

Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions

Aflatoxins are well recognized as a cause of liver cancer, but they have additional important toxic effects. In farm and laboratory animals, chronic exposure to aflatoxins compromises immunity and interferes with protein metabolism and multiple micronutrients that are critical to health. These effects have not been widely studied in humans, but the available information indicates that at least some of the effects observed in animals also occur in humans. The prevalence and level of human exposure to aflatoxins on a global scale have been reviewed, and the resulting conclusion was that approximately 4.5 billion persons living in developing countries are chronically exposed to largely uncontrolled amounts of the toxin. A limited amount of information shows that, at least in those locations where it has been studied, the existing aflatoxin exposure results in changes in nutrition and immunity. The aflatoxin exposure and the toxic affects of aflatoxins on immunity and nutrition combine to negatively affect health factors (including HIV infection) that account for >40% of the burden of disease in developing countries where a short lifespan is prevalent. Food systems and economics render developed-country approaches to the management of aflatoxins impractical in developing-country settings, but the strategy of using food additives to protect farm animals from the toxin may also provide effective and economical new approaches to protecting human populations.

Hepatic proteins and nutrition assessment

Serum hepatic protein (albumin, transferrin, and prealbumin) levels have historically been linked in clinical practice to nutritional status. This paradigm can be traced to two conventional categories of malnutrition: kwashiorkor and marasmus. Explanations for both of these conditions evolved before knowledge of the inflammatory processes of acute and chronic illness were known. Substantial literature on the inflammatory process and its effects on hepatic protein metabolism has replaced previous reports suggesting that nutritional status and protein intake are the significant correlates with serum hepatic protein levels. Compelling evidence suggests that serum hepatic protein levels correlate with morbidity and mortality. Thus, serum hepatic protein levels are useful indicators of severity of illness. They help identify those who are the most likely to develop malnutrition, even if well nourished prior to trauma or the onset of illness. Furthermore, hepatic protein levels do not accurately measure nutritional repletion. Low serum levels indicate that a patient is very ill and probably requires aggressive and closely monitored medical nutrition therapy.

Mycotoxins

Mycotoxins are secondary metabolites produced by microfungi that are capable of causing disease and death in humans and other animals. Because of their pharmacological activity, some mycotoxins or mycotoxin derivatives have found use as antibiotics, growth promotants, and other kinds of drugs; still others have been implicated as chemical warfare agents. This review focuses on the most important ones associated with human and veterinary diseases, including aflatoxin, citrinin, ergot akaloids, fumonisins, ochratoxin A, patulin, trichothecenes, and zearalenone.

Human exposure to mycotoxins in Egypt

This investigation examined the exposure of Egyptian infants to Aflatoxin M1 (AfM1) and of lactating mothers to Aflatoxin B1, using AfM1 in human milk as a biomarker for exposure to AfB1. The presence of ochratoxin A (OA) in human milk was also investigated to determine the levels of infants exposure to OA from human milk. The results indicated that AfM1 was found in 66 (55 %) of 120 human milk samples with a mean of 0.3 ± 0.53 ng/mL (range 0.02 to 2.09 ng/mL). OA was found in 43 (35.8 %) of 120 human milk samples with a mean of 21.1 ± 13.7 ng/mL (range 5.07 to 45.01 ng/mL), which will cause a daily intake of OA from human milk exceeding the suggested tolerable dose of 5 ng/kg-1 of OA body weight. On the other side AfM1 was found in 25 % of blood samples (5 out of 20 samples), at a mean of 1.18 ng/mL, but it was detected only in one urine sample (1 out of 20 samples). OA was detected only in 2 out of 13 blood samples (15.4 %) with an average 3.67 ng/mL. Whereas OA was not detected in all analyzed urine samples.

Nutritional modulation of malaria morbidity and mortality

This review critically examines the relationship between nutritional status and malaria. The data indicate that protein-energy malnutrition is associated with greater malaria morbidity and mortality in humans. In addition, controlled trials of either vitamin A or zinc supplementation show that these nutrients can substantially reduce clinical malaria attacks. Data for iron indicate that supplementation may minimally aggravate certain malariometric indices in some settings and also strongly improve hematologic status. Withholding of iron supplements from deficient population is, therefore, not currently indicated. Available evidence for other nutrients describe varied effects, with some deficiencies being exacerbative (e.g., thiamine), protective (e.g., vitamin E), or both exacerbative and protective in different settings (e.g., riboflavin, vitamin C). The roles of folate, other B vitamins, unsaturated fatty acids, amino acids, and selenium are also examined. Study of the interactions between nutrition and malaria may provide insight to protective mechanisms and result in nutrient-based interventions as low-cost and effective adjuncts to current methods of malaria prevention and treatment.

Situation of mycotoxins in milk, dairy products and human milk in Egypt

ABSTACT: Milk and dairy products purchased at Egyptian markets and breast milk from lactating mothers in Cairo and Giza governorates were analyzed for some mycotoxins. Three of 15 cows' milk samples were found positive for Afl. M1 with mean value 6.3 ppb. Only one sample of dried milk was positive (5 ppb). Two of 10 hard cheese samples contained detectable levels of Afl. M1 (3and 6 ppb), whereas one sample containing Afl. B1 and G1 (10 and 4 ppb resp.). For soft cheese one sample of 10 was positive for Afl. M1 (0.5 ppb). Blue veined cheeses were free of Afl. M1 and PR-toxins.For breast milk two of 10 samples were positive for Afl. M1 (20%) with mean value 2.75 ppb, while 3 of 10 samples were positive for Ochratoxin A (30 %).