Microcystin contamination in fish from the Jacarepaguá Lagoon (Rio de Janeiro, Brazil): ecological implication and human health risk

Chronic and subchronic toxicity from exposure to microcystins, cyclic peptide liver toxins from certain cyanobacteria, poses an important hazard, which has received little study. No in vivo information exists on accumulation and transfer of microcystin from the food chain to humans. This paper present results of a 3-year study that demonstrates bioaccumulation of microcystins by fish and potential rates of microcystin ingestion by humans. The study was carried out in a shallow coastal lagoon in the city of Rio de Janeiro (Jacarepaguá Lagoon). Fish (Tilapia rendalli) were collected every 2 weeks from August 1996 to November 1999. Microcystins were analyzed by HPLC in phytoplankton, fish liver and viscera while fish muscle tissue was analyzed by enzyme linked immunosorbant assay (ELISA). Phytoplankton samples, dominated by the genus Microcystis, were confirmed to contain microcystins as were fish livers, viscera and muscle tissue. During the entire study period, including times of low water bloom densities, fish muscle tissue contained concentrations of microcystins close to or above the recommended limit for human consumption (0.04 microg x kg(-1) day). Our findings demonstrate that microcystins can accumulate in fish tissue used for human consumption. Rates of ingestion routinely exceed the TDI guidelines as set by the WHO for drinking water. Appropriate epidemiology and risk assessment should be undertaken so that an acceptable TDI and appropriate risk management decisions can be made for human consumption of fish which are harvested from cyanobacterial blooms that contain cyanotoxins.

Human fatalities from cyanobacteria: chemical and biological evidence for cyanotoxins

An outbreak of acute liver failure occurred at a dialysis center in Caruaru, Brazil (8 degrees 17' S, 35 degrees 58' W), 134 km from Recife, the state capital of Pernambuco. At the clinic, 116 (89%) of 131 patients experienced visual disturbances, nausea, and vomiting after routine hemodialysis treatment on 13-20 February 1996. Subsequently, 100 patients developed acute liver failure, and of these 76 died. As of December 1996, 52 of the deaths could be attributed to a common syndrome now called Caruaru syndrome. Examination of phytoplankton from the dialysis clinic's water source, analyses of the clinic's water treatment system, plus serum and liver tissue of clinic patients led to the identification of two groups of cyanobacterial toxins, the hepatotoxic cyclic peptide microcystins and the hepatotoxic alkaloid cylindrospermopsin. Comparison of victims' symptoms and pathology using animal studies of these two cyanotoxins leads us to conclude that the major contributing factor to death of the dialyses patients was intravenous exposure to microcystins, specifically microcystin-YR, -LR, and -AR. From liver concentrations and exposure volumes, it was estimated that 19.5 microg/L microcystin was in the water used for dialysis treatments. This is 19.5 times the level set as a guideline for safe drinking water supplies by the World Health Organization.

The first evidence of paralytic shellfish toxins in the fresh water cyanobacterium Cylindrospermopsis raciborskii, isolated from Brazil

The blooms of toxic cyanobacteria (blue-green algae) are causing problems in many countries. During a screening of toxic freshwater cyanobacteria in Brazil, three strains isolated from the State of Sao Paulo were found toxic by the mouse bioassay. They all were identified as Cylindrospermopsis raciborskii by a close morphological examination. Extracts of cultured cells caused acute death to mice when injected intraperitoneally after developing neurotoxic symptoms which resembled to those caused by paralytic shellfish toxins. The analysis of the sample by HPLC-FLD postcolumn derivatization method for paralytic shellfish toxins resulted in the detection of several saxitoxin analogs. To avoid being misled by false peaks, the sample was reanalyzed after purification and also under the different postcolumn derivatizing conditions. Finally, the newly developed LC-MS method for paralytic shellfish toxins was applied to unambiguously identify the toxins. One isolate produced neosaxitoxin predominantly with saxitoxin as a minor component. The other two showed identical toxin profiles containing saxitoxin and gonyautoxins 2/3 isomers in the ratio of 1:9. This is the first evidence of paralytic shellfish toxins in this species and also the occurrence of the toxin producing cyanobacterium in South American countries.

Liver failure and death after exposure to microcystins at a hemodialysis center in Brazil

BACKGROUND

Hemodialysis is a common but potentially hazardous procedure. From February 17 to 20, 1996, 116 of 130 patients (89 percent) at a dialysis center (dialysis center A) in Caruaru, Brazil, had visual disturbances, nausea, and vomiting associated with hemodialysis. By March 24, 26 of the patients had died of acute liver failure.

METHODS

A case patient was defined as any patient undergoing dialysis at dialysis center A or Caruaru's other dialysis center (dialysis center B) during February 1996 who had acute liver failure. To determine the risk factors for and the source of the outbreak, we conducted a cohort study of the 130 patients at dialysis center A and the 47 patients at dialysis center B, reviewed the centers' water supplies, and collected water, patients' serum, and postmortem liver tissue for microcystin assays.

RESULTS

One hundred one patients (all at dialysis center A) met the case definition, and 50 died. Affected patients who died were older than those who survived (median age, 47 vs. 35 years, P<0.001). Furthermore, all 17 patients undergoing dialysis on the Tuesday-, Thursday-, and Saturday-night schedule became ill, and 13 of them (76 percent) died. Both centers received water from a nearby reservoir. However, the water supplied to dialysis center B was treated, filtered, and chlorinated, whereas the water supplied to dialysis center A was not. Microcystins produced by cyanobacteria were detected in water from the reservoir and from dialysis center A and in serum and liver tissue of case patients.

CONCLUSIONS

Water used for hemodialysis can contain toxic materials, and its quality should therefore be carefully monitored.