Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins

Abstract

ArticlesAn outbreak of acute liver failure occurred at a dialysis center in Caruaru, Brazil (8°17 ' S, 35°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 µg/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.

Quantitative Determination of Microcystins in Rat Plasma by LC–ESI Tandem MS

“…After the sample precipitation, the Oasis HLB cartridge was applied. Compared to the clean-up by C18 cartridge for serum samples in the literature [32], the HLB sorbent gave higher and more reproducible recovery for MCYSTs. In the sample preparation, MCYSTs were added to whole blood and stirred uniformly.…”

Effects of oxidative and physical treatments on inactivation of Cylindrospermopsis raciborskii and removal of cylindrospermopsin

“…Cylindrospermopsis raciborskii is not only an invasive species, but is also a species with different physiological strains or ecotypes. Beginning 1997, Cylindrospermopsis raciborskii occurrence began to rapidly increase and to dominate some Florida (USA) water bodies (Carmichael et al 2001). doi: 10.2166/wst.2009.385 Its invasive behavior at mid-latitudes was also observed with Cylindrospermopsis raciborskii being reported in (Duy et al 2000;Saker & Griffiths 2001;Briand et al 2002).…”

Occurrence of anatoxin-a(s) during a bloom of Anabaena crassa in a water-supply reservoir in southern Brazil

“…In Brazil, cyanotoxins have been reported in several studies: microcystins (Azevedo et al 1994;Matthiensen et al 2000;Minillo et al 2000;Vieira et al 2005;SoteroSantos et al 2008;Ferrão-Filho et al 2009), cylindrospermopsin (Carmichael et al 2001), saxitoxins (Lagos et al 1999Yunes et al 2003;Molica et al 2005;Ferrão-Filho et al 2009), and anatoxin-a(s) (Monserrat et al 2001;Yunes et al 2003;Molica et al 2005). However, anatoxin-a has never been found at detectable levels (Molica et al 2005;Colvara 2005).…”