Liver Failure and Death after Exposure to Microcystins at a Hemodialysis Center in Brazil

Em, Jochimsen; Ww, Carmichael; Js, An; Dm, Cardo; St, Cookson; Ce, Holmes; Mb, Antunes; Da, de Melo Filho; Tm, Lyra; Vs, Barreto; Sm, Azevedo; Wr, Jarvis

doi:10.1056/nejm199803263381304

Cited by 1,028 publications

(545 citation statements)

References 19 publications

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“…The mechanism of MC toxicity has been regarded as the potent inhibition of eukaryotic protein phosphatases (MacKintosh et al 1990;Honkanen et al 1991). MCs are mainly associated with Microcystis blooms (Hilborn et al 2007) in freshwater bodies and threat the safety of water supply (Bourke et al 1983;Jochimsen et al 1998). A guideline value of 1.0 μg l −1 for MCs in drinking water has been issued by the World Health Organization (WHO 2006).…”

Section: Introductionmentioning

confidence: 99%

Variation of Microcystis and microcystins coupling nitrogen and phosphorus nutrients in Lake Erhai, a drinking-water source in Southwest Plateau, China

Jiang

Song

et al. 2014

Environ Sci Pollut Res

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Lake Erhai is the second largest lake of Southwest China and an important drinking water source. The lake is currently defined as the preliminary stage of eutrophic states, but facing a serious threat with transfer into intensive eutrophication. The present study examined the dynamics of Microcystis blooms and toxic Microcystis in Lake Erhai during 2010, based on quantitative real-time PCR method using 16S rRNA gene specific for Microcystis and microcystin systhesis gene (mcy), and chemical analysis on microcystin (MC) concentrations. Total Microcystis cell abundance at 16 sampling sites were shown as an average of 1.7×10 7 cells l −1 (1.3×10 2 -3.8×10 9 cells l −1 ). Microcystin LR (MC-LR) and microcystin RR (MC-RR) were the main variants. The strong southwesterly winds, anticlockwise circular flows and geographical characteristics of lake and phytoplankton community succession impacted the distribution patterns of Chl a and MC in the lake. The concentration of Chl a and MC and abundances of total Microsytis and MC-producing Microsystis (MCM) were shown to be positively correlated with pH, DO and TP, negatively correlated with SD, NO 3 -N, TN/Chl a and TN/TP, and not correlated with NH 4 -N, TN, dissolved total nitrogen (DTN) and water temperatures. When TN/TP decrease, Microcystis tended to dominate and MC concentrations tended to increase, suggesting that the "TN/TP rule" can be partially applied to explain the correlation between the cyanobacterial blooms and nutrients N and P only within a certain nutrient level. It is speculated that N and P nutrients and the associated genes (e.g., mcy) may jointly drive MC concentration and toxigenicity of Microcystis in Lake Erhai.

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Section: Introductionmentioning

confidence: 99%

Variation of Microcystis and microcystins coupling nitrogen and phosphorus nutrients in Lake Erhai, a drinking-water source in Southwest Plateau, China

Jiang

Song

et al. 2014

Environ Sci Pollut Res

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“…In recent few years, cyanobacterial blooms occurred in many large freshwater lakes such as Lake Dianchi (the 6th largest freshwater lake in China) and Lake Taihu (the 3rd largest freshwater lake in China) with increasing frequency and intensity (Li et al, 2001;Song et al, 1998). As a result, toxic cyanobacterial blooms and MCs have received more attention following the report by Jochimsen and his colleagues (Jochimsen et al, 1998) regarding the deaths of 50 patients exposed to MCcontaminated water during a dialysis treatment. Reduction of threats to human health and aquatic life involves toxic cyanobacteria blooms and/or microcystins to be removed from water columns, especially water supplies (Miller et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Sorption, degradation and mobility of microcystins in Chinese agriculture soils: risk assessment for groundwater protection

Chen

Song

Gan

et al. 2006

Environmental Pollution

124

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“…Outro grave incidente ocorreu em Pernambuco, em 1996, no qual morreram mais de 50 pessoas após uma sessão de hemodiálise. Análises confirmaram a presença de microcistinas no carvão ativado utilizado no sistema de filtração de água na clínica e também em amostras de sangue e de fígado dos pacientes que foram a óbito (JOCHIMSEN et al, 1998;CARMICHAEL et al, 2001;CARMICHEL;HILBRON, 2006 ERIKSSON, 1991;KOTAK et al, 1996;.…”

Section: Exposição àS Cianotoxinas E Sinais Clínicosunclassified

Hepatotoxicidade associada à microcistina

Santos¹,

Bracarense

2008

Sem. Ci. Agr.

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ResumoEfluentes industriais e urbanos e a intensa exploração agrícola e de pescado têm levado à eutrofização de muitos mananciais de água, destinados ao consumo e às atividades recreacionais. A eutrofização das águas, freqüentemente, tem como conseqüência o desenvolvimento expressivo de cianobactérias. Estas florações induzem a sérios problemas, visto que a ocorrência de Microcystis aeruginosa, uma das cianobactérias mais difundidas, pode produzir microcistinas (MCs). O efeito citotóxico da MC tem sido descrito no fígado, pulmões, estômago e intestino. Mortes de seres humanos, de animais silvestres e domésticos têm sido associadas à exposição a MC. Esta pode ocorrer diretamente por ingestão, inalação, contato, inoculação intravenosa (hemodiálise) ou indiretamente, pelo consumo de animais, dentre os quais os peixes e moluscos, que podem ingerir as cianobactérias e suas toxinas. A mais tóxica e também mais comum das MCs é a microcistina-LR (MC-LR), cujo órgão alvo é o fígado. A MC chega ao fígado especificamente por transporte dos ácidos biliares e, uma vez no citoplasma, inibe as proteínas fosfatases 1 e 2A, induzindo ao aumento da fosforilação protéica. Esta reação tem duas conseqüências: destruição do citoesqueleto, causando efeitos citotóxicos e descontrole da divisão celular, levando à promoção tumoral. A exposição aguda à MC induz severa hemorragia intra-hepática, necrose e apoptose, enquanto a exposição crônica pode causar neoplasia hepática ou intestinal. Também tem sido relatado que a hepatotoxicidade da MC está intimamente associada à formação intracelular de espécies reativas de oxigênio. A MC pode ser naturalmente degradada por bactérias ou pela radiação solar. Contudo, se não houver eficiente degradação, a MC poderá persistir na cadeia alimentar aquática. A contaminação de águas pela MC representa, portanto, perigo à saúde humana e de animais. Assim, esforços para evitar a eutrofização de fontes de águas são essenciais para minimizar riscos à saúde pública. Palavras-chave: Microcystis aeruginosa, microcistina, cianotoxinas, hepatotoxina AbstractUrban and industrial discharges, intense agricultural exploitation and fisheries have been causing the eutrophication in both drinking and recreational waters. A frequent consequence of eutrophication in waters is the massive development of cyanobacteria. The occurrence of these blooms induces a severe problem, as Microcystis aeruginosa, the most widespread distributed cyanobacteria, can produce microcystins (MC). Toxic effects of MC have been described in liver, lungs, stomach, and intestine. Deaths in wildlife, livestock and human beings were also associated with MC exposition. MC exposition can occurs directly by ingestion, inhalation, contact, intravenous inoculation of contaminated water (hemodialysis) or indirectly, by the consumption of animals, as fish and mollusks, the majors ingestors of cyanobacteria and its toxins. The most 1 Prof. Ass.,

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Liver Failure and Death after Exposure to Microcystins at a Hemodialysis Center in Brazil

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

Cited by 1,028 publications

References 19 publications

Variation of Microcystis and microcystins coupling nitrogen and phosphorus nutrients in Lake Erhai, a drinking-water source in Southwest Plateau, China

Variation of Microcystis and microcystins coupling nitrogen and phosphorus nutrients in Lake Erhai, a drinking-water source in Southwest Plateau, China

Sorption, degradation and mobility of microcystins in Chinese agriculture soils: risk assessment for groundwater protection

Hepatotoxicidade associada à microcistina

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