Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins

Carmichael, Wayne W., Azevado, Sandra M. F. O., An, Ji Si, Molica, Renato J. R., Jochimsen, Elise M., Lau, Sharon, Rinehart, Kenneth L., Shaw, Glen R. and Eaglesham, Geoff K. (2001) Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins. Environmental Health Perspectives, 109 7: 663-668. doi:10.2307/3454781

Author Carmichael, Wayne W.
Azevado, Sandra M. F. O.
An, Ji Si
Molica, Renato J. R.
Jochimsen, Elise M.
Lau, Sharon
Rinehart, Kenneth L.
Shaw, Glen R.
Eaglesham, Geoff K.
Title Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins
Journal name Environmental Health Perspectives   Check publisher's open access policy
ISSN 0091-6765
Publication date 2001
Sub-type Article (original research)
DOI 10.2307/3454781
Open Access Status DOI
Volume 109
Issue 7
Start page 663
End page 668
Total pages 6
Place of publication Triangle Pk, NC, USA
Publisher US Dept Health Human Sciences Pub Health Sc
Collection year 2001
Language eng
Subject C1
321299 Public Health and Health Services not elsewhere classified
730210 Environmental health
Abstract 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 mug/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.
Keyword Environmental Sciences
Public, Environmental & Occupational Health
Peptide Toxin
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collection: National Research Centre for Environmental Toxicology Publications
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Created: Tue, 14 Aug 2007, 15:50:13 EST