Human fatalities from cyanobacteria: chemical and biological evidence for cyanotoxins.

By W. Carmichael, S. Azevedo, J. An, R. Molica, E. Jochimsen, S. Lau, K. Rinehart, G. Shaw, G. Eaglesham. Environmental Health Perspectives, 2001

1,016 citations recorded by the source corpus.

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.

Subfields: Ecology, Ecology, Evolution, Behavior and Systematics, Environmental Chemistry

View Paper: https://www.semanticscholar.org/paper/32fbfdf6a565ea9a0fc78f356ad6cb881486036c

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In Ecology

1. J. Huisman
2. L. Tonk
3. P. Visser
4. O. Sarnelle

In Ecology, Evolution, Behavior and Systematics

1. J. Huisman
2. Alan E. Wilson
3. Hans W. Paerl

In Environmental Chemistry

1. J. Huisman
2. P. Visser
3. Alan E. Wilson
4. O. Sarnelle
5. Hans W. Paerl
6. Giovanni Sandrini
7. Timothy G. Otten

Citations in the corpus

• Diversity and dynamics of microcystin―Producing cyanobacteria in China's third largest lake, Lake Taihu (2009, background): “Indeed, acute exposure to MC, which is the most widespread cyanobacterial toxin present in freshwater systems, can cause liver failure and death (Carmichael et al., 2001), aswell as chronic effects in humans that are subjected to low level exposure (Falconer et al.”
• Health Effects of Toxin-Producing Cyanobacteria: “The CyanoHABs” (2001, neutral): “Newly published information on this outbreak provides evidence for the cyanotoxins present and the cyanobacteria that produced them (Carmichael et al. 2001).”
• Methods and Approaches Used for Detection of Cyanotoxins in Environmental Samples: A Review (2013, neutral): “The wide varieties of toxins produced by cyanobacteria, called cyanotoxins, are the cause of widespread deaths of livestock, animals and more recently humans (Carmichael et al., 2001; Codd, 2000).”
• Benthic-pelagic coupling in the population dynamics of the harmful cyanobacterium Microcystis (2005, neutral): “Moreover, some species of Microcystis can produce a group of hepatotoxins, called microcystins, which can be toxic to both humans and animals (Codd, 1995; Falconer, 1999; Carmichael et al. , 2001; Huisman, Matthijs & Visser, 2005).”
• Biomagnification or biodilution of microcystins in aquatic foodwebs? Meta-analyses of laboratory and field studies (2012, neutral): “, 2008) and humans (Jochimsen et al., 1998; Carmichael et al., 2001).”
• Cyanotoxin production and phylogeny of benthic cyanobacterial strains isolated from the northeast of Brazil (2015, neutral): “In Brazil, this perception was intensified after the fatal poisoning caused by microcystins in at least 65 renal patients in a hemodialysis clinic in Caruaru, Pernambuco, Brazil (Carmichael et al., 2001).”
• Grazing on colonial and filamentous, toxic and non-toxic cyanobacteria by the zebra mussel Dreissena polymorpha (2005, neutral): “Human illness and even death have been also linked to toxicity by cyanobacteria (Carmichael et al., 2001).”
• Human intoxication by microcystins during renal dialysis treatment in Caruaru-Brazil. (2002, positive): “Further analysis for cylindrospermopsins (alkaloid hepatotoxin) in sand, carbon, ion exchange resins and liver and sera samples were done by chemical methods (HPLC/MS/MS), also described in Carmichael et al. (2001).”
• Effects of cyanobacterial toxicity and morphology on the population growth of freshwater zooplankton: Meta‐analyses of laboratory experiments (2006, background): “In addition, cyanobacteria produce secondary metabolites that can cause illness and, in some cases, death of livestock and humans exposed to water with high cyanobacterial concentrations (Carmichael et al. 2001).”
• Salt tolerance of the harmful cyanobacterium Microcystis aeruginosa (2007, background): “…WORDS: Harmful algal blooms · Harmful cyanobacteria · Microcystis · Microcystins · Salinity · HPLC Resale or republication not permitted without written consent of the publisher Aquat Microb Ecol 46: 117–123, 2007 & Bartram 1999, Carmichael et al. 2001, Huisman et al. 2005).”