Human intoxication by microcystins during renal dialysis treatment in Caruaru-Brazil
Human intoxication by microcystins during renal dialysis treatment in Caruaru-Brazil
复制标题
DOI：
10.1016/s0300-483x(02)00491-2
复制
发表时间：
2002-12-27
期刊：
影响因子：
4.5
通讯作者：
Eaglesham, GK
中科院分区：
文献类型：
--
作者：
Azevedo, SMFO;Carmichael, WW;Eaglesham, GK
1996年2月，巴西伯南布哥州Caruaru的一家血液透析诊所爆发疾病。在该诊所，131例患者中有116例（89%）在常规血液透析治疗后出现视力障碍、恶心、呕吐和肌无力。随后，100名患者发生急性肝功能衰竭。截至1996年12月，其中52人的死亡可归因于一种常见的综合症，现在称为“Caruaru综合症”。通过对历年浮游植物数量的检测，发现自1990年以来，该供水水库中的浮游植物以蓝藻为主。从诊所的水处理系统加上患者的血清和肝组织的碳和其他树脂的分析导致识别两组肝毒性氰毒素：微囊藻毒素（环七肽）在所有这些样品和柱孢菌素（生物碱肝毒性）的碳和树脂。比较受害者的症状和病理与动物研究这两种蓝藻毒素，导致我们得出结论，透析患者死亡的主要因素是静脉内暴露于微囊藻毒素，特别是微囊藻毒素-YR，-LR和-AR。2000年，巴西卫生部与泛美卫生组织合作，对巴西饮用水质量条例进行了审查，将蓝细菌和蓝毒素作为水质控制必须监测的参数纳入这一新条例。(C)2002爱思唯尔科学爱尔兰有限公司保留所有权利。
In February 1996, an outbreak of illness occurred at a hemodialysis clinic in Caruaru, Pernambuco State-Brazil. At this clinic 116 (89%) of 131 patients experienced visual disturbances, nausea, vomiting, and muscle weakness, following routine haemodialysis treatment. Subsequently, 100 patients developed acute liver failure. As of December 1996, 52 of the deaths could be attributed to a common syndrome now called 'Caruaru Syndrome'. Examination of previous years' phytoplankton counts showed that cyanobacteria were dominant in the water supply reservoir since 1990. Analyses of carbon and other resins from the clinic's water treatment system plus serum and liver tissue of patients led to the identification of two groups of hepatotoxic cyanotoxins: microcystins (cyclic heptapeptides) in all of these samples and cylindrospermopsin (alkaloid hepatotoxic) in the carbon and resins. Comparison of victims symptoms and pathology with animal studies on these two cyanotoxins, leads us to conclude that the major contributing factor to death of the dialysis patients was intravenous exposure to microcystins, specifically microcystin-YR, -LR and -AR. In 2000, a review of the Brazilian regulation for drinking water quality, promoted by Brazilian Health Ministry with collaboration of PAHO, incorporated cyanobacteria and cyanotoxins into this new regulation as parameters that must to be monitored for water quality control. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.