AFLATOXINS AND HUMAN HEALTH: PRESENTATION TO TANZANIA AFLATOXIN STAKEHOLDERS MEETING 2012

1. DR.FRANK GEORGE MADINDA(MD,M.MED(SURG),FELLOW-COSECSA) CONSULTANT SURGEON ALMC CHIEF OF SURGERY ALMC DECEMBER 2012 AFLATOXINS AND HUMAN HEALTH:PRESENTATION TO TANZANIA AFLATOXIN STAKEHOLDERS MEETING 2012

2. ARUSHA LUTHERAN MEDICAL CENTRE

3. INTRODUCTION • Mycotoxin are secondary metabolites of moulds that exert toxic effects on animals and humans( Mycotoxicosis) • Aflatoxins is one of the mycotoxins that frequently contaminate foods such as groundnuts , maize, rice and other cereals. • Contamination comes when storage practice is not proper.

4. The toxic effects of moulds and fungi was known already in ancient times • “Robigalia” in 17 &18 century BC. The honour of god robigus. “Vergilius PM. Georgike.VelikaGorica,Papir,1994” “Ovidius PN. Opera omnia.III Fasti,Tristia,Epistolae ex ponto.Leipzig,Nova editio stereotypa, 1845” • Spiritual wives rituals in Malawi • Msunyunho in Dodoma Tanzania

6. Aflatoxins • Aflatoxin contaminates nuts, maize, cereals, pepper and rice under condition of high humidity and temperature. • They are a risk to human health

7. They are produced by a fungal specie Aspergillus. • The two major species that produce Aflatoxins are A.flavus thatproduces only B Aflatoxins, and A.parasiticus which produces both B and G aflatoxins • Aflatoxins M1 and M2 are oxidative metabolic products of aflatoxins B1 and B2 produced by animals following ingestion, and so appear in milk(both animal and human) and can pass through the placenta.

8. Aflatoxins induces the transversion of G>T in codon 249 of the p53 tumor suppressor gene in human cells with the liver cells being more susceptible than others. “F Aguilar, SP Hussain, and P Cerutti Department of carcinogenesis, Swiss institute for experimental cancer research (pubmed)”

9. The main target organ for toxicity is the liver. However recent studies have shown that It can affect any other organ, it is non specific “Peers FG, Linsell CA. Dietary aflatoxins and human liver cancer: a study in Swaziland. Br J Cancer 1976;17:167-176.”

10. Aflatoxins are acutely toxic, immunosuppressive, mutagenic, teratogenic and carcinogenic compounds.

14. Aflatoxin is present in blood of pregnant women, neonatal umbilical cord blood, and in breast milk . • Implicated in encephalopathy, fatty degeneration of viscera, Reye syndrome. • HIV/AIDS and exposure to aflatoxin forms a fatal combination because aflatoxin on its own is immunosuppressive

15. Neonatal jaundice and Aflatoxins “Sodeinde O et al. Neonatal jaundice, Aflatoxins and naphthols: report of a study in Ibadan Nigeria. Annals of tropicalpaediatrics,1995,15:107-113.” • Aflatoxins and kwashiorkor: It is more apparent when Aflatoxins is in high peak

16. Children diagnosed of pneumonia were found to have high levels of aflatoxins • It is implicated in alveolar cell carcinoma “Dvorackova I. Aflatoxins inhalation and alveolar cell carcinoma. British medical journal,1976,691.”

17. Exposure range from 10-200ng/kg body weight per day in sub-Saharan Africa • Malawi and Tanzania belongs to this group • Common to see HCC in surgical wards • From 2004-July2008 32 cases of HCC has been attended at the surgical unit of KCH-26 cases were advanced and no surgery could be offered • The remaining were operated but died after 4 months

19. Aflatoxin detection in human blood Project sites(Surveilance)

20. We have received patients from all over Malawi but majority of our patients are from Salima, Ntcheu, Dowa Mzimba, and Nkhotakhota • No study exist to document the relationship with aflatoxin exposure • We believe that exposure to aflatoxins plays a great role.

22. Performing a random aflatoxin assay in human blood in randomly selected patients will help to establish the relationship and to determine the extent of human exposure to aflatoxin in Tanzania.

23. A collaborative study is needed to document the extent of aflatoxin exposure to human through blood samples investigations and regular surveillance in areas with high levels of contamination in Tanzania.

25. THANK YOU AND BLESSINGS!

26. References • 1. Vergilius PM. Georgike. Velika Gorica, Papir, 1994. • 2. Ovidius PN. Opera omnia. III Fasti, Tristia, Epistolae ex ponto. • Leipzig, Nova editio stereotypa, 1845. • 3. Van Dongen PWJ, De Groot ANJA. History of ergot alkaloids • from ergotism to ergometrine. European journal of obstetrics, • gynecology and reproductive biology, 1995, 60: 109±116. • 4. Schneider DJ et al. First report of field outbreaks of ergotalkaloid • toxicity in South Africa. Onderstepoort journal of • veterinary research, 1996, 63: 97±108. • 5. Uraguchi K. Mycotoxic origin of cardiac beriberi. Journal of • stored products research, 1969, 5: 227±236. • 6. Ueno Y. The toxicology of mycotoxins. Critical reviews in • toxicology, 1985, 14: 99±132. • 7. Reiss J. Effects of mycotoxins on higher plants, algae, fungi and • bacteria. In: Wyllie T, Morehouse L, eds. Mycotoxic fungi, • mycotoxins, mycotoxicoses, vol. 3. New York, Marcel Dekker, • 1978: 118±144. • 8. Flieger M, Wurst M, Shelby R. Ergot alkaloids ± sources, • structures and analytical methods. Folia microbiologica, 1997, • 42: 3±30.