U.S. Food & Drug Administration
Center for Food Safety & Applied Nutrition

Foodborne Pathogenic Microorganisms
and Natural Toxins Handbook

-->Morbidity and Mortality Weekly Reports on Aflatoxins

 at Centers for Disease Control | 

1. Name of Toxin: Aflatoxins
2. Name of Acute Disease: Aflatoxicosis

Aflatoxicosis is poisoning that results from ingestion of aflatoxins in contaminated food or feed. The aflatoxins are a group of structurally related toxic compounds produced by certain strains of the fungi Aspergillus flavus and A. parasiticus. Under favorable conditions of temperature and humidity, these fungi grow on certain foods and feeds, resulting in the production of aflatoxins. The most pronounced contamination has been encountered in tree nuts, peanuts, and other oilseeds, including corn and cottonseed. The major aflatoxins of concern are designated B1, B2, G1, and G2. These toxins are usually found together in various foods and feeds in various proportions; however, aflatoxin B1 is usually predominant and is the most toxic. When a commodity is analyzed by thin-layer chromatography, the aflatoxins separate into the individual components in the order given above; however, the first two fluoresce blue when viewed under ultraviolet light and the second two fluoresce green. Aflatoxin M a major metabolic product of aflatoxin B1 in animals and is usually excreted in the milk and urine of dairy cattle and other mammalian species that have consumed aflatoxin-contaminated food or feed.

3. Nature of Disease: Aflatoxins produce acute necrosis, cirrhosis, and carcinoma of the liver in a number of animal species; no animal species is resistant to the acute toxic effects of aflatoxins; hence it is logical to assume that humans may be similarly affected. A wide variation in LD50 values has been obtained in animal species tested with single doses of aflatoxins. For most species, the LD50 value ranges from 0.5 to 10 mg/kg body weight. Animal species respond differently in their susceptibility to the chronic and acute toxicity of aflatoxins. The toxicity can be influenced by environmental factors, exposure level, and duration of exposure, age, health, and nutritional status of diet. Aflatoxin B1 is a very potent carcinogen in many species, including nonhuman primates, birds, fish, and rodents. In each species, the liver is the primary target organ of acute injury. Metabolism plays a major role in determining the toxicity of aflatoxin B1; studies show that this aflatoxion requires metabolic activation to exert its carcinogenic effect, and these effects can be modified by induction or inhibition of the mixed function oxidase system.
4. Normal Course of Disease: In well-developed countries, aflatoxin contamination rarely occurs in foods at levels that cause acute aflatoxicosis in humans. In view of this, studies on human toxicity from ingestion of aflatoxins have focused on their carcinogenic potential. The relative susceptibility of humans to aflatoxins is not known, even though epidemiological studies in Africa and Southeast Asia, where there is a high incidence of hepatoma, have revealed an association between cancer incidence and the aflatoxin content of the diet. These studies have not proved a cause-effect relationship, but the evidence suggests an association.

One of the most important accounts of aflatoxicosis in humans occurred in more than 150 villages in adjacent districts of two neighboring states in northwest India in the fall of 1974. According to one report of this outbreak, 397 persons were affected and 108 persons died. In this outbreak, contaminated corn was the major dietary constituent, and aflatoxin levels of 0.25 to 15 mg/kg were found. The daily aflatoxin B1 intake was estimated to have been at least 55 ug/kg body weight for an undetermined number of days. The patients experienced high fever, rapid progressive jaundice, edema of the limbs, pain, vomiting, and swollen livers. One investigator reported a peculiar and very notable feature of the outbreak: the appearance of signs of disease in one village population was preceded by a similar disease in domestic dogs, which was usually fatal. Histopathological examination of humans showed extensive bile duct proliferation and periportal fibrosis of the liver together with gastrointestinal hemorrhages. A 10-year follow-up of the Indian outbreak found the survivors fully recovered with no ill effects from the experience.

A second outbreak of aflatoxicosis was reported from Kenya in 1982. There were 20 hospital admissions with a 60% mortality; daily aflatoxin intake was estimated to be at least 38 ug/kg body weight for an undetermined number of days.

In a deliberate suicide attempt, a laboratory worker ingested 12 ug/kg body weight of aflatoxin B1 per day over a 2-day period and 6 months later, 11 ug/kg body weight per day over a 14-day period. Except for transient rash, nausea and headache, there were no ill effects; hence, these levels may serve as possible no-effect levels for aflatoxin B1 in humans. In a 14-year follow-up, a physical examination and blood chemistry, including tests for liver function, were normal.

5. Diagnosis of Human Illnesses: Aflatoxicosis in humans has rarely been reported; however, such cases are not always recognized. Aflatoxicosis may be suspected when a disease outbreak exhibits the following characteristics:
  • the cause is not readily identifiable
  • the condition is not transmissible
  • syndromes may be associated with certain batches of food
  • treatment with antibiotics or other drugs has little effect
  • the outbreak may be seasonal, i.e., weather conditions may affect mold growth.

The adverse effects of aflatoxins in animals (and presumably in humans) have been categorized in two general forms.

A. (Primary) Acute aflatoxicosis is produced when moderate to high levels of aflatoxins are consumed. Specific, acute episodes of disease ensue may include hemorrhage, acute liver damage, edema, alteration in digestion, absorption and/or metabolism of nutrients, and possibly death.

B. (Primary) Chronic aflatoxicosis results from ingestion of low to moderate levels of aflatoxins. The effects are usually subclinical and difficult to recognize. Some of the common symptoms are impaired food conversion and slower rates of growth with or without the production of an overt aflatoxin syndrome.

7. Associated Foods: In the United States, aflatoxins have been identified in corn and corn products, peanuts and peanut products, cottonseed, milk, and tree nuts such as Brazil nuts, pecans, pistachio nuts, and walnuts. Other grains and nuts are susceptible but less prone to contamination.
8. Relative Frequency of Disease: The relative frequency of aflatoxicosis in humans in the United States is not known. No outbreaks have been reported in humans. Sporadic cases have been reported in animals.
9. Target Populations: Although humans and animals are susceptible to the effects of acute aflatoxicosis, the chances of human exposure to acute levels of aflatoxin is remote in well-developed countries. In undeveloped countries, human susceptibility can vary with age, health, and level and duration of exposure.
9. Analysis of Foods: Many chemical procedures have been developed to identify and measure aflatoxins in various commodities. The basic steps include extraction, lipid removal, cleanup, separation and quantification. Depending on the nature of the commodity, methods can sometimes be simplified by omitting unnecessary steps. Chemical methods have been developed for peanuts, corn, cottonseed, various tree nuts, and animal feeds. Chemical methods for aflatoxin in milk and dairy products are far more sensitive than for the above commodities because the aflatoxin M animal metabolite is usually found at much lower levels (ppb and ppt). All collaboratively studied methods for aflatoxin analysis are described in Chapter 26 of the AOAC Official Methods of Analysis.
10. Outbreaks: Very little information is available on outbreaks of aflatoxicosis in humans because medical services are less developed in the areas of the world where high levels of contamination of aflatoxins occur in foods, and, therefore, many cases go unnoticed.
For more information on recent outbreaks see the Morbidity and Mortality Weekly Reports from CDC.
The CDC/MMWR link will provide a list of Morbidity and Mortality Weekly Reports at CDC relating to this organism or toxin. The date shown is the date the item was posted on the Web, not the date of the MMWR. The summary statement shown are the initial words of the overall document. The specific article of interest may be just one article or item within the overall report.
The NIH/PubMed button at the top of the page will provide a list of research abstracts contained in the National Library of Medicine's MEDLINE database for this organism or toxin.

January 1992 with periodic updates

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