Abstract
In January 2015, a 20-month-old child and her family took part in recreational activities at Carrasco and Malvín beaches (Montevideo, Uruguay). An intense harmful algae bloom (HAB) was developing along the coast at that time. A few hours after the last recreational exposure episode, the family suffered gastrointestinal symptoms which were self-limited except in the child’s case, who was admitted to hospital in Uruguay with diarrhea, vomiting, fatigue, and jaundice. The patient had increased serum levels of liver enzymes and bilirubin and five days later presented acute liver failure. She was referred to the Italian Hospital in Buenos Aires, being admitted with grade II–III encephalopathy and hepatomegaly and requiring mechanical respiratory assistance. Serology tests for hepatitis A, B, and C, Epstein-Barr virus, and cytomegalovirus were negative. Laboratory features showed anemia, coagulopathy, and increased serum levels of ammonium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin. Autoimmune Hepatitis Type-II (AH-II) was the initial diagnosis based on a liver kidney microsomal type 1 antibodies (LKM-1) positive result, and twenty days later a liver transplant was performed. The liver histopathology had indicated hemorrhagic necrosis in zone 3, and cholestasis and nodular regeneration, which were not characteristic of AH-II. LC/ESI-HRMS (liquid chromatography electrospray ionization high-resolution mass spectrometry) analysis of MCs in the explanted liver revealed the presence of Microsytin-LR (MC-LR) (2.4 ng·gr−1 tissue) and [D-Leu1]MC-LR (75.4 ng·gr−1 tissue), which constitute a toxicological nexus and indicate a preponderant role of microcystins in the development of fulminant hepatitis.
Highlights
Toxigenic cyanobacteria blooms favored by environmental conditions and eutrophication of water bodies worldwide occur periodically [1,2]
In January 2015 an intense toxic cyanobacteria bloom occurred in the Uruguayan bank of the Río de La Plata river, and certain beaches were disqualified for bathing [21]
A sample of 20 g of of liver were extracted as we have described in the Material and Methods section and the methanolic liver were extracted as we have described in the Material and Methods section and the methanolic extract was analyzed by LC/electrospray ionization (ESI)-HRMS in order to evaluate the presence of microcystins in liver extract was analyzed by LC/ESI-HRMS in order to evaluate the presence of microcystins in liver tissue
Summary
Toxigenic cyanobacteria blooms favored by environmental conditions and eutrophication of water bodies worldwide occur periodically [1,2]. Cyanobacteria genera, such as Microcystis, Anabaena, Oscillatoria, and Nostoc, among others, are capable of producing a wide range of toxins, like microcystins, cylindrospermopsins, nodularin, and anatoxins [3]. In the La Plata basin one of the most toxic and frequently-present cyanobacteria is Microcystis sp., often producing microcystin-LR (MC-LR) and [D-Leu1 ]MC-LR [4,5]. These toxins are considered among the most toxic hepatotoxins produced by cyanobacteria. This worrying situation constitutes a major health and environmental hazard [3,6]
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