Aflatoxin and outcome from acute lower respiratory infection in children in The Philippines
Denning, D.W.; Quiepo, S.C.; Altman, D.G.; Makarananda, K.; Neal, G.E.; Camallere, E.L.; Morgan, M.R.; Tupasi, T.E.
Annals of Tropical Paediatrics 15(3): 209-216
1995
ISSN/ISBN: 0272-4936 PMID: 8534039 DOI: 10.1080/02724936.1995.11747774Document Number: 295889
Between December 1986 and January 1987 at the Research Institute for Tropical Medicine, a small hospital serving inhabitants of peri-urban slums and middle-class housing in Alabang, the Philippines, clinical researchers measured aflatoxin in the serum and urine of 115 children aged less than 13 who had a cough for less than three weeks (i.e., acute lower respiratory infection [ALRI]). They wanted to learn whether consumption of aflatoxin found in many foods in the Philippines could increase ALRI-related mortality among Filipino children. Almost all 115 children had probably been exposed to aflatoxin. 59% were admitted to the hospital. 11% of the hospitalized children died. No child died among those not admitted to the hospital. 73% of all children were severely malnourished. 82% had abnormal chest radiographs. 49% had severe ALRI, 31% mild ALRI, 12% moderate ALRI, and 8% severe-complicated ALRI. 67% of the children and none of the mothers had no detectable aflatoxin in their sera. The mean and median aflatoxin levels in the positive sera were 462 and 140 pg/ml, respectively (range, 20-5600 pg/ml). 64 of 65 sera had some aflatoxin metabolites (0.1-4.77 ng/ml). The mean aflatoxin metabolite/creatinine ratio was 1.27 (range, 0.19-4.43). Undetectable serum aflatoxin was associated with death (p = 0.006). Both anorexia and impaired consciousness level were significantly associated with death (p 0.001). The concentration of urinary aflatoxin metabolites had no apparent effect on outcomes. These findings do not support the hypothesis that aflatoxin acts as an immunosuppressant. Since almost all children tested had aflatoxin metabolites (indicating recent ingestion of aflatoxin), however, the researchers could not exclude aflatoxin's role as a potential immunosuppressant.