AFLATOXIN AND OUTCOME FROM ACUTE LOWER RESPIRATORY-INFECTION IN CHILDREN IN THE PHILIPPINES

Aflatoxin is immunosuppressive in experimental conditions. This study addressed its potentially contributory role in the poor outcome of acu te lower respiratory infections (ALRI) in children in The Philippines. The catchment area included peri-urban slums and middle-class housing . One hundred and fifteen children (mean age 2.1, range 0.08-12 years) were enrolled and their serum and urine obtained at presentation with ALRI. Aflatoxins in serum and aflatoxin metabolites in urine were mea sured by previously validated ELISA tests. Using the 1986 WHO criteria for the severity of ALRI, 31% had mild, 12% moderate, 49% severe and 8% severe complicated pneumonia. Eighty of 97 (82%) chest radiographs were abnormal. Ninety per cent of the children were below average weig ht for age, using Filipino standards, with a mean of 79% (range 27-157 %). Thirteen (11%) children died. Aflatoxin in their serum, reflecting recent ingestion, was detected in 33%, with a mean positive value of 462 pg/ml. Aflatoxin metabolites (reflecting chronic ingestion) were d etected in 64 of 65 urines collected, with a mean value of 0.1-4.17ng/ ml. None of the children with detectable serum aflatoxin died. Anorexi a and impaired consciousness were strongly associated with a poor outc ome (prolonged fever or death). There was a strong association between undetectable serum aflatoxin concentrations and death (p = 0.004), pe rhaps reflecting anorexia. There was no relationship between the conce ntration of urinary aflatoxin metabolites and outcome. Serum was also obtained from 29 mothers on admission and none contained detectable af latoxin. As virtually all the children had evidence of exposure to afl atoxin, a potentially immunosuppressive role in the context of pneumon ia cannot be excluded.