Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addictsand food poisoning: research on the influence of aflatoxins on child health in the tropics

Similarities between the geographical and climatic prevalences of kwashiork or and of exposure to dietary aflatoxins, and between the biochemical, meta bolic and immunological derangements in kwashiorkor and those in animals ex posed to aflatoxins, prompted investigation of the associations between kwa shiorkor and aflatoxins. Studies in Africa in the 1980s indicated a role fo r these toxins in the pathogenesis of the disease. Paediatric cases of kwas hiorkor are less prone to severe Plasmodium falciparum malaria than normal children. In mice infected with P. berghei, aflatoxin exposure inhibits par asite growth and ameliorates morbidity. Aflatoxins occur in less than or eq ual to 40% of samples of breast-milk from tropical Africa, usually as low c oncentrations of the relatively non-toxic derivatives of aflatoxin B-1 (AFB (1)) but sometimes as high concentrations of the very toxic AFB(1). This co uld explain kwashiorkor in breastfed babies. Aflatoxin exposure occurs in g reater than or equal to 30% of pregnancies in tropical Africa and the toxin s are often in cord blood, sometimes at extremely high concentrations. Afla toxins are now incriminated in neonatal jaundice and there is circumstantia l evidence that they cause perinatal death and reduced birthweight. Aflatox in-induced immunosuppression may explain the aggressive behaviour of HIV in fection in Africa. There are similarities between observations on HIV cases in Africa and those on heroin addicts in Europe, where 'street' heroin is frequently contaminated with aflatoxin. Aflatoxins were found in 20% of ran dom urine samples from heroin addicts in the UK and The Netherlands. Aflato xins have also been incriminated in episodes of food poisoning which have b een associated with serious morbidity and mortality, particularly among you ng children.