Recognized effects on human health
Improvements in food security in the developed countries mentioned above have eliminated dangerous mycotoxicoses such as ergotism, which was popularly known during the Middle Ages in Western Europe. However, this outbreak is still prevalent in rural communities in developing countries, as evidenced by documented cases in Ethiopia, East Africa, where crime broke out in 1978 after a grain meal contaminated with Claviceps aimurea (Demeke et al. 1979; King) 1979). The most serious outbreak of recent mycotooticosis occurred in Kenya, where deaths from aflatoxin exposure occurred for many years. Aflatooticosis is a toxic hepatitis that leads to jaundice, and in severe cases, death. Recurrent incidents of this nature occurred in Kenya between 1981, 2001, 2004 and 2005 (Shephard 2004; Lewis et al. 2005). From January to July 2004, in the eastern and central parts of Kenya, 317 cases were reported to jaundice. Of these, 125 died. Maize collected in the affected areas had high levels of AFB1 with 55% contaminated samples above Kenyan law of 20 µg kg-1, 35% with concentrations above 100 µg kg-1, and 7% more than 1000 µg kg-1 . The highest level obtained was more than 8000 µg kg-1. A similar outbreak in eastern Kenya in mid-2005 resulted in 75 cases being hospitalized (as of June 21, 2005) and 32 deaths (Centers for Disease Control (CDC) 2006). Of the maize resources collected in interviews in the affected region, 42% were contaminated with AFB1 levels above 20 µg kg-1, 24% more than 100 µg kg-1, and 7% more than 1000 µg kg -1. Acute human aflatooticosis has been reported and originated in Asian countries such as India (Bhat 1991) and Malaysia (Lye et al. 1995).
AFB1 is strongly linked to primary liver cancer where it works in conjunction with HBV infection and has been classified by the International Agency for Research on Cancer (IARC) as a human carcinogen (group 1 carcinogen) (IARC 1993a). This combination represents the heavy burden of cancer in developing countries. Recent comparisons of the estimated population risk between Kenya and France have highlighted the huge burden that can be placed on developing countries (Shephard 2006). Based on the aflatoxin exposure estimates of 133 day exposure and 0.12 ng kg-1 and the associated HBV reduction of 25 and 1%, the risk of liver cancer is about 11 vs.0000 human cancer per year to 100,000 people, respectively. Given the prevalence of newly diagnosed liver cancer in the European Union of 10.0 per 100,000 males and 3.3 per 100,000 females (Bray et al. 2002), it is clear that aflatoxin plays a major role in international liver cancer they are still developing, but not in the developed world where other risk factors such as cirrhosis are more important.
Fumonisins have been implicated in another food allergy phenomenon in India where borborygmy, stomach, and diarrhea occur in association with maize and tobacco use contaminated with high levels of fumonisins (Bhat et al. 1997). Fumonisin B1, which is high in most fumonisin analogues, was classified by IARC as a 2B carcinogen (possibly carcinogenic in humans) (IARC 2002). Studies in the Transkei region of South Africa and in the provinces of Linxian and Cixian, China, have shown an association between exposure to fumonisin in rural farming areas and high oesophageal cancer diets (Rheeder et al. 1992; Zhang et al. 1997). Fumonisins, which inhibit folic acid uptake by folate receptor (Stevens and Tang 1997), have also been implicated in severe neural tube damage in rural areas known to consume polluted maize, such as the former Transkei region of South Africa. and areas of North China (Marasas et al. 2004).
Three other important agricultural mycotoxins have also been linked to the outbreak of various human diseases, especially in developing countries. Several cases of foodborne illnesses affecting India and China including diarrhea have been reported with the use of contaminated DON grains (Luo 1988; Bhat et al. 1989). OTA has long been associated with Balkan endemic nephropathy (BEN), fatal histopathological-like kidney disease and OTA-indened nephropathy in pigs, and has been linked to the occurrence of epithelial tumors of high urinary tract (Benford et al. 2001; Castegnaro et al. 2006). OTA was classified by IARC as much as possible carcinogenic in humans (group 2B carcinogen) (IARC 1993b). ZON is a naturally occurring chemical that disrupts endocrine and is associated with clinical manifestations of hyper-oestrogenism in humans, including the emergence of potentially harmful mutations in young children in Puerto Rico in the Caribbean (Saenz de Rodrigues et al. 1985) and gynecomastia with testicular atrophy for rural men in southern Africa (Campbell 1991).
Impact on human health
The cited side effects of mycotoxin exposure in human health, as demonstrated by acute aclatoxicosis and primary liver cancer, are increasingly being seen as the iceberg’s unhealthy behavior associated with mycotoxin exposure (Miller 1998; Williams et al. 2004). The World Health Report 2002 (2002) identified ten major health risks in developing countries with high mortality. These are listed in Table I, along with their associated disease burden as measured by the adjusted life expectancy years (DALYs) and the primary type of outcome affected. The WHO report lists ten types of affected effects associated with the total loss of 833 million DALYs in developing countries with high mortality. In these results, infectious and mild diseases represent more than 90% of the effects of these five high risk factors (low weight, unprotected sex, unsafe water, internal smoke from solid charcoal and zinc deficiency) and range in 300 million DALY. Although mycotoxins are not specifically mentioned, they may appear to play a role in estimating a number of these substances. According to WHO, weight loss caused 3.7 million deaths in the year 2000, especially among children under the age of five in developing countries. Death and malnutrition are the result of malnutrition, which leads to digestive diseases, malaria, measles, and pneumonia. Recent results show that dysfunction and immunity are directly related to aflatoxin exposure in developing countries. Studies in Benin and Togo, West Africa, have shown that exposure to aflatoxin in infants, which promotes body weight, can directly lead to reduced growth and development (Gong et al. 2002). Aflatoxin has long been linked to kwashiorkor, a disease that is commonly referred to as a form of protein malnutrition, although some aspects of the disease are known to be caused by aflatoxins in animals. It has been suggested that either aflatoxins may play a role in catching the disease (Hendrickse 1991) or that children exposed to the disease are at greater risk for the dangers of taking aflatoxin intake (Adhikari et al. 1994). Studies in the Gambia and Ghana, and in West Africa, have begun to explain the role of aflatoxin in the immune system. Aflatoxin exposure was associated with reduced levels of immunoglobulin A (IgA) secretion in Gambian children (Turner et al. 2003). Changes in sub-distribution of subset distribution and alterations in the function of a particular lymphocyte have been implicated in the exposure of aflatoxin to older adults in Ghana and suggest that aflatoxins may cause human immune system dysfunction which can reduce disease resistance (Jiang et al. 2005).
Challenges and conclusions
Exposure to mycotoxins is a major threat to human health, especially in developing countries where the effects of poverty and malnutrition lead to an increase in the side effects of these food-borne pains by reducing the spread of various diseases. Or when the health risks of grains on human health are recognized, contaminated grain can be fed to livestock, reduced animal production and food supply, and increased poverty (Wu et al. 2005). Apart from the fact that aflatoxin is a risk factor for liver cancer, strong evidence for killing mycotoxins as the cause of various diseases no longer exists. However, exposure to these compounds should be addressed as an urgent food safety issue as they place significant pressure on efforts to improve human health in developing countries. Measures to achieve the UN Millennium Development Goals are aimed at having a direct impact on poverty in developing countries and therefore on food choice and food security.
In dealing with mycotoxins as a food safety problem, difficulties arise in addressing this issue in communities where food is not available. In the search for ways to address this question, it is unclear whether the appropriate technology meets the specific needs of the subsistence farmer (Turner et al. 2005) or develops global technologies such as improved varieties, genetically modified organisms and the agricultural model (Gressel et al. 2004) (or a combination of both) will work. better at improving food safety. Finally, the effects of climate change on fungal distribution and toxic production may present a series of new food safety challenges.
