Incidence and mortality of acute aflatoxicosis: A systematic review.

Kokeb Tesfamariam, Chibundu N Ezekiel, Limbikani Matumba, Yun Yun Gong, Zdenko Herceg, Carl Lachat, Tess Goessens, Patrick Berka Njobeh, Nyadani Jali-Meleke, Sarah De Saeger, Marthe De Boevre

Journal: Environment international 2025;199():109461

PMID: 40252547

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Abstract

BACKGROUND

Aflatoxins are mycotoxins produced by Aspergillus fungi in crops intended for food and feed. Acute exposure to high levels of aflatoxin B1, one of the most toxic mycotoxins, can result in severe poisoning, defined as acute aflatoxicosis, which manifests as acute hepatic failure followed by death in severe cases. Currently global burden estimates of acute aflatoxicosis are lacking - in contrast to burden estimates of chronic exposure - making it difficult to implement and prioritize risk management strategies in the prevention and control of aflatoxin exposure.

AIM

This systematic review assessed global evidence on the incidence and mortality of acute aflatoxicosis from 1990 to 2023. While symptomology & disease duration was also examined, it served as a secondary outcome to provide additional clinical context.

SEARCH STRATEGY AND ELIGIBILITY

A structured search was conducted in PubMed, Web of Science, Embase, Scopus, INASP and grey literature. Studies were imported into Covidence for review.

STUDY SELECTION AND EXTRACTION

Two independent reviewers screened and extracted titles, abstracts, and full texts. Eligible studies included all human studies.

RESULTS

From 11,539 references, 9 studies were included. Heterogeneity existed in study design, region, age of the study population and aflatoxin analysis. Number of cases ranged from 1 to 317, with aflatoxin concentrations varying widely, i.e. between 10 and 51,100 µg/kg in food, 36 and 209,000 pg/mg albumin in serum, and 19 and 18,521 pg/g in tissue. Only one outbreak provided sufficient data to estimate an attack rate of 8 cases per 100,000. Mortality ranged from 16.2 to 76.5 %, affecting children under 15 and adults over 40 most severely. Common symptoms included vomiting (77-100 %), jaundice (88-100 %), and abdominal pain (8-87 %). The risk of bias was generally low.

CONCLUSION

This review shows that acute aflatoxicosis remains a significant public health burden, especially among vulnerable groups in African countries, although the variability in studies and lack of standardized reporting make burden estimation difficult, highlighting the need for better warning systems and standardized reporting, despite challenges with infrastructure and resources in affected areas.

Address: Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium. Electronic address: [email protected].; Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium. Electronic address: [email protected].; Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, PO Box 17011, Doornfontein 2028, South-Africa. Electronic address: [email protected].; Food Technology & Nutrition Group, Lilongwe University of Agriculture and Natural Resources, Ntcheu Street Plot 182, Lilongwe, Malawi. Electronic address: [email protected].; Food Technology & Nutrition Group, Lilongwe University of Agriculture and Natural Resources, Ntcheu Street Plot 182, Lilongwe, Malawi. Electronic address: [email protected].; School of Food Science and Nutrition, University of Leeds, Woodhouse Ln, Woodhouse, Leeds LS2 9JT England, United Kingdom. Electronic address: [email protected].; Epigenomics and Mechanisms, International Agency for Research on Cancer, 150 Cours Albert Thomas, F-69008 Lyon, France. Electronic address: [email protected].; University of Natural Resources and Life Sciences, Department of Agrobiotechnology (IFA-Tulln), Institute of Bioanalytics and Agro-Metabolomics, Konrad-Lorenz-Strasse 20, Vienna 3430, Tulln an der Donau, Austria. Electronic address: [email protected].; Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, PO Box 17011, Doornfontein 2028, South-Africa. Electronic address: [email protected].; Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium. Electronic address: [email protected].; Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium. Electronic address: [email protected].

DOI: 10.1016/j.envint.2025.109461

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MeSH Terms: Humans, Aflatoxins, Incidence, Mycotoxicosis, Aflatoxin Poisoning