Aflatoxicosis

Aflatoxicosis is poisoning by aflatoxins, toxins made by Aspergillus molds that grow on crops such as maize (corn), peanuts, tree nuts and some spices, especially when they are stored in warm, humid conditions. Acute aflatoxicosis is rare and occurs mainly in outbreaks in parts of Africa and Asia, after eating heavily contaminated food. It can cause vomiting, abdominal pain, jaundice, swelling and acute liver failure, which can be fatal. Long-term exposure to lower amounts is a known cause of liver cancer, especially in people with hepatitis B, and is linked to poor growth in children. Food safety controls keep exposure low in the US and Europe.

Lab tests linked to aflatoxicosis:

• Aflatoxins (B1, B2, G1, G2): measured in urine on some panels. Results show recent exposure but are not validated for diagnosing illness in individuals, and many healthy people have detectable low levels.
• In suspected acute poisoning, doctors check liver tests (ALT, AST, bilirubin, ALP), INR, albumin, a CBC and kidney function, and test for viral hepatitis. Public health testing of the suspected food confirms an outbreak. In research, aflatoxin-albumin adducts in blood measure longer-term exposure.

How results are read:

• Very high liver enzymes, jaundice and a prolonged INR after eating moldy grain or nuts suggest acute liver injury, which needs urgent care.
• A detectable urine aflatoxin level without symptoms or abnormal liver tests doesn't diagnose aflatoxicosis.
• People with hepatitis B are at higher risk from long-term exposure, so hepatitis B testing and vaccination are important.

When to see a doctor:

• See a doctor if you're concerned about exposure, especially if you have liver disease or hepatitis B.
• Get urgent medical assessment for new yellowing of the skin or eyes, or abdominal pain and vomiting after eating moldy grain or nuts.
• Get emergency care for confusion, severe drowsiness or vomiting blood.

Clinical takeaway: aflatoxicosis is diagnosed from exposure history and liver tests, and urine aflatoxin results show exposure but can't diagnose illness on their own.