Exposed: Beach Babes Exposed Volume 1

We have also summarized the report on the environmental monitoring of Montevideo beach water quality undertaken by the authorities of Montevideo city between December and January [ 21 ].

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The results indicate that the recreational exposure to MCs played a preponderant role in the development of acute hepatic failure suffered by the patient. Doppler ultrasonography showed hepatomegaly and echogenic images in both lobes.

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Brain tomography showed cerebral edema. The patient has had a coagulopathy INR: Total bilirubin; 2 DB: International Normalized Ratio; 6 PT: Serological evaluation was positive for antinuclear antibodies ANAs: The patient was treated with three i. After a week of treatment, the patient continued with severe coagulopathy and hyperammonemia, requiring hemodialysis Table 1. The medical staff, therefore, recommended a liver transplant and the patient was accepted on the waiting list. The liver external macroscopic appearance was irregular and presented cholestasis with a coarsely nodular surface and some areas with parenchymal extinction Figure 1.

Macroscopic external appearance of explanted liver. Note the coarsely cholestatic nodular surface red arrows and the areas with parenchymal extinction black arrow. Representative hematoxylin and eosin H and E -stained slides showed a pattern of damage characterized by hemorrhage, some degree of intracytoplasmic cholestasis, zones of nodular regeneration, and a lack of inflammatory activity Figure 2. In Figure 2 A there are areas of hemorrhage around central veins and hepatocyte dropout.

However, bile ducts showed conserved features and no portal inflammation was evident. Representative slices H and E staining of the explanted liver: A Liver parenchyma with hemorrhage around central veins with hepatocyte dropout black arrows.

B Portal tract without inflammatory activity black arrows. Reticulin-stained sections Figure 3 showed large areas of weft collapse around the central veins, hepatocyte dropout, and signs of regeneration with a necrosis pattern consistent with interstitial hemorrhage and parenchymal extinction. The presence of regeneration process is evidence as a macronodular nodule with macrotrabecular arrangement of two or three hepatocytes Figure 3 A.

However, centrilobular fibrosis was not observed Figure 3 A,B. Representative slices of the reticulin-stained explanted liver. A Central vein with confluent necrosis, hepatocyte dropout yellow arrow , and a macronodular nodule with macrotrabecular arrangement of two or three hepatocytes black arrow. B Centrilobular zone 3 area with hepatocyte confluent necrosis and parenchymal collapsing pattern around the central vein.

The black arrow shows a regenerative macrotrabecular pattern.

Recreational Exposure during Algal Bloom in Carrasco Beach, Uruguay: A Liver Failure Case Report

Perl and Rhodamine stains, used to demonstrate iron and copper hepatocytes and cytoplasmic accumulation, respectively, were negative Figures S1—S3. Taking into account the fact that exposure to cyanobacteria was identified as a possible cause, we carried out MCs analysis in the explanted liver using a LC-Orbitrap-MS system. A quantitative analysis revealed the presence of 2. Based on these results and the pathological findings in the explanted liver, physicians performed a final diagnosis of acute liver failure related to exposure to toxic cyanobacteria and the cyanotoxin microcystin.

After 30 days of hospitalization the infant was discharged. At eight months post-transplant, the patient had normal clinical parameters and biological marker levels Table 1. People frequently engage in recreational activities involving contact with the environment without being aware of possible adverse health effects arising from a range of contaminants present in the surroundings.

Harmful algal bloom HAB , characterized by the exponential growth of several species of toxin-producing Cyanobacteria, frequently occurs in summer and constitutes a sanitary and environmental problem all around the world [ 2 ]. Microcystins MCs , one of the most widely distributed groups of cyanotoxins, are part of a potent hepatotoxin group produced by genera such as Microcystis , Anabaena , Oscillatoria , and Nostoc , among others. HAB have been associated with periodic incidents of human and animal illness and death all around the world.

Depending on the kind of contact that people have with cyanobacteria and their toxins, a condition characterized by different symptoms is defined. The first records of gastrointestinal diseases due to contact of the population in several cities on the Ohio River shore with cyanotoxins date from [ 9 ]. Similar alterations were observed in Harare, Zimbabwe, where children from certain areas of the city developed gastroenteritis every year coinciding with the senescence of Microcystis bloom [ 10 ].

One of the worst gastrointestinal toxic events, even with some lethal cases, relating to cyanotoxins, occurred in in Paulo Alfonso, Bahia, Brazil.

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After the construction of the Itaparica dam there was a severe epidemic of gastroenteritis associated with an Anabaena and Microcystis sp. Furthermore, there are numerous reports of people who suffered symptoms, such as conjunctivitis, earache, hay fever-like syndrome, swollen lips, allergic dermatitis, rush, itching, and headache, after consuming water or coming into contact with water during a cyanobacterial bloom [ 23 ]. One of the most severe and well-documented cases of acute exposure to cyanotoxins occurred in Caruaru, Brazil, where 55 dialysis patients developed hepatic failure and died due to the use of cyanotoxin-contaminated water in the dialysis procedure.

Another important way in which population come into contact with cyanobacterial blooms is through recreational activities. However, the effects on health of recreational MCs exposure are not yet sufficiently understood and this type of poisoning often remains undiagnosed.

Recreational Exposure during Algal Bloom in Carrasco Beach, Uruguay: A Liver Failure Case Report

Whilst engaging in nautical sports in this lake, a young man was immersed in an intense bloom of Microcystis sp. A level of Four hours after exposure, the patient showed nausea, abdominal pain, and fever. The initial diagnosis was stress. Three days later, dyspnea and respiratory distress were reported. The patient was hospitalized in intensive care and was diagnosed with atypical pneumonia. Complete recovery took place within 20 days [ 14 ].

In this work we report the symptoms suffered by a family after recreational activities at beaches in Montevideo, Uruguay in January A few hours after the last exposure event, three adults developed gastrointestinal symptoms which were rapidly self-limited and a month-old girl suffered gastrointestinal symptoms followed by acute liver failure, ending in liver transplant. Likewise, these results are not surprising since the liver is the main target of microcystins and these toxins are actively transported within the hepatocytes. Thus, the inhibition of protein phosphatases, the main mechanism of action of these toxins, rapidly damages these metabolically highly-active cells.

The coagulopathy developed by the patient, characterized by alteration in PT and INR levels, is physiologically associated with the observed hepatic injury and the consequent alteration in protein synthesis factors necessary for normal functioning of the clotting and fibinolytic systems. The clinical parameters led to an initial diagnosis of acute liver failure, and serological evaluation had pointed to autoimmune hepatitis type II as the cause of liver failure.

However, the patient did not improve after pharmacological treatment and was derived to undergo liver transplant. Liver histological studies had indicated a pattern of damage characterized by liver hemorrhagic necrosis, portal tracts without inflammatory activity and parenchyma with nodular regeneration, which is not typical for autoimmune hepatitis [ 25 ].

Although autoimmune hepatitis type II could have been triggered by several factors, including exposure to hepatotoxic substances, such as MCs, the damage observed at the histological level and the presence of MC-LR and [DLeu 1 ]MC-LR in the liver, led us to consider a preponderant role for cyanotoxins in the development of the acute liver failure suffered by the patient.

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We surmise that the exposure characteristics were intermittent, sub-acute for several days, and absorbed mainly via oral and dermal routes. Levels of toxin were detected in liver ranging from Even though in the current case we cannot know the exact dose and number of exposure events suffered, the values found in the liver of the patient 2. Previously, micrcosystin levels in human liver were only determined in Caruaru victims. Consistent with this, in the present case Our findings show that exposure to toxic cyanobacteria blooms generated differential effects in adults gastrointestinal symptoms and a baby acute liver failure.

This difference between the pathologies presented in adults and the child may be due to: In this work we have reported a case of recreational exposure to cyanobacteria and cyanotoxins, suffered by a family three adults and a month-old child during January on the beaches of Uruguay. The adults had only self-limiting gastrointestinal symptoms while the child had more severe gastrointestinal condition resulting in acute liver failure requiring liver transplant. To the best of our knowledge this is the first report on the presence of MC-LR and [D-Leu 1 ] MC-LR in liver of a patient who has undergone recreational exposure to a harmful algal bloom dominated by Microcystis.

This report highlights the need to encourage and promote discussion on the health assessment which focus on environmental health determinants such as toxigenic cyanobacteria bloom and their toxins. Likewise management frameworks should be generated through cooperation and co-financing in order to ensure adequate data sharing among all the sectors involved, at the same time intensifying research with a view to providing improved human health protection. It is, therefore, necessary to include this type of hepatotoxicosis in diagnosis protocols, especially in areas affected by harmful algae blooms, so that medical staff will be aware of the pathology and be able to make a correct differential diagnosis.

Furthermore, institutional links should be established, allowing samples to be derived from hospitals and health centers to laboratories and other entities specializing in cyanotoxins in order to detect the presence of MCs in biological fluids as a confirmatory parameter. Since summer —, when toxic blooms were detected on the Montevideo coast for the first time [ 5 ], the Quality Assessment and Environmental Control Service has begun to monitor the water quality on the beaches of Montevideo in summer period on a routine basis between 15 November and 31 March.

Monitoring includes a visual record, by naked eye observation in real time, using three categories of visual detection: The patient was attended by the medical staff of the Toxicology and Hepatology department of the Italian Hospital of Buenos Aires, Argentine, who evaluated the patient and provided the appropriate medical treatment. Serum samples were taken and levels of alanine aminotransferase ALT , aspartate aminotransferase AST , total and direct bilirubin, albumin, and ammonium were determined CMD ixl, Wiener. The photos are real images by photographer Jack Watson and are meant for your entertainment and viewing enjoyment.

Watson will refine the books to accommodate the viewing audience consensus. The collection is designed for those who enjoy and admire photos of the female form. Please leave feedback, good or bad. As with any commercial endeavor success depend on satisfying you the customer. Your constructive feedback is essential in developing the EXPOSED series into an inexpensive alternative to expensive websites and magazine rack purchases. Read more Read less. Enabled Similar books to Exposed: Beach Babes Exposed Volume 1 Due to its large file size, this book may take longer to download.

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