الفهرس 
Introduction
Ergot alkaloids-producing fungiOnly 14 pages are availabe for public view
 |  | from | 104 |  |  |
| | | from | 104 | | |
Abstract
Fungi cause human illness in different ways. Mycoses are the best-known diseases of fungal etiology, but toxic secondary metabolites produced by saprophytic species are also an important health hazard. The term mycotoxin is an artificial rubric used to describe pharmacologically active mold metabolites characterized by vertebrate toxicity. They fall into several chemically unrelated classes, are produced in a strain-specific way, and elicit some complicated and overlapping toxigenic activities in sensitive species that include carcinogenicity, inhibition of protein synthesis, immunosuppression, dermal irritation, and other metabolic perturbations. Mycotoxins usually enter the body via ingestion of contaminated foods, but inhalation of toxigenic spores and direct dermal contact are also important routes. It is difficult to prove that a disease is a mycotoxicosis.
Molds may be present without producing any toxin. Thus, the demonstration of mold contamination is not the same thing as the demonstration of mycotoxin contamination. Moreover, even when mycotoxins are detected, it is not easy to show that they are the etiological agents in a given human health problem. Nevertheless, there is sufficient evidence and human epidemiological data to conclude that mycotoxins pose an important danger to human health, albeit one that is hard to pin down. The incidence of mycotoxicoses may be more common than suspected. It is easy to attribute the symptoms of acute mycotoxin poisoning to other causes; the opposite is true of etiology. It is not easy to prove that cancer and other chronic conditions are caused by mycotoxin exposure. In summary, in the absence of appropriate investigative criteria and reliable laboratory tests, the mycotoxicoses will remain diagnostically daunting diseases.
Pediatricians should be able to recognize that some cases of vomiting illnesses, bone marrow failure, acute pulmonary hemorrhage, and recurrent apnea and/or “pneumonia” may be caused by mycotoxins. Diseases caused by mycotoxins are great masqueraders. Familiarity with the symptoms of exposure to the major classes of mycotoxins mentioned in this review will enable the clinician to ask pertinent questions about possible fungal exposures and to remove the infant or child from the source of the exposure, which could be contaminated food(s), clothing, and furniture, or indoor air. Failure to prevent recurrent exposure often results in recurrent illness. Pediatricians also should recognize that other conditions, including hepatocellular and esophageal cancer and neural tube defects, although less well-researched, are associated with consumption of foods contaminated with mycotoxins. Pediatricians can serve as better advocates for children and families if they are aware of the short- and long-term consequences of exposures to natural toxins.
Mycotoxicoses can cause serious and sometimes fatal diseases. The possibility of mycotoxin intoxication should be considered when an acute disease occurs in several persons when there is no evidence of infection with a known etiological agent, and no improvement in the clinical picture following treatment. Most of the outbreaks of mycotoxicoses are a consequence of the ingestion of food that is contaminated with mycotoxins. The strict control of food quality, in both industrialized and developing countries, is therefore necessary to avoid such outbreaks. The natural occurrence of mycotoxins varies between localities and at different times in the same locality. It may be single, multiple or combined with other environmental toxins and the concentrations may be too low under strict control. Meanwhile, human exposure to mycotoxins is difficult to avoid because fungal growth in foods is not easy to prevent. Mycotoxins have been linked to a wide range of adverse health effects in children including poor growth and development and suppressed immune. In developing countries, mycotoxin interactions with malnutrition and infection are particularly significant in terms of coin- cidence and outcomes that need more scientific evaluations.