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Previous Volume 338:873-878 March 26, 1998 Number 13 Next

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ABSTRACT

Background Hemodialysis is a common but potentially hazardous procedure. From February 17 to 20, 1996, 116 of 130 patients (89 percent) at a dialysis center (dialysis center A) in Caruaru, Brazil, had visual disturbances, nausea, and vomiting associated with hemodialysis. By March 24, 26 of the patients had died of acute liver failure.

Methods A case patient was defined as any patient undergoing dialysis at dialysis center A or Caruaru's other dialysis center (dialysis center B) during February 1996 who had acute liver failure. To determine the risk factors for and the source of the outbreak, we conducted a cohort study of the 130 patients at dialysis center A and the 47 patients at dialysis center B, reviewed the centers' water supplies, and collected water, patients' serum, and postmortem liver tissue for microcystin assays.

Results One hundred one patients (all at dialysis center A) met the case definition, and 50 died. Affected patients who died were older than those who survived (median age, 47 vs. 35 years; P<0.001). Furthermore, all 17 patients undergoing dialysis on the Tuesday-, Thursday-, and Saturday-night schedule became ill, and 13 of them (76 percent) died. Both centers received water from a nearby reservoir. However, the water supplied to dialysis center B was treated, filtered, and chlorinated, whereas the water supplied to dialysis center A was not. Microcystins produced by cyanobacteria were detected in water from the reservoir and from dialysis center A and in serum and liver tissue of case patients.

Conclusions Water used for hemodialysis can contain toxic materials, and its quality should therefore be carefully monitored.

Source Information

From the Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (E.M.J., D.M.C., S.T.C., W.R.J.); the Department of Biological Sciences, Wright State University, Dayton, Ohio (W.W.C., J.A.); Secretaria de Saúde de Pernambuco, Recife, Brazil (C.E.M.H., M.B.C.A., D.A.M.F., T.M.L.); Hospital Barão de Lucena, Recife, Brazil (V.S.T.B.); and Núcleo de Pesquisas de Produtos Naturais, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (S.M.F.O.A.).

Address reprint requests to Dr. Jochimsen at the Hospital Infections Program, Mailstop E-69, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333.

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