Endotoxins from Cyanobacteria and Gram-negative Bacteria as the Cause of an Acute Influenza-like Reaction after Inhalation of Aerosols

Endotoxins (lipopolysaccharides) in aerosols, originating from cyanobacteria and gram-negative bacteria, were the likely etiological agent behind outbreaks of a transient, flu-like syndrome, described from four Scandinavian towns and Harare, Zimbabwe. The syndrome with fever, malaise, muscle pains, tightness of the chest and respiratory-tract symptoms, also known as toxic pneumonitis, occurred 1.5–6 hours after taking a bath or shower. The outbreaks were associated with mass developments of cyanobacteria in the drinking water reservoirs. Cyanobacterial cells and elevated levels of endotoxins were detected in the Harare tap water when human subjects reported symptoms. In a field study of 21 water bodies, the concentrations of endotoxins were much higher in water dominated by cyanobacteria, compared to water with dominance of eukaryotic algae. This observation may partially be explained by the fact that cyanobacteria possess endotoxins and partially by our findings that endotoxin-possessing bacteria inhabit the mucilage of several mass developing cyanobacterial taxa.