Comparison of Early and Late Toxic Effects of Sulfur Mustard in Iranian Veterans

Abstract

Sulfur mustard is an alkylating agent that reacts with ocular, respiratory, cutaneous, and bone marrow tissues, resulting in early and late toxic effects. We compare these effects based on the experience in Iranian veterans exposed to the agent during the Iran-Iraq conflict . The first clinical manifestations of sulfur mustard poisoning occurred in the eyes with a sensation of grittiness, lacrimation, photophobia, blepharospasm, and corneal ulceration. Respiratory effects appeared as rhinorhea, laryngitis, tracheobronchitis, and dyspnoea. Skin lesions varied from erythema to bullous necrotization. Initial leukocytosis and lymphopenia returned to normal within four weeks in recovered patients, but marked cytopenia with bone marrow failure occurred in fatal cases. Late toxic effects of sulfur mustard were most commonly found in lungs, skin and eyes. Main respiratory complications were chronic obstructive pulmonary disease, bronchiectasis, asthma, large airway narrowing, and pulmonary fibrosis. Late skin lesions were hyperpigmentation, dry skin, atrophy, and hypopigmentation. Fifteen of the severely intoxicated patients were diagnosed with delayed keratitis, having corneal vascularization, thinning, and epithelial defect. Respiratory complications exacerbated over time, while cutaneous and ocular lesions decreased or remained constant. Both the severity and frequency of bronchiectatic lesions increased during long-term follow-up. The only deteriorating cutaneous complication was dry skin. The maximum incidence of delayed kaeratitis was observed 15 to 20 years after initial exposure. Being suggested as the main cause ofassociated with malignancies and recurrent infections, natural killer cells were significantly lower 16 to 20 years after intoxication.

Long Term Ocular Effects of Mustard Gas Poisoning: A Cross-Sectional Study in Iraqi Kurdish Civilians

“…two eyes of the same patient may be comparable though by no means always, even when the lesions are caused by vapour [3]. An asymptomatic period for the eyes is followed by redness and irritation which can progress to corneal damage with photophobia, blepharospasm, excessive lacrimation, and blindness [8,10,11]. At first, SM causes vasodilation and increased vascular permeability in the conjunctiva, which lead to progressive edema and secretion of mucus.…”

“…The history of any ocular surgery was documented. Finally, the severity of the disease was noted, according to a chart from the Foundation of Martyrs and Veterans Affairs (Iranian Ophthalmic Committee of Chemical Warfare Veterans) [8], as follows:…”

Measuring Tumor Necrosis Factor-Alpha and Interleukin-1 Beta Levels in Mustard Gas Exposed Patients

“…There are several reports about the harmful effects of SM in various organs which show the early and late effects of just one exposure [8] [24]. Late cutaneous lesions of SM-exposed subjects include severe dry skin, hyper and hypopigmentation, local hair loss, Eczema and chronic urticaria.…”

“…Besides, the published literature about long term effects of SM on their immune system and the amount of cytokines are rare. The studies on short term effects showed that both cellular and humoral immune functions are impaired [8]. Some experimental models showed that shortly after SM exposure, cytokine production increases strongly [29] [30].…”

“…Short and long term effects of SM in various organs of exposed people, especially the skin, eyes and respiratory tract are reported [4] [5] [6] [7]. The damaging mechanisms are not clearly understood [8] [9]. Considering the importance of inflammatory cytokines in many delayed complications of skin and lung injuries [10] [11] [12], this study has focused on the serum concentrations of the most important inflammatory cytokines including TNF-α and IL-1β.…”