Fipronil Poisoning Presenting as Sinus Bradycardia - A Rare Case Report

Abstract

Fipronil is an N-phenylpyrazole insecticide, a second-generation insecticide which is relatively new and now commonly used in cotton growing community of rural Central India. Farmer suicide and deliberate self-poisoning is menace to the Vidarbha region of rural Central India. There is paucity of research published on fipronil poisoning, clinical features, complications and treatment data. It is scarcely documented worldwide. Agricultural insecticides are common household items in rural areas of developing countries. Because of their easy availability, insecticides became a major source of deliberate self-poisoning. As per World Health Organization (WHO), around 3 million poisoning cases with around 0.2 million deaths are noted annually in the world. 1 About 99 % of these deaths occur in developing countries. Insecticide poisoning is an important public issue in India.Around 168,000 deaths occurred from pesticide self-poisoning which totals to almost 19.7 % of the global suicides.2 The most common cause of self-poisoning in Central India is ingestion of organophosphorus compounds (OPC). Poisoning with organophosphorus compound insecticides has high mortality rate.1 In the last 20 years, there is development of a new class of insecticides in view of mortality due to accidental exposures of organophosphorus and organochlorine compounds. Fipronil being one of these chemicals, is considered less harmful to humans. According to WHO classification fipronil is class II moderately hazardous pesticide.3 Fipronil, an N-phenylpyrazole with a trifluoromethyl sulfinyl substituent, one of the first second generation insecticides, acts at the γ-aminobutyric acid (GABA) receptor and blocks the chloride channel. Fipronil is often used to control pests, fleas and ticks on pets. There is, however, very less evidence or research on human beings on their toxicity; thus, post marketing surveillance is important to detect any undesirable health issues associated with these chemicals. Until now only 3 case reports are published regarding fipronil poisoning, two cases form India and others from Sri Lanka. Hence, we are reporting a case of acute fipronil poisoning which presented as acute gastritis and sinus bradycardia.

Human Exposure of Fipronil Insecticide and the Associated Health Risk

“…In this Perspective, epidemiological studies on health effect of fipronil were identified through PubMed, Web of Science, and Scopus. In total, 10 human epidemiological studies were found, including 7 acute poisoning cases − and 3 chronic exposure ,, as shown in Table . Among these acute poisoning caused by fipronil exposure, all showed slight and temporary health effects in different body systems and symptoms, such as neurological, gastrointestinal, respiratory symptoms, acute kidney injury, status epilepticus anuria, etc.…”