Investigation of an Outbreak of Unintentional Acute Pesticide Poisoning: Assessment of Exposure to Carbamate and Organophosphate Insecticides, Rural Bangladesh, 2009

Martin, Colleen; Schier, Joshua G.; Chang, Arthur; Gurley, Emily S.; Hossain, M. Jahangir; Rahman, Mahmudur; Luby, Stephen P.; Haider, Mohammad Sabbir; Alamgir, A. S. M.; Homaira, Nusrat; Husain, Mohammad Mushtuq; Wazed, M. A.; Birkholz, Detlef; Skinner, Carl; Yard, Ellen E.; Wolkin, Amy; Lewis, Lauren; Thomas, Jerry D.

doi:10.1097/01.ede.0000392020.64753.3c

Cited by 7 publications

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“… 37 Similarities between that outbreak and those cases include age distribution of the case-patients, a sudden outcry, onset of illness early in the morning, mid-dilated or fixed pupils, lung crepitations on auscultation, excess sweating, froth at the mouth, excess respiratory secretions, convulsions, and coma. 37 In our study, the signs and symptoms are also consistent with acute pesticide poisoning in children reported in different countries of the world. 38–41 Fever has been reported as part of the clinical syndrome following pesticide poisoning in many countries.…”

Section: Discussionmentioning

confidence: 94%

“…Third, children involved in this outbreak presented with clinical illnesses similar to those identified during confirmed outbreaks of pesticide poisoning in Bangladesh. 37 During an outbreak of sudden child deaths in 2009, investigators detected carbamate insecticides in the biological specimens collected within 6 hours of illness onset, which suggested poisoning. 37 Similarities between that outbreak and those cases include age distribution of the case-patients, a sudden outcry, onset of illness early in the morning, mid-dilated or fixed pupils, lung crepitations on auscultation, excess sweating, froth at the mouth, excess respiratory secretions, convulsions, and coma.…”

Section: Discussionmentioning

confidence: 99%

“… 37 During an outbreak of sudden child deaths in 2009, investigators detected carbamate insecticides in the biological specimens collected within 6 hours of illness onset, which suggested poisoning. 37 Similarities between that outbreak and those cases include age distribution of the case-patients, a sudden outcry, onset of illness early in the morning, mid-dilated or fixed pupils, lung crepitations on auscultation, excess sweating, froth at the mouth, excess respiratory secretions, convulsions, and coma. 37 In our study, the signs and symptoms are also consistent with acute pesticide poisoning in children reported in different countries of the world.…”

Section: Discussionmentioning

confidence: 99%

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Outbreak of Sudden Death with Acute Encephalitis Syndrome Among Children Associated with Exposure to Lychee Orchards in Northern Bangladesh, 2012

Islam

Sharif

Sazzad

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Abstract.Recurrent outbreaks of acute encephalitis syndrome (AES) among children in lychee growing areas in Asia highlight the need to better understand the etiology and the context. We conducted a mixed-methods study to identify risk factors for disease, and behaviors and practices around lychee cultivation in an AES outbreak community in northern Bangladesh in 2012. The outbreak affected 14 children; 13 died. The major symptoms included unconsciousness, convulsion, excessive sweating, and frothy discharge. The median time from illness onset to unconsciousness was 2.5 hours. The outbreak corresponded with lychee harvesting season. Multiple pesticides including some banned in Bangladesh were frequently used in the orchards. Visiting a lychee orchard within 24 hours before onset (age-adjusted odds ratio [aOR] = 11.6 [1.02–109.8]) and 3 days (aOR = 7.2 [1.4–37.6]), and family members working in a lychee orchard (aOR = 7.2 [1.7–29.4]) and visiting any garden while pesticides were being applied (aOR = 4.9 [1.0–19.4]) in 3 days preceding illness onset were associated with illness in nearby village analysis. In neighborhood analysis, visiting an orchard that used pesticides (aOR = 8.4 [1.4–49.9]) within 3 days preceding illness onset was associated with illness. Eating lychees was not associated with illness in the case–control study. The outbreak was linked to lychee orchard exposures where agrochemicals were routinely used, but not to consumption of lychees. Lack of acute specimens was a major limitation. Future studies should target collection of environmental and food samples, acute specimens, and rigorous assessment of community use of pesticides to determine etiology.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outbreak of Sudden Death with Acute Encephalitis Syndrome Among Children Associated with Exposure to Lychee Orchards in Northern Bangladesh, 2012

Islam

Sharif

Sazzad

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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“…Compared to our investigation, these malaoxon levels were less than half of the concentrations we found in blood and gastric contents of the 3 descents indicating a high level of toxicity in these cases. Although organophosphates are rarely associated with human outbreaks, a few documented outbreaks exist, including one in India (60 men ate chapatti containing malathion and 1 person died [3]) and another in two farming villages in Bangladesh, which resulted in 2 deaths [16]. Incidents of acute unintentional organophosphate poisoning (due to monocrotophos) after consumption of contaminated millet flour and oil have also been documented in India [26, 27].…”

Section: Discussionmentioning

confidence: 99%

“…In this case report, we used clinical and epidemiological investigations to ascertain the cause of death and inform public health actions to prevent future incidents. There are a few cases of organophosphate poisoning in developing countries that have been comprehensively investigated using both clinical and epidemiological methods [16–18].…”

Section: Introductionmentioning

confidence: 99%

Fatal cases associated with eating chapatti contaminated with organophosphate in Tororo District, Eastern Uganda, 2015: case series

et al. 2019

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Background Few cases of organophosphate poisoning in developing countries have been investigated using clinical and epidemiological methods. On 30 October 2015, 3 students at Mukuju School, Tororo District, Uganda, died soon after eating chapatti (locally-made flat bread) from the same food stand. Ministry of Health investigated to identify the cause and recommend prevention measures. Methods We defined a case as onset during 30–31 October 2015 in a resident of Mukuju Town of ≥1 of the following symptoms: excessive saliva, profuse sweating, dizziness, low blood pressure, constricted pupils or loss of consciousness. We reviewed medical/police records and interviewed survivors, healthcare workers, and police officers. We collected samples of implicated food for toxicological analysis. Autopsies were performed on decedents to identify the cause of death. Results We identified 7 cases with 3 deaths (case-fatality ratio = 43%). Clinical manifestations included acute onset of confusion (100%), constricted pupils (43%), excessive saliva (43%), and low blood pressure (43%). All 7 cases had onset from 16:00–18:00 h on 30 October, with a point-source exposure pattern. Of the 7 cases, 86% (6/7) were men; the mean age was 24 (range: 20–32) years. The 3 decedents each ate a whole chapatti while the other 4 cases ate half or less. Autopsy findings of the 3 decedents indicated organophosphate poisoning. Toxicological analysis found high levels of malathion in leftover foods (266 mg/L in dough and 258 mg/L in chapatti) and malaoxon (a highly toxic malathion derivative) in decedents’ postmortem specimens (mean levels of 19 mg/L in the blood and 22 mg/L in the gastric contents). There was a delay of 4 h before the patients received appropriate treatment. Police investigations revealed that flour used to make the chapatti was intentionally contaminated with an organophosphate pesticide. Conclusion This fatal outbreak of organophosphate poisoning was associated with consumption of roadside-vended chapatti made of flour contaminated with pesticide. Clinicians should be aware of symptoms of organophosphate poisoning and prepared to treat it quickly. Street vendors should carefully consider the source of their ingredients. An in-depth surveillance review of such poisonings in Uganda would guide policymakers in reducing access by criminals and accidental exposures for the public. Electronic supplementary material The online version of this article (10.1186/s12889-019-7143-0) contains supplementary material, which is available to authorized users.

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Sustainable pesticide governance in Bangladesh: socio-economic and legal status interlinking environment, occupational health and food safety

et al. 2017

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Investigation of an Outbreak of Unintentional Acute Pesticide Poisoning: Assessment of Exposure to Carbamate and Organophosphate Insecticides, Rural Bangladesh, 2009

Cited by 7 publications

References 0 publications

Outbreak of Sudden Death with Acute Encephalitis Syndrome Among Children Associated with Exposure to Lychee Orchards in Northern Bangladesh, 2012

Outbreak of Sudden Death with Acute Encephalitis Syndrome Among Children Associated with Exposure to Lychee Orchards in Northern Bangladesh, 2012

Fatal cases associated with eating chapatti contaminated with organophosphate in Tororo District, Eastern Uganda, 2015: case series

Sustainable pesticide governance in Bangladesh: socio-economic and legal status interlinking environment, occupational health and food safety

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