Lesson of the week: A foodborne outbreak of organophosphate poisoning

Chaudhry, Rama; Lall, Shyam Bala; Mishra, Baijayantimala; Dhawan, Benu

doi:10.1136/bmj.317.7153.268

Cited by 38 publications

(18 citation statements)

References 3 publications

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“…Organophosphorusbased pesticides are widely used globally and have emerged as the major pesticide contributor to ill health [2]. Ill health related to these irreversible inhibitors of acetylcholinesterase has been reported recently in studies from China [3], India [4][5][6], Brazil [7], Mexico [8], Canada [9], Costa Rica [10], Columbia [11], Puerto Rico [12], France [13], Spain [14,15], Poland [16], Italy [17,18], Belgium [19], Romania [20], Portugal [21], Greece [22], Germany [23], Japan [24], Jordan [25], South Africa [26], Turkey [27], Taiwan [28] and Sri Lanka [29,30]. In 1996, the American Association of Poison Control Centers reported 86 914 human exposures to pesticides in the US [31].…”

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confidence: 99%

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Organophosphorus poisoning and anaesthesia

1999

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SummaryOrganophosphorus compounds, used as insecticides and agents of chemical warfare, are a major global cause of health problems. These irreversible inhibitors of cholinesterase produce three wellrecognised clinical entities: the initial cholinergic phase, which is a medical emergency often requiring management in an intensive care unit; the intermediate syndrome, during which prolonged ventilatory care is necessary; and delayed polyneuropathy. In addition, disturbances of body temperature and endocrine function, electrolyte imbalances, immunological dysfunction and disorders of reproduction have been reported in animals and man. Vocal cord paralysis, pancreatitis, cardiac arrhythmias and a wide range of neuropsychiatric disorders are known to follow acute and chronic exposure to organophosphorus compounds. As a result of the inhibition of plasma cholinesterase, there can be increased sensitivity to drugs hydrolysed by this enzyme, e.g. suxamethonium and mivacurium. The inhibition of acetylcholinesterase causes dysfunction at the neuromuscular junction which can produce altered responses to nondepolarising neuromuscular blockers. Anaesthetists may encounter patients exposed to organophosphorus compounds either following acute poisoning, trauma (warfare) or as patients with a wide range of nonspecific disorders presenting for surgery. The traditional use of oximes and atropine in treatment has failed to reduce the morbidity and mortality associated with poisoning. The roles of agents that have reduced the toxicity of organophosphorus compounds in animal experiments are discussed as potential therapeutic agents. There is an urgent need for accurate information on the problems associated with exposure to organophosphorus compounds. This would best be achieved by collaborative research between technologically advanced countries and developing countries, where organophosphorus compounds are a leading cause of ill health.

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“…A study from South Africa suggested that at least 17.5% of male rural workers engaged in crop spraying suffer from chronic OP poisoning [39]. Misapplication of OP pesticides commonly used in households has caused poisoning [4]. The OP compounds soman, sarin and tabun have been used as chemical warfare agents and continue to feature in threats to world peace.…”

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Organophosphorus poisoning and anaesthesia

1999

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“…The World Health Organization (WHO) has estimated that each year more than 200,000 people in the world die from pesticide poisoning (4); most of them occur in Asia and at least 50% of them are of OP-poisoning (1,4). Episodes of mass poisoning due to OP pesticides have been reported from developing countries like Pakistan and India (5,6); the first from India was reported in 1958 and occurred following the consumption of parathion-contaminated wheat, killing more than 100 people (7).…”

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confidence: 99%

Mass ethion poisoning with high mortality

Dewan

Patel

Pal

et al. 2008

Clinical Toxicology

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Introduction. Fifteen people who consumed a meal during a social ceremony at a remote farm developed symptoms and signs of organophosphate poisoning. Methods. Information was gathered from villagers and doctors at the primary health center and district hospital. Serial measurements of plasma and red blood cell cholinesterase activity levels were carried out and the organophosphate compound was identified in blood samples. Results. Clinical toxicity included abdominal pain, vomiting, diarrhea, excessive secretions, and respiratory distress. The victims were taken to a community health center about 30 km away where three people died. The others were taken to the district level hospital at Palanpur where five died. Of the seven remaining victims who were transferred to a tertiary care hospital at Ahmedabad, one died during transport and another succumbed within a few hours. The remaining five people were hospitalized. Three recovered within a week but two developed complications: one had a lung infection and the other had cerebral anoxia following cardiorespiratory arrest. The person with cerebral anoxia died after eight and a half months. Red blood cell cholinesterase levels on the day of admission correlated well with clinical severity and outcome of the patients. The pesticide was identified as ethion. Conclusions. Pesticide poisonings in developing countries have high morbidity and mortality rates, as facilities for immediate treatment are not readily available. Such incidents should sensitize clinical toxicologists, health authorities, and policy makers to the problems of pesticide poisoning in third world countries.

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“…Sign-symptoms of cholinergic crisis, noted in this study, are matched with that of literature. [1][2][3][4]12 Patients had a well-defined cholinergic phase. Presenting features were consistent with organophosphate poisoning.…”

Section: Discussionmentioning

confidence: 99%

Study of Victims of Orgnophosphorus Compound Poisoning in a Tertiary Care Center

A¹,

Patil²,

Mudbi³

et al. 2014

jemds

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OBJECTIVES: Indiscriminate use of organophosphorus compounds (OPC) increase the potential threat self-poisoning and death. To make a conclusive diagnosis on academic interest a retrospective record based study was undertaken. METHODOLOGY: Post autopsy studies were carried out on 100 victims of OPC poisoning by collecting data from following 3 sources.: Medicolegal autopsy reports, inquest reports and inpatient case sheets. Intention of ingestion of OPC was to commit suicide. Incidence was more in 20 to 30 years of age group, in females and in urban area. RESULTS: Diagnosis was confirmed by history of poison exposure, clinical well-defined cholinergic effects, and characteristic autopsy finding. Early and correct identification of the cause of OP poisoning enables specific treatment. CONCLUSION: Restrictions on access of very toxic pesticides through national polices and enforcement, public education on storage and safe use, early recognition of poisoning, and appropriate medical management may reduce the incidence of poisoning and death.

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Lesson of the week: A foodborne outbreak of organophosphate poisoning

Cited by 38 publications

References 3 publications

Organophosphorus poisoning and anaesthesia

Organophosphorus poisoning and anaesthesia

Mass ethion poisoning with high mortality

Study of Victims of Orgnophosphorus Compound Poisoning in a Tertiary Care Center

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