Long‐term complications of sulphur mustard poisoning in severely intoxicated Iranian veterans

Abstract

Sulphur mustard (SM) is an alkylating chemical warfare agent that was widely used during the World War I and in the Iran-Iraq conflict. Delayed complications of SM in different organs and their severity correlations have not previously been reported. Dermatological, ophthalmological, neurological and respiratory examinations, as well as spirometry, gasometry, high resolution computed tomography scanning of the chest, electromyography, nerve conduction velocity, cell blood counts, flow-cytometric analyses, and measurement of serum immunoglobulins and complement factors were performed on all severely SM poisoned veterans in the province of Khorasan, Iran. Haematological and immunological studies were also performed on a control group consisting of 35 healthy male subjects. The severity of dermal, ocular and respiratory complications were classified into four grades and their correlations with each other as well as with the haematological and immunological parameters were determined, using Spearman's rank correlation test. Forty male patients (aged 43.8 +/- 9.8 years) with confirmed SM poisoning 16-20 years after the exposure were studied. The most common complications were found in the lungs (95%), peripheral nerves (77.5%), skin (75%), and eyes (65%). WBC, RBC, haematocrit (HCT), IgM, C3, and the percentages of monocytes and CD3+ lymphocytes were significantly (P < 0.042) higher and the percentage of CD16 + 56 positive cells was significantly (P = 0.006) lower in the patients than in the control group. The severity of respiratory complications revealed a significant correlation with the severity of ocular complications (r = 0.322, P = 0.043), as well as with the haemoglobin (r = 0.369, P = 0.024) and HCT (r = 0.470, P =0.003). Although late complications of SM poisoning in the skin, eyes, and respiratory system are mainly due to its direct toxic effects, the neuromuscular, haematological and immunological complications are probably the result of systemic toxicity.

Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran

“…(95%, 77.5%, 75% and 65%, respectively) (Balali-Mood et al, 2005) although in present study peripheral nerve complications were not studied, but just like this study respiratory complications are of great prevalence(94.5%) , but ocular and cutaneous complications in present study are more prevalent.…”

Comparative proteome analysis of peripheral neutrophils from sulfur mustard-exposed and COPD patients

“…Long-term pulmonary complications from sulfur mustard (SM) exposure have included chronic obstructive pulmonary disease (COPD), chronic bronchitis, bronchiolitis obliterans, bronchiectasis, airway hyper-reactivity, and lung fibrosis (Balali-Mood et al, 2005;Emad & Rezaian, 1997;Ghanei et al, 2008a,b;Khateri et al, 2003). The SM-exposed patients suffer from pulmonary disorders due to previous documented exposure to a single high dose of SM gas they faced during the Iran-Iraq conflict in 1987.…”

Relationship Between Serum Bilirubin Concentration and Inflammatory Cytokines in Victims Exposed to Sulfur Mustard

“…One possible explanation for the observed clinical results may be due to long term side-effects of poisoning, reported by other investigators, which include severe respiratory complications and the resulting oxygenation disorder that may ensue (5,14,15). Therefore, it is expected for the victims to develop polycythemia, to compensate for the hypoxemia, but according to previous studies, this type of manifestation, which can be caused by destruction of RBCs, was not noted.…”