Possible estuary-associated syndrome: symptoms, vision, and treatment.

Shoemaker, Ritchie C.; Hudnell, H. Kenneth

doi:10.1289/ehp.01109539

Cited by 24 publications

(37 citation statements)

References 28 publications

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“…The VCS deficits spanned the spatial frequency spectrum in both exposed groups, similar to the VCS deficit profiles seen in other solvent exposed populations (21)(22)(23)(24)(25)(26) and in contrast to the VCS spatial-frequency profiles observed in populations exposed to methyl mercury (44,45) and inorganic mercury (46,47). Differences between the shapes of altered VCS spatial-frequency profiles can indicate differential effects of various toxic exposures (40)(41)(42)(43)(44)(45)(46)(47)(48).…”

Section: Discussionsupporting

confidence: 59%

“…High levels of airborne perc in occupational exposure studies (280,060-83,080 µg/m 3 ) have been associated with increased neurologic symptoms (19) and deficits on cognitive and motorspeed tasks (16)(17)(18) that depend heavily on visual system function (48). Deficits in color discrimination have been reported at lowerlevel (41,245 µg/m 3 ) occupational exposures (14,15). Altmann and colleagues (20) reported deficits in visual memory, simple visual reaction times and complex visual reaction times in residents near dry-cleaning facilities where mean indoor air perc concentration was 4,980 µg/m 3 (median = 1,360 µg/m 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Persistent or permanent VCS deficits in the presence of normal visual acuity have been observed in workers exposed to styrene (21,22) and mixed solvents (23)(24)(25)(26), as have color discrimination deficits (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) in the absence of detectable optical, retinal, or optic nerve head pathology (39). VCS, a nonspecific indicator of subclinical visual impairment (40), also revealed neurologic effects associated with exposure to toxic Pfiesteria sp.-inhabited estuaries (40)(41)(42), with lead and mercury exposure (43)(44)(45)(46)(47), and was useful in differentiating vision effects from other exposure-induced deficits in neurobehavioral functions (48).…”

mentioning

confidence: 99%

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Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Schreiber¹,

Hudnell²,

Geller³

et al. 2002

Environ Health Perspect

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Tetrachloroethylene (also called perchloroethylene, or perc), a volatile organic compound, has been the predominant solvent used by the dry-cleaning industry for many years. The U.S. Environmental Protection Agency (EPA) classified perc as a hazardous air pollutant because of its potential adverse impact on human health. Several occupational studies have indicated that chronic, airborne perc exposure adversely affects neurobehavioral functions in workers, particularly visual color discrimination and tasks dependent on rapid visual-information processing. A 1995 study by Altmann and colleagues extended these findings, indicating that environmental perc exposure at a mean level of 4,980 microg/m(3) (median=1,360 microg/m(3)) alters neurobehavioral functions in residents living near dry-cleaning facilities. Although the U.S. EPA has not yet set a reference concentration guideline level for environmental exposure to airborne perc, the New York State Department of Health set an air quality guideline of 100 microg/m(3). In the current residential study, we investigated the potential for perc exposure and neurologic effects, using a battery of visual-system function tests, among healthy members of six families living in two apartment buildings in New York City that contained dry-cleaning facilities on the ground floors. In addition, a day care investigation assessed the potential for perc exposure and effects among workers at a day care center located in the same one-story building as a dry-cleaning facility. Results from the residential study showed a mean exposure level of 778 microg/m(3) perc in indoor air for a mean of 5.8 years, and that perc levels in breath, blood, and urine were 1-2 orders of magnitude in excess of background values. Group-mean visual contrast sensitivity (VCS), a measure of the ability to detect visual patterns, was significantly reduced in the 17 exposed study participants relative to unexposed matched-control participants. The groups did not differ in visual acuity, suggesting that the VCS deficit was of neurologic origin. Healthy workers in the day care investigation were chronically exposed to airborne perc at a mean of 2,150 microg/m(3) for a mean of 4.0 years. Again, group-mean VCS, measured 6 weeks after exposure cessation, was significantly reduced in the nine exposed workers relative to matched controls, and the groups did not differ significantly in visual acuity. These results suggested that chronic, environmental exposure to airborne perc adversely affects neurobehavioral function in healthy individuals. Further research is needed to assess the susceptibility of the young and elderly to perc-induced effects, to determine whether persistent solvent-induced VCS deficits are a risk factor for the development of neurologic disease, and to identify the no observable adverse effect level for chronic, environmental, perc exposure in humans.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Schreiber¹,

Hudnell²,

Geller³

et al. 2002

Environ Health Perspect

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“…The VCS deficit greatest at midspatial frequencies (i.e., midsize dark and light bar sinusoidal gratings) was similar to but larger than that observed in the North Carolina estuarine cohort (13,17). Treatment with the toxin-binding polymer cholestyramine (CSM) (20) to increase toxin(s) elimination rate led to symptom abatement and VCS recovery in all cases within 2 weeks of treatment initiation (19). Cases with repeated acquisition of PEAS showed VCS loss, followed by recovery with CSM treatment on each occasion (19).…”

mentioning

confidence: 58%

“…A report on nonoccupationally related, acute, and chronic PEAS cases diagnosed at a private medical clinic in Pocomoke City, Maryland, indicated that a VCS deficit was present in subjects with either conditions (19). The VCS deficit greatest at midspatial frequencies (i.e., midsize dark and light bar sinusoidal gratings) was similar to but larger than that observed in the North Carolina estuarine cohort (13,17).…”

mentioning

confidence: 80%

Residential and recreational acquisition of possible estuary-associated syndrome: a new approach to successful diagnosis and treatment.

Shoemaker

2001

Environ Health Perspect

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Evidence suggests that the estuarine dinoflagellates, Pfiesteria piscicida Steidinger & Burkholder and P. shumwayae Glasgow & Burkholder, members of the toxic Pfiesteria complex (TPC), may release one or more toxins that kill fish and adversely affect human health. In the current study we investigated the potential for undiagnosed cases of possible estuary-associated syndrome (PEAS), as termed by the Centers for Disease Control and Prevention (CDC), in a population that had residential and/or recreational exposure to TPC-affected estuaries, but that did not have direct contact with fish kills or lesioned fish. Age-adjusted visual contrast sensitivity (VCS) was significantly lower and the presence of PEAS-associated symptoms was much higher in the estuary cohort (n = 77) than in combined-control cohorts (n = 87), one without exposure to bodies of water (n = 53) and one with exposure to marine waters (n = 34). In the estuary cohort, 37 individuals met the CDC case definition for PEAS and had significantly lower VCS than non-PEAS cases. The VCS improved and symptoms abated after 2 weeks of treatment with cholestyramine. Cholestyramine, the original drug approved for treatment of hypercholesterolemia, has previously been reported to enhance the elimination rates of a variety of toxins, presumably by interruption of enterohepatic recirculation through toxin entrapment in its polymeric structure and/or anion-exchange process. Control studies showed that repeated VCS testing alone did not improve VCS scores and that cholestyramine treatment did not affect VCS in patients with elevated cholesterol levels. These results suggested that a) susceptible individuals may acquire PEAS through residential and/or recreational contact with TPC-affected estuaries in the absence of an active fish kill; b) VCS is a useful indicator in PEAS diagnosis and treatment monitoring; and c) PEAS can be effectively treated with cholestyramine. Because the study did not use population sampling techniques, the results do not indicate PEAS prevalence. Furthermore, definitive diagnosis of PEAS and association with TPC toxin(s) must await identification of, and a serologic test for, the putative TPC toxin(s).

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Yang¹

2016

Physical and Biological Hazards of the Workplace

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Possible estuary-associated syndrome: symptoms, vision, and treatment.

Cited by 24 publications

References 28 publications

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Residential and recreational acquisition of possible estuary-associated syndrome: a new approach to successful diagnosis and treatment.

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