Presentation on theme: "Pesticide Illness Part 3 Fumigants, Fungicides, Herbicides, Disinfectants, Miscellaneous Pesticides Prepared by: Rupali Das, MD, MPH, California Department."— Presentation transcript:
Pesticide Illness Part 3 Fumigants, Fungicides, Herbicides, Disinfectants, Miscellaneous Pesticides Prepared by: Rupali Das, MD, MPH, California Department of Health Services, Michael O’Malley, MD, MPH, University of California, Davis, Laura Styles, MPH, Public Health Institute
2 Toxicology, Diagnosis & Management of Pesticide Illness by Functional Category IIIInsecticides FFFFumigants FFFFungicides HHHHerbicides DDDDisinfectants MMMMiscellaneous
11 Illness After House Fumigation Pesticide Application History Uncovered electrical conduit: one pipe had a 2” diameter and the others a 1” diameter Methyl bromide fumigation
12 Illness After House Fumigation Health Effects Tenant found convulsing on floor the following evening Serum bromide level 270 ppm Refractory seizures, intermittent fever, multi-organ failure
13 Methyl Bromide Phase-out Ozone depletion –“100% reduction” in 2005 Exemptions –Critical agricultural uses –Pre-shipment & quarantine –Emergency uses No “ideal” substitute Source: US EPA “Frequently Asked Questions” on methyl bromide phase-out
15 Fumigants Metam Sodium Hydrolyzes to mixture of irritants Health effects –Irritant dermatitis –Reactive airways dysfunction syndrome/asthma
16 Case Transportation Worker with Cough 40 year-old male transportation worker with metallic taste; burning eyes, chest, nose; nausea; dizziness. Recurrent cough with wheezing, phlegm for 5 days. Chest tightness, dyspnea on exertion.
17 Transportation Worker with Cough Exposure History Tank car derailment –>19,000 gallons metam sodium released Worker involved in response to accident –Symptoms onset within 20 minutes –Worked 6.5 hours alongside river
29 Case Pear Pickers with Skin Rash 26 people picking pears complained of skin rashes Physical exam: –Contact dermatitis Applied five days before: –NAA 800 –Ziram Granuflo USDA Graphics
30 Pear Pickers with Skin Rash Pesticide Application Workers followed requirements for re-entry Ziram applications –D'Anjou pears, Golden Delicious apples –Symptoms in Bosc pear pickers only Postulated mechanism of dermatitis –Sharp latent bud on Bosc pears –Increased susceptibility to dermal irritation
31 Pear Pickers with Skin Rash Regulatory Action Re-entry interval of 14 days established for formulations of ziram on Bosc pears
33 Case Nursery Worker with Urticaria Itching and hives in redwood nursery worker Chlorothalonil patch test: –Local Type I hypersensitivity 1% chlorothalonil open test –Systemic Type I reaction
34 Chlorothalonil: Pigmentary Changes Blue-gray pigmentation in antecubital area Positive skin reaction to chlorothalonil Diagnosis: Ashy dermatitis
35 Ashy Dermatitis: Mechanism Disruption of basal membrane of epidermis Melanin deposits in dermis Panagos et al. 1996
46 Paraquat Toxicity: Treatment Skin, Eye Decontamination GI decontamination Fluids Hemoperfusion Oxygen contraindicated Severe cases –High dose steroids and cyclophosphamide
47 Case Farmer Attempts Suicide 46 year-old male farmer intentionally ingested a greenish liquid. Complains of dysphagia, sore throat. Previous history of depression. Profuse, prolonged vomiting Plasma paraquat at 4 hours –3 mg/mL
48 Farmer Attempts Suicide Hospital Course Day 2: Severe dysphagia Day 3: SOB Day 4-9: pO 2 33. Day 12: Pt died due to respiratory failure.
49 Herbicides: Glyphosate Health effects –Case reports of eye, skin irritation –Death due to ingestion of large amounts –Experimental studies fail to show skin irritation Mechanism of human toxicity unknown –Surfactant preservative?
50 Chlorophenoxy Herbicides 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) –Derived from tetrachlorobenzene –Dioxin byproducts 2,4-dichlorophenoxyacetic acid (2,4-D) –Derived from phenol –Dioxin contaminants not present
54 Case Custodian with Shortness of Breath 29 year-old custodian with cough, sore throat, shortness of breath after mixing bleach and ammonia Exam: –Cough, dyspnea, RR=36; –Lungs: rales & wheezes; –O 2 saturation 94% on room air –PEFR 80%