Clinical manifestations and diagnosis of acute pyrethroid poisoning

Tumourigenic studies on deltamethrin in Swiss albino mice

Deltamethrin, an alpha-cyano type II synthetic pyrethroid insecticide is used to control a wide range of insects on a variety of crops. Deltamethrin is reported to cause many adverse effects on non-target species. Deltamethrin is reported to cause DNA damage and micronuclei induction in human lymphocytes. It is highly toxic for other organisms such as aquatic invertebrates, fish and Daphnia. About the tumorigenic risk (both tumour initiating and promoting) associated with deltamethrin exposure, very few reports are available in literature. In the present set of investigations, deltamethrin has been evaluated for its tumorigenic and co-carcinogenic (tumour initiating and tumour promoting) potential following long term dermal exposure in Swiss albino mice. The results revealed that deltamethrin has only tumour initiating potential in both the sexes of Swiss albino mice, initiated with deltamethrin and promoted by standard tumour promoter, 12-O-tetra decanoyl phorbol-13-acetate (TPA). In the single dose initiated mice (deltamethrin 4 mg/kg body weight, once only), 44% males and 43% females developed benign skin tumours. A much higher incidence of tumorigenesis was recorded in multiple dose initiated animals (deltamethrin 4 mg/kg body weight, three times per week for 3 weeks), where 71% male and 75% female mice developed tumours at the site of application of deltamethrin. Deltamethrin exposure failed to show any tumour promoting and complete tumorigenic potential at all the three tested dose levels.

Risk assessment of the use of deltamethrin on bednets for the prevention of malaria

Risk assessments covering the use of the pyrethroid, deltamethrin, on bednets for the prevention of malaria have been conducted The toxicity of deltamethrin in humans and animals is reviewed following both dermal and oral exposure. The no-adverse-effect level (NOEL) for exposure via the dermal route was 1000 mg/kg body weight/day. From this an acceptable exposure level (AEL) of 10 mg/kg body weight/day has been derived. The NOEL for exposure via the oral route was 1 mg/kg body weight/day, with exposures above this causing neurotoxic effects in animals. This NOEL has been used to derive margins of safety compared with predicted exposures. While direct skin contact does not seem to cause systemic toxicity in humans, it can cause burning, numbness and tingling of the skin, which is a local effect. This too is taken into account in the risk assessments. The risk assessments cover those treating bednets, on an intermittent or regular basis, the washing of treated nets, sleeping under treated nets (infants, children and adults). Worst case scenarios for each of these situations show that dermal exposures are low (one-tenth or less of the AEL) and the margins of safety for systemic exposure derived from oral data are acceptable, ranging from 10 to 3300. The benefits of the use of treated bednets in reducing morbidity and mortality from malaria are considerable and it can be concluded that the risk:benefit ratio is very favourable.

Cost-comparison of DDT and alternative insecticides for malaria control

In anti-malaria operations the use of DDT for indoor residual spraying has declined substantially over the past 30years, but this insecticide is still considered valuable for malaria control, mainly because of its low cost relative to alternative insecticides. Despite the development of resistance to DDT in some populations of malaria vector Anopheles mosquitoes (Diptera: Culicidae), DDT remains generally effective when used for house-spraying against most species of Anopheles, due to excitorepellency as well as insecticidal effects. A 1990 cost comparison by the World Health Organization (WHO) found DDT to be considerably less expensive than other insecticides, which cost 2 to 23 times more on the basis of cost per house per 6 months of control. To determine whether such a cost advantage still prevails for DDT, this paper compares recent price quotes from manufacturers and WHO suppliers for DDT and appropriate formulations of nine other insecticides (two carbamates, two organophosphates and five pyrethroids) commonly used for residual house-spraying in malaria control programmes. Based on these 'global' price quotes, detailed calculations show that DDT is still the least expensive insecticide on a cost per house basis, although the price appears to be rising as DDT production declines. At the same time, the prices of pyrethroids are declining, making some only slightly more expensive than DDT at low application dosages. Other costs, including operations (labour), transportation and human safety may also increase the price advantages of DDT and some pyrethroids vs. organophosphates and carbamates, although possible environmental impacts from DDT remain a concern. However, a global cost comparison may not realistically reflect local costs or effective application dosages at the country level. Recent data on insecticide prices paid by the health ministries of individual countries showed that prices of particular insecticides can vary substantially in the open market. Therefore, the most cost-effective insecticide in any given country or region must be determined on a case-by-case basis. Regional coordination of procurement of public health insecticides could improve access to affordable products.

Pyrethroid insecticides: poisoning syndromes, synergies, and therapy

BACKGROUND

Pyrethroid insecticides are widely used, but there have been relatively few reports of systemic poisoning. These reports have, however, shown that pharmacotherapy is difficult and that the duration of poisoning can be unexpectedly long. Pyrethroids are ion channel toxins prolonging neuronal excitation, but are not directly cytotoxic. Two basic poisoning syndromes are seen. Type I pyrethroids produce reflex hyperexcitability and fine tremor. Type II pyrethroids produce salivation, hyperexcitability, choreoathetosis, and seizures. Both produce potent sympathetic activation. Local effects are also seen: skin contamination producing paresthesia and ingestion producing gastrointestinal irritation. The slow absorption of pyrethroids across the skin usually prevents systemic poisoning, although a significant reservoir of pyrethroid may remain bound to the epidermis. Carboxyesterase inhibitors can enhance pyrethroid toxicity in high-dose experimental studies. Hence, the unauthorized pyrethroid/organophosphate mixtures marketed in some developing countries may precipitate human poisoning. Pyrethroid paresthesia can be treated by decontamination of the skin, but systemic poisoning is difficult to control with anticonvulsants. Pentobarbitone, however, is surprisingly effective as therapy against systemic type II pyrethroid poisoning in rats, probably due to its dual action as a chloride channel agonist and a membrane stabilizer.

Management of pyrethroid exposure

OVERVIEW

Severe pyrethroid insecticide poisoning is uncommon in the developed world, but more common in developing countries because of its wide use in agriculture. This short review proposes a management strategy for pyrethroid poisoning based on the present literature. It also mentions an experimental approach, which will require further study in animals and may have eventual relevance for man.

Chemical Hazards and Poison Control for the Health Professional—Review of Select Principles and Exposures

Exposure to a wide variety of chemicals can pose significant hazards to patients, and present health care professionals with scenarios that require proper assessment and treatment. Knowing when a chemical exposure requires emergency medical attention is equally as important as knowing when such assistance is not necessary and that simple treatment measures performed at home will suffice. This current discussion is intended to highlight selected principles and clinical information pertaining to common chemical exposures, but not to replace the full spectrum of information that would be available to health care professionals (and the lay public) by contacting their nearest poison control center. There are several factors that should be considered when assessing the nature of and possible clinical outcomes (and medical needs) from patient exposure to chemicals. Identification of the chemical(s) involved, events leading up to the exposure, route of exposure (e.g., ingestion, dermal, inhalation, ocular), patient medical history and current symptoms, are just a few of the variables that must be ascertained before various treatment approaches can be undertaken.

The role of voltage-gated chloride channels in type II pyrethroid insecticide poisoning

Pyrethroids act on mammalian sodium channels, but we have previously shown that low concentrations of the type II pyrethroid deltamethrin also decrease the open channel probability (P(o)) of voltage-gated chloride channels. This effect would be expected to amplify the sodium channel-mediated signs of poisoning produced by pyrethroids. In the present study we evaluated potential chloride channel agonists in vitro, and then tested the most effective of these on pyrethroid-poisoned rats to determine the practical significance of chloride channel effects in vivo. Patch clamp experiments showed that, for voltage-gated maxi chloride channels in excised, inside-out patches from mouse N1E 115 neuroblastoma cells, ivermectin (10(-7) M) and pentobarbitone (10(-6) M) significantly increased open channel probability (p </= 0.01 and p </= 0.02, respectively), whereas phenobarbitone, hexobarbitone, mephobarbitone, thiopentone, and barbituric acid did not. This suggested that, if chloride channels were important in vivo, ivermectin and pentobarbitone should antagonize type II pyrethroid poisoning and phenobarbitone should not. Male F344 rats were then pretreated with ivermectin (4 mg/kg iv), equisedative doses of either pentobarbitone (15 mg/kg ip) or phenobarbitone (45 mg/kg ip), or solvent controls. This was followed by deltamethrin (1.5 or 2 mg/kg iv) or the type I pyrethroid cismethrin (4 mg/kg iv). Ivermectin produced a marked fall in deltamethrin-induced salivation (p </= 0.05) and also (in anesthetized rats) in repetitive electromyogram discharge and muscle twitch (p </= 0.01 and p </= 0.05, respectively). Pentobarbitone significantly reduced the motor signs score due to deltamethrin (p </= 0.01). Ivermectin therefore protected against the peripheral signs of deltamethrin poisoning and pentobarbitone protected against the central signs. As expected phenobarbitone had no protective effects. The motor signs produced by the type I pyrethroid cismethrin (which does not act on chloride channels) were not diminished by either barbiturate. The peripheral benzodiazepine receptor blocker PK11195 did not diminish the protective action of ivermectin on the muscle twitch (p </= 0.05), although it partially reversed the block of salivation (p </= 0.05). These results support the hypothesis that the voltage-dependent chloride channel is a toxicologically significant additional site of action for deltamethrin and that the use of chloride channel agonists can provide a rationale for a novel and effective therapy against type II pyrethroid poisoning.

Biological Monitoring of Pesticide Exposure: a review. Introduction

Pesticides are used worldwide in agriculture, industry, public health and for domestic applications: as a consequence, a great part of the population may be exposed to these compounds. In spite of this extensive use, knowledge on the health risks associated with prolonged exposure is rather poor, and major uncertainties still exist. Epidemiological observations in man have so far produced little conclusive information, mainly because of weaknesses in exposure assessment. Therefore, information on the type and levels of exposure is fundamental in order to better understand and characterize risk to human health. Exposure assessment can be carried out via measurement of environmental concentrations, as well as via determination of the chemical or its metabolites in body tissues (biological monitoring). Besides indices of internal dose, biological monitoring also includes measurements of early effects attributable to interaction between the chemical agent and the human body. Biological monitoring has the advantage, over environmental monitoring, of determining the dose actually absorbed via any possible route: differences in absorption can be taken into account. whether they are due to biological variability or to use of protective equipment. When, in some cases, a combination of occupational and non-occupational exposure occurs, this also can be taken into consideration by biological monitoring. Few reference documents have been published on biological monitoring of pesticides. For this reason, the Office of Occupational Health of the World Health Organization gave ICPS a mandate to prepare a monograph specifically addressed to reviewing methods for biological monitoring of pesticide exposure. This review is based on more than 300 studies published over the period 1980-1999. For the most representative chemical classes, the available biological exposure indices are reported. Both indices of internal dose and. when available, of early effects are discussed. The reported tests were used to monitor exposure of pesticide applicators in agriculture and public health, manufacturing and formulating workers. subjects poisoned after accidental exposure or attempted suicide, volunteers involved in pharmacokinetic studies, as well as sub-groups of the general population exposed to environmentally persistent pesticides. Single chapters deal with organophosphorus insecticides, carbamate pesticides, dithiocarbamates, phenoxyacids, quaternary ammonium compounds. coumarin rodenticides, synthetic pyrethroids, organochlorine pesticides, chlorotriazines, and pentachlorophenol.

Time course and temperature dependence of allethrin modulation of sodium channels in rat dorsal root ganglion cells

Key effects of the pyrethroid insecticide allethrin, delivered to or washed out from cells at 10 or 100 microM in 0.1% DMSO, on neuronal Na(+) channel currents were studied in rat dorsal root ganglion (DRG) cells under whole-cell patch clamp. Tetrodotoxin-resistant (TTX-R) Na(+) channels were more responsive to allethrin than tetrodotoxin-sensitive (TTX-S) Na(+) channels. On application of 10 or 100 microM allethrin to cells with TTX-R Na(+) channels, the Na(+) tail current during repolarization developed a large slowly decaying component within 10 min. This slow tail developed multiphasically, suggesting that allethrin gains access to Na(+) channels by a multiorder process. On washout (with 0.1% DMSO present), the slow tail current disappeared monophasically (exponential tau=188+/-44 s). Development and washout rates did not depend systematically on temperature (12 degrees, 18 degrees, or 27 degrees C), but washout was slowed severely if DMSO was absent. As the duration of a depolarizing pulse was increased (range 0.32-10 ms), the amplitude of the slow component of the succeeding tail conductance first increased then decreased. Tail current amplitude had the same dependence on preceding pulse duration (at 18 degrees ) at 10 or 100 microM, consistent with allethrin modification of Na(+) channels at rest before opening. At 10 microM, slow tail conductance was at maximum 40% of the peak conductance during the previous depolarization, independent of temperature; evidently, the fraction of open modified channels did not change. However, at low temperature, the tail is more prolonged, bringing more Na(+) ions into a cell. In functioning neurons, this Na(+) influx would cause a larger depolarizing afterpotential, a condition favoring the repetitive discharges, which are signatory of pyrethroid intoxication.

Chronic sequelae and irreversible injuries following acute pyrethroid intoxication

For patients the author has observed, the majority of complaints following an acute pyrethroid intoxication disappeared after the end of exposure. Residuals frequently observed after more than 2 years were: (1) cerebro-organic disorders (reduced intellectual performance with 20-30% reduction of endurance during mental work, personality disorder), visual disturbances, dysacousia, tinnitus; (2) sensomotor-polyneuropathy most frequently in the lower legs; (3) vegetative nervous disorders (paroxysmal tachycardia, pollakisuria, increased heat-sensitivity, orthostatic hypotonia and reduced exercise tolerance due to circulatory disorder). Non-neurological symptoms include deficiency of cellular and humoral immune system established by laboratory findings: opportunistic infections, especially Candida-infections of the gastro-intestinal tract, relapsing infections of the urinary and respiratory tract, the latter often aggravating to respiratory obstruction. Most of the patients exhibit positive epi- or intracutantest against pyrethroids or pyrethrines, and acquainted sensitivity also to other antigens. Many of these patients exhibit pathological autoimmune diagnostical findings and developed autoimmune diseases as for instance scleroderma-like syndrome, myasthenia-like syndrome with progredient muscle atrophy, autoimmun-hemolysis and autoimmun-thrombocytopenic purpura.

Effects of cypermethrin on the electroencephalographic activity of the rat: a model of chemically induced seizures

Cypermethrin is a potent representative member of the type II pyrethroid insecticides. This pyrethroid is used worldwide and has become a part of our environment. Until the present study, little information about its toxic effects in the central nervous system (CNS) was available. The aim of this study was, then, to determine the effects of repeated exposure to cypermethrin by means of assessing the electroencephalographic (EEG) activity in the rat. Cypermethrin was administered daily in a 300 mg/kg i.p. dose, below the LD50 value. After daily administration, the EEG activity was recorded and evaluated for 30 min. Paroxysmal epileptic activity appeared after the first and second days of cypermethrin administration. Frequency and numbers of bursts of epileptic activity also increased throughout the days of exposure to cypermethrin. Some of the paroxysmal events were present with behavioral anomalies, such as generalized tonic-clonic seizures. These effects are important because they could be related to the incidence of epileptic activity in humans chronically exposed to cypermethrin.

Influence of neonatal treatment with the pyrethroid insecticide cypermethrin on the development of dopamine receptors in the rat kidney

The influence of neonatal treatment with the pyrethroid insecticide cypermethrin ((R,S)alpha-cyano-3-phenoxybenzyl (1R,S)-cis-trans-3-(2,2-dichloro-vinyl)-2,2-dimethylcyclopropane carboxylate) on postnatal development of renal dopamine receptors was investigated by radioligand binding assay techniques. Treatment with cypermethrin was made on rats from the 10th to the 16th day after birth. Dopamine D1- and D2-like receptors were assayed in frozen sections of kidney of 21-, 30-, 60- and 90-day-old rats using as ligands of dopamine D1- and D2-like receptors [3H]([R](+)-(chloro-2,3,4,5,-tetrahydro-5-phenyl-1,4,-benzazepinal hemimaleate) (SCH 23390) and [3H]spiperone, respectively. Treatment with cypermethrin was without effect on the affinity (Kd value) or the density (Bmax value) of dopamine D1- and D2-like receptors of rats of 21 days of age. In older groups, treatment with the compound reduced the affinity and increased the density of dopamine D1-like receptors, whereas it was without effect on the affinity of dopamine D2-like receptors and decreased their density. These findings indicate that neonatal treatment with the pyrethroid insecticide cypermethrin induces long-lasting impairment of renal dopamine D1- and D2-like receptors and that kidney is a target of the toxic action of the compound. Renal dopamine receptor changes caused by cypermethrin are consistent with possible alterations of renal tubular function and of sympathetic neuroeffector modulation. The above data suggest also that, different from the adult, neonatal exposure to pyrethroid insecticides may induce toxic effects.

The importance of electrodiagnostic studies in acute organophosphate poisoning

Six patients with acute organophosphate pesticide poisoning in whom electrodiagnostic studies influenced or supported specific decisions in management are described. One patient was admitted to hospital with a diagnosis of acute alcoholic intoxication. Electrodiagnostic studies revealed single stimulus induced repetitive responses and decrement-increment responses at 30 and 50 Hz repetitive nerve stimulation, findings that are indicative of a depolarization block due to inactivation of acetylcholinesterase at the motor end-plate. The patient was subsequently treated as a case of acute organophosphate poisoning. The administration of edrophonium (0.1 mg) to another patient with normal neuromuscular transmission studies unmasked the latent electrophysiological abnormalities. Three instances are described in which electrodiagnostic studies were useful in predicting whether pralidoxime administration was likely to be useful and for how long was pralidoxime therapy to be continued. Phrenic nerve conduction study in one patient with impending respiratory failure revealed an unstimulable phrenic nerve. The potential role of phrenic nerve conduction studies and neuromuscular transmission studies in influencing decisions like intubation and mechanical ventilation is discussed.

Permethrin emulsion ingestion: clinical manifestations and clearance of isomers

BACKGROUND

Oral intoxication with permethrin, an insecticide which prolongs axonal sodium channel depolarization, has not been documented in humans. We treated a 59-year-old man who drank approximately 600 mL of 20% permethrin emulsion in a suicide attempt.

METHODS

Sequential blood samples were obtained to determine permethrin isomer levels using high-performance liquid chromatography.

RESULTS

Vomiting and diarrhea occurred after ingestion. On admission, loss of consciousness and metabolic acidosis were observed. On regaining consciousness, the patient complained of a burning sensation in the oral cavity. He received fluid therapy after gastric lavage and recovered without severe complications. Apart from initially impaired consciousness, no clinical neurotoxicity such as tremor, hyperexcitation, ataxia, convulsions, or paralysis occurred, though these have been reported in permethrin-intoxicated animals. Serum permethrin concentrations peaked 3-4 hours after ingestion at 868 ng/mL. Clearance of trans permethrin was more rapid than that of cis permethrin.

CONCLUSION

The unequal clearance of permethrin isomers paralleled findings in animal experiments. Vomiting and diarrhea probably limited absorption in the present case, resulting in a peak serum concentration and a degree of neurotoxicity far less than those seen in animals.

Cypermethrin-induced alteration of thymocyte distribution and functions in prenatally-exposed rats

The synthetic pyrethroid insecticide, cypermethrin (50 mg/kg) was given during gestation to pregnant rats by gavage in corn oil. Prenatal cypermethrin exposure induced a significant decrease in the absolute number of all thymocyte subsets during the first 30 days after birth, being the double negative CD4-CD8-, single positive CD4 and CD8 T cells preferentially affected. Later on day 60 and 90 double positive CD4+CD8+ and single positive thymocytes gradually recovered, while the total number of CD4 CD8 cells was increased. Moreover, thymocytes from rats prenatally exposed to cypermethrin showed an impaired ability to proliferate in response to different doses of Concanavalin A (ConA) and human recombinant interleukin-2 (hrIL-2) and to produce and/or release IL-2. Overall, our results indicate that cypermethrin administered during prenatal period can affect multiple steps in thymocyte differentiation pathways resulting in an altered cell subset distribution and an impairment of thymocyte functions.

In vivo induction of sister chromatid exchange in mouse bone marrow following oral exposure to commercial formulations of alpha-cyano pyrethroids

In vivo genetic toxicity potential of cypermethrin and deltamethrin, two alpha-cyano pyrethroid insecticides was evaluated through induction of sister chromatid exchange in mouse bone marrow cells. Groups of four healthy, adult, male albino mice were each administered with a single oral dose of 10.6, 21.1 and 32 mg cypermethrin a.i./kg b.w. or 6.6, 13.2 and 20 mg deltamethrin a.i./kg b.w. in peanut oil. For reference, a peanut-oil vehicle control and cyclophosphamide (20 mg/kg, i.p.) positive control group of animals were run in parallel. Sister chromatid exchange (SCE) analysis in bone marrow metaphase chromosomes, 24 h post-treatment, revealed modest induction with statistical significance at the highest test dose of both insecticides as compared to the vehicle control group. Further, the SCE induction by cypermethrin was more prominent than by deltamethrin. Marked induction of SCE frequency by exposure to cyclophosphamide, an alkylating mutagen, lent authenticity to these observations which, together with earlier evidence of mitotic and chromosomal abnormalities by these pyrethroids, substantiated their genetic toxicity potential and susceptibility of mammals to consequent risks.

Apparent poisoning by wood preservatives: an attributional syndrome

Recent reports have pointed to an increased number of patients presenting with multisystem symptoms which they attribute to chemical exposures or to heightened chemical sensitivity. Twenty patients exposed to wood preservative products, who attended a joint toxicology and psychiatric clinic, were reviewed by a retrospective case note analysis. Thirteen patients attributed their symptoms to the wood preservative soon after the exposure, and seven patients developed the attribution only at a later date. Reported symptoms referred to all body systems, but there were few physical signs. Clinical findings suggest that the acute symptoms were consistent with the expected toxic effects, but the chronic symptoms could not be explained physically. Patient's beliefs about chemical poisoning could be understood as arising in the context of an attributional process, representing a sociopsychosomatic syndrome precipitated by wood preservative exposure. Patient management included a discussion of findings from assessments, published information, along with counseling where appropriate. Follow-up information from their general practitioners indicated a possible improvement in 50% of patients.

Analytical method for the determination of urinary 3-phenoxybenzoic acid in subjects occupationally exposed to pyrethroid insecticides

The determination of urinary 3-phenoxybenzoic acid enables exposure to pyrethroid insecticides to be evaluated. A method for the quantitative determination of this metabolite in urine is described. The compound and the internal standard (2-phenoxybenzoic acid) are derivatized with pentafluorobenzylbromide and transformed into pentafluorobenzyl esters, which are determined by gas chromatography with an intermediate polarity capillary column and an electron-capture detector. Before GC analysis, the urinary extracts are purified on LC-Si SPE columns. The proposed method has a detection limit of 0.5 microg/l and a mean recovery of 91.3%. The coefficient of variation of the analytical procedure, evaluated at a concentration of 24.96 microg/l, was 9.58%. Storage of the urine samples for 3 months at -18 degrees C did not lead to significant changes in the concentration of analyte. The method was tested analysing the urine of a farm worker with symptoms of pyrethroid poisoning, occupationally exposed to esfenvalerate.

Biological monitoring of pyrethroids in blood and pyrethroid metabolites in urine: applications and limitations

The objective of this study was to perform biological monitoring of subjects who are occupationally exposed to pyrethroids. The study group consisted of 30 pest control operators exposed to cyfluthrin, cypermethrin or permethrin. After exposure, 24-h urine samples were collected and 20 ml of blood was drawn. The pyrethroid metabolites cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropanecarboxylic acid, 3-phenoxybenzoic acid and fluorophenoxybenzoic acid were determined in the urine samples (limit of detection: 0.5 micrograms/l) by GC MS and the pyrethroids in plasma (limit of detection: 5 micrograms) GC-ECD. The concentrations of metabolites in the urine of the pest control operators ranged between < 0.5 micrograms/l and 277 micrograms/l urine. The concentrations of cyfluthrin, cypermethrin and permethrin in the plasma were below the limits of detection (< 5 micrograms/l). To test if the metabolites are specific for pyrethroid exposure, they were determined in the urine of non-exposed subjects (n = 40). In no case could pyrethroid metabolites be detected. A cyfluthrin elimination experiment showed that cyfluthrin metabolites are eliminated following first-order kinetics (t 1/2 = 6.4 h). Storage experiments demonstrate that frozen urine samples (-21 degrees C) show no significant losses of metabolites within a year. In contrast, pyrethroids stored in plasma are susceptible to further biodegeneration.

Biomarkers of human exposure to pesticides

For centuries, several hundred pesticides have been used to control insects. These pesticides differ greatly in their mode of action, uptake by the body, metabolism, elimination from the body, and toxicity to humans. Potential exposure from the environment can be estimated by environmental monitoring. Actual exposure (uptake) is measured by the biological monitoring of human tissues and body fluids. Biomarkers are used to detect the effects of pesticides before adverse clinical health effects occur. Pesticides and their metabolites are measured in biological samples, serum, fat, urine, blood, or breast milk by the usual analytical techniques. Biochemical responses to environmental chemicals provide a measure of toxic effect. A widely used biochemical biomarker, cholinesterase depression, measures exposure to organophosphorus insecticides. Techniques that measure DNA damage (e.g., detection of DNA adducts) provide a powerful tool in measuring environmental effects. Adducts to hemoglobin have been detected with several pesticides. Determination of chromosomal aberration rates in cultured lymphocytes is an established method of monitoring populations occupationally or environmentally exposed to known or suspected mutagenic-carcinogenic agents. There are several studies on the cytogenetic effects of work with pesticide formulations. The majority of these studies report increases in the frequency of chromosomal aberrations and/or sister chromatid exchanges among the exposed workers. Biomarkers will have a major impact on the study of environmental risk factors. The basic aim of scientists exploring these issues is to determine the nature and consequences of genetic change or variation, with the ultimate purpose of predicting or preventing disease.

Clinical evaluation of pesticide exposure and poisonings

Pesticide exposures cause disorders varying from straightforward topical irritant reactions, such as those to synthetic pyrethroid insecticides, to complex systemic illness, such as that resulting from cholinesterase inhibition by organophosphate pesticides. The acute illness syndromes associated with pesticides most commonly encountered by clinicians are illustrated here by cases reported to the California Pesticide Illness Surveillance Program. The issues raised include asthma associated with exposure to contaminants in organophosphate insecticides, systemic toxicity of ingested pyrethroids (in children), and illnesses associated with spills or misuse of fumigants.

Agricultural pesticide use in developing countries: health effects and research needs

Large worker populations in the Third World are exposed to increasing amounts of pesticides, including pesticides severely restricted and banned in industrialized countries. Studies on knowledge, attitudes, and practices indicate that unsafe use of pesticides is the rule in Third World countries. Surveys of acute poisonings show high rates in these countries, despite underregistration. The scarce studies on chronic health outcomes demonstrate neurotoxic, reproductive, and dermatologic effects. Exposure assessment consists mainly of cholinesterase testing, and few studies have quantified dermal and respiratory exposure. The few intervention studies demonstrate the need for evaluation of the impact of preventive measures and policies. There is no evidence that widespread "safe-use" programs have greatly affected exposure and morbidity. It was concluded that research should focus on simple methods for surveillance of exposure and on surveillance of acute illness and its causes in order to develop and evaluate rapid local interventions. Studies on chronic effects should be carried out in selected countries, aiming at long-term and broader interventions. Policies that promote the use of pesticides should be critically evaluated. North-South and South-South research collaborations must be encouraged to address this global health problem.

A systemic reaction following exposure to a pyrethroid insecticide

The pyrethroids are a group of pesticides in wide use around the world. They are felt to be safer than the organophosphates. We report a case of an acute systemic reaction in a farmer following exposure to the synthetic pyrethroid flumethrine.

Biological monitoring of deltamethrin exposure in greenhouses

This study examined the possibility of using biological monitoring to assess deltamethrin exposure among greenhouse workers. The synthetic pyrethroid deltamethrin was sprayed in five greenhouses by cold for generators, and the exposure was biologically monitored by analysing the concentration of its metabolite, 3-phenoxybenzoic acid, by a gas chromato-graphic method after derivatization with pentafluorobenzyl bromide. 3-Phenoxybenzoic acid was found in the urine of two of the ten workers studied. The urine concentration of the metabolite varied from 2.4 to 51.7 micrograms/l. These results show that 3-phenoxybenzoic acid is suitable for biological monitoring for the assessment of exposure to deltamethrin.

Effect of deltamethrin on regional brain polyamines and behaviour in young rats

The present study examines the mechanism of neurotoxic action of a synthetic pyrethroid formulation deltamethrin in young rats. Newly weaned Wistar Albino male rats received deltamethrin of technical grade at a dose of 7.0 mg/kg body weight/day in corn oil, orally from postnatal day 22 to postnatal day 37. Deltamethrin significantly decreased the wet weight of the hippocampus without much affecting the weight of cerebellum, pons medulla, hypothalamus, frontal cortex and corpus striatum in comparison to respective controls. A significant increase in the activities of mitochondrial monoamine oxidase and microsomal acetylcholinesterase without any effect on microsomal Na+, K(+)-ATPase activity was observed in the brain of experimental animals. Our results further indicate that deltamethrin markedly impaired learning function and significantly increased the spontaneous locomotor activity while aggressive behaviour remained unaffected. An overall enhancement of polyamine levels in hypothalamus and corpus striatum accompanied with an overall decline in pon medulla and cerebellum was also noted. Maximum decrease of spermine and spermidine was registered in hippocampus, while these polyamines showed an increase in frontal cortex. In striatal membranes the binding of 3H-spiperone decreased and 3H-quinuclidinyl benzilate was elevated significantly. Deltamethrin-induced deviations in regional brain polyamine levels may be a possible cause for altered pathophysiology of the neurone.

Five office workers inadvertently exposed to cypermethrin

Five cases of poisoning by cypermethrin, a pyrethroid pesticide, are presented. The chemical was inadvertently introduced to the air-conditioning ducts and the patients inhaled it. Exposed patients experienced shortness of breath, nausea, headaches, and irritability. The exposure was compounded by repeated entry into the contaminated area and slow referral to a physician experienced in pesticide exposures.

Changes of nerve excitability and urinary deltamethrin in sprayers

The nerve excitability of median nerve as well as the urinary deltamethrin and its metabolite dibromovinyl-dimethyl-cyclopropane carboxylic acid (Br2A) were detected in 24 deltamethrin sprayers in an assessment of the exposure and effect of deltamethrin. Twenty-nine male, unexposed referents of the same age range were also selected. The urinary deltamethrin and its metabolite Br2A were detectable by GC and HPLC in the sprayers after exposure. The nerve excitability detected with an electromyograph and pairs of stimuli at variable intervals showed that there was a prolongation of supernormal period in median nerve of the exposed group after a 3-d spraying compared with that before spraying which became more significant 2 d after cessation of exposure. In the mean time, no change of supernormal period in the median nerve of reference group was found at the 3-d interval. Nearly half of the sprayers had a supernormal period prolonged by more than 4 ms after spraying, whereas nearly none of the reference group showed similar changes after repeated examinations. Although there was neither correlation between the nerve excitability changes and the urinary deltamethrin or Br2A excretion, nor was a case of acute deltamethrin poisoning diagnosed, the non invasive technique used for nerve excitability detection in this study seems to be valuable in studying deltamethrin toxicity on human.

Levels of exposure and biological monitoring of pyrethroids in spraymen

To assess the exposure response relation of pyrethroids in spraymen, 50 adult male cotton growers were selected and divided into three groups, one group to spray pyrethroids for one day, two groups to spray for three days. Deltamethrin, fenvalerate, and a deltamethrin methamidophos mixture were sprayed by appropriate subgroups for five hours a day. Exposure levels were evaluated by measuring the air concentration, dermal exposure concentration, and urinary content of pyrethroids by gas chromatography. Air concentrations of deltamethrin at the breathing zone were 0.01-0.89 microgram/m3 in the deltamethrin exposed group. For fenvalerate, air concentrations were 0.06-1.98 micrograms/m3. Dermal exposure, particularly on the legs, feet, and hands was appreciable and indicated that this was the main route of absorption. In those spraying for one day, urinary deltamethrin was not detectable by 12 hours after the beginning of exposure whereas fenvalerate was still detectable up to 24 hours after first exposure. Both pyrethroids could be detected two days after the end of three day spraying. Health effects were investigated by interview and physical examination. Twenty nine spraymen complained of abnormal facial sensations that developed mostly two to three hours from the start of pyrethroid spraying and that disappeared by 24 hours after exposure ceased. Some had dizziness, headache, and nausea, but no subject was diagnosed as having acute pyrethroid poisoning. The symptoms showed no significant correlation with urinary pyrethroid excretion. Blood cholinesterase activity of spraymen using the pyrethroid methamidophos mixture did not change.

An epidemiological study on occupational acute pyrethroid poisoning in cotton farmers

A cross sectional survey on the prevalence of acute pyrethroid poisoning in cotton farmers was conducted in 1987 and 1988. A total of 3113 pyrethroid spraymen (2230 men (71.6%) and 883 women (28.4%] were interviewed after spraying and followed up for 72 hours. Adverse effects of pyrethroid exposure were found in 834 of them (26.8%) manifested as abnormal facial sensations, dizziness, headache, fatigue, nausea, or loss of appetite. Only 10 subjects, who developed significant systemic symptoms and had signs of listlessness or muscular fasciculation, were diagnosed as having mild occupational acute pyrethroid poisoning with a prevalence of 0.31% in subjects exposed to pure pyrethroids and 0.38% in subjects exposed to pyrethroid organophosphate mixtures. Measurements of pyrethroid concentrations in the air of the breathing zone, in skin pads, and in urine samples showed that dermal contamination is the main route of exposure to pyrethroids in cotton growers. Preventive measures are recommended.

Block of deltamethrin-modified sodium current in cultured mouse neuroblastoma cells: local anesthetics as potential antidotes

Effects of local anesthetics and anticonvulsants on the pyrethroid-modified sodium current in cultured mouse neuroblastoma cells have been investigated using the suction pipette voltage clamp technique. In the presence of 10 microM of the pyrethroid deltamethrin the sodium current consists of an enhanced peak current during membrane depolarization and a slowly decaying, deltamethrin-induced tail current remaining after repolarization. At the onset of block the local anesthetics tetracaine, lidocaine and QX 314 reduced the deltamethrin-induced tail current more effectively than the peak current. Lidocaine, but not phenytoin, caused a time-dependent block of tail currents evoked by membrane depolarizations lasting 10-1000 ms. Both lidocaine- and phenytoin-induced blocks were independent of the membrane potential during the tail current. The anticonvulsants phenytoin, phenobarbital and valproate blocked the tail and the peak sodium current to the same extent, but diazepam, mephenesin and urethane blocked the peak current more effectively. Vitamin E, which suppresses pyrethroid-induced paresthesia of the skin, had no effect on the voltage-dependent sodium current. It is concluded that indirect effects of anticonvulsants on pyrethroid-induced toxic symptoms predominate, whereas local anesthetics preferentially block the pyrethroid-induced tail current. Therefore, local anesthetics are potentially useful pyrethroid antidotes.

Neurotoxicological effects and the mode of action of pyrethroid insecticides

Neuroexcitatory symptoms of acute poisoning of vertebrates by pyrethroids are related to the ability of these insecticides to modify electrical activity in various parts of the nervous system. Repetitive nerve activity, particularly in the sensory nervous system, membrane depolarization, and enhanced neurotransmitter release, eventually followed by block of excitation, result from a prolongation of the sodium current during membrane excitation. This effect is caused by a stereoselective and structure-related interaction with voltage-dependent sodium channels, the primary target site of the pyrethroids. Near-lethal doses of pyrethroids cause sparse axonal damage that is reversed in surviving animals. After prolonged exposure to lower doses of pyrethroids axonal damage is not observed. Occupational exposure to pyrethroids frequently leads to paresthesia and respiratory irritation, which are probably due to repetitive firing of sensory nerve endings. Massive exposure may lead to severe human poisoning symptoms, which are generally treated well by symptomatic and supportive measures.