MERCURY EXPOSURE IN A CHLORINE PLANT

Personalized Prevention in Mercury-Induced Amyotrophic Lateral Sclerosis: A Case Report

Chronic exposure to low levels of mercury is involved in the development of motor neuron diseases (MND). Genetic alterations may have a crucial role in the onset and progression. We presented a case of a TANK-binding kinase 1 (TBK1)-mutated 54-year-old male worker who developed a MND due to chronic mercury exposure at work. He was employed in a chlor-alkali plant in Central Italy. After two years of employment he had acute mercury intoxication with suggestive neurological symptoms and a high urinary level of the metal. Through years, many episodes of intoxication occurred, but he continued to perform the same job and be exposed to mercury. After yet another episode of intoxication in 2013, he showed fasciculations of the upper limbs and trunk, and electromyographic activity patterns were consistent with amyotrophic lateral sclerosis (ALS). In 2016, a genetic test revealed a mutation of TBK1, an ALS-related gene. This case highlights the important role of genetics in personalized occupational medicine. Occupational physicians should use genetic tests to identify conditions of individual susceptibility in workers with documented frequent episodes of mercury intoxication recorded during health surveillance programs to customize prevention measures in the workplace and act before damage appears.

Mercury-induced motor and sensory neurotoxicity: systematic review of workers currently exposed to mercury vapor

The neurotoxicity of elemental mercury (Hg0) is well-recognized, but it is uncertain whether and for how long neurotoxicity persists; among studies that evaluated previously exposed workers, only one examined workers during and also years after exposure ceased. The aim of this review is to document the type, frequency, and dose-relatedness of objective neurological effects in currently exposed mercury workers and thereby provide first approximations of the effects one would have expected in previously exposed workers evaluated during exposure. We systematically reviewed studies of neurotoxicity in currently exposed mercury workers identified by searching MEDLINE (1950-2015), government reports, textbook chapters, and references cited therein; dental cohorts were not included. Outcomes on physical examination (PE), neurobehavioral (NB) tests, and electrophysiological studies were extracted and evaluated for consistency and dose-relatedness. Forty-five eligible studies were identified, comprising over 3000 workers chronically exposed to a range of Hg0 concentrations (0.002-1.7 mg/m3). Effects that demonstrated consistency across studies and increased frequency across urine mercury levels (<50; 50-99; 100-199; ≥200 μg/L) included tremor, impaired coordination, and abnormal reflexes on PE, and reduced performance on NB tests of tremor, manual dexterity and motor speed. The data suggest response thresholds of UHg ≈275 μg/L for PE findings and ≈20 μg/L for NB outcomes. These results indicate that PE is of particular value for assessing workers with UHg >200 μg/L, while NB testing is more appropriate for those with lower UHg levels. They also provide benchmarks to which findings in workers with historical exposure can be compared.

Reconstruction of occupational mercury exposures at a chloralkali plant

OBJECTIVE

To reconstruct historical workplace exposure to mercury (Hg) from 1956 to 1994 at a large chloralkali factory for use in a current epidemiology study of the factory.

METHODS

All job activities of the employees were classified into one of 16 exposure categories, and the dates of changes in the processes were identified. Exposures to Hg for each job category, at each period of the plant's operation, were then reconstructed from several data sources. A job-time period-exposure matrix was created, and the individual exposures of former workers were calculated. Data on exposure to Hg in air were compared with modelled concentrations of Hg in air and data on urinary Hg of the employees.

RESULTS

Within an exposure category, concentrations of Hg in air were fairly constant for the first 20 years of the factory's operation, but began to increase in the late 1970s. Employees working in the cell room had the greatest exposures to Hg. The exposure estimates had significant correlations (p<0.001) with the urinary data and were well within the modelled range of concentrations of Hg in air.

CONCLUSIONS

The highest exposures occurred from 1987 until the plant closed in early 1994 with some exposure categories having time weighted average exposures to Hg greater than 140 microg/m(3).

Oral and dental affections in mercury-exposed workers

A total of 222 mercury-exposed workers in the Chlor-Alkali plant in Kuwait were investigated for oral and dental affections. The levels of mercury-vapor ranged from 566.6 microgram/m3 to 0.3 microgram/m3 in different parts of the factory. The periods of exposure varied from 1 to 11 years. Although the level of mercury vapor in the air and the period of exposure proved to be the main factors as regards the oral signs and symptoms, the oral hygiene condition and the individual sensitivity played substantial roles. Oral affections were found not to be due to allergy to mercury.