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Nozawa H, Minakata K, Hasegawa K, Yamagishi I, Suzuki M, Kitamoto T, Watanabe K, Suzuki O. A fatal case involved in pyrethroid insecticide ingestion: quantification of tetramethrin and resmethrin in body fluids of a deceased by LC–MS/MS. Forensic Toxicol 2021; 40:189-198. [DOI: 10.1007/s11419-021-00594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
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Zheng S, Zhang S, Hong S, Lou Q. Severe dyspnea and uncontrolled seizures following meperfluthrin poisoning: a case report. BMC Pediatr 2021; 21:51. [PMID: 33494742 PMCID: PMC7829090 DOI: 10.1186/s12887-021-02509-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Meperfluthrin is a novel sanitary cyhalothrin insecticide invented in China and has increasingly been used to produce liquid mosquito repellents. Oral meperfluthrin poisoning in human has rarely been reported. Here, we reported a case of meperfluthrin poisoning by ingestion of a meperfluthrin-based liquid mosquito repellent in a 16-month-old infant. Case presentation A 16-month-old boy with a history of accident ingestion of meperfluthrin was admitted to our hospital’s emergency department. He exhibited severe dyspnea, and lung radiograph showed multiple patchy and cord-like high-density shadows bilaterally in a short time. He also suffered 35 min of seizures which were finally controlled by the intravenous infusion of propofol. He was diagnosed with meperfluthrin poisoning, status epilepticus and severe pneumonia. After treated with methylprednisolone, aerosolized beclomethasone dipropionate, anti-infection, and some critical supportive therapy, the patient was in good health and showed no symptoms during 12 months of follow-up. Conclusions Meperfluthrin poisoning is rare. Oral meperfluthrin poisoning shows neurotoxic effects and pulmonary toxicity. Controlling seizures rapidly and ensuring an adequate oxygen supply are critical to the successful treatment.
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Affiliation(s)
- Shengkun Zheng
- Department of Emergency, Xiamen Children's Hospital, 92-98 N Yibin road, Huli District, Xiamen, 361006, Fujian province, China
| | - Shengxin Zhang
- Department of Pediatric Intensive Care Unit, Xiamen Children's Hospital, 92-98 N Yibin road, Huli District, Xiamen, 361006, Fujian province, China
| | - Shaoxian Hong
- Department of Pediatric Intensive Care Unit, Xiamen Children's Hospital, 92-98 N Yibin road, Huli District, Xiamen, 361006, Fujian province, China
| | - Qing Lou
- Department of Emergency, Xiamen Children's Hospital, 92-98 N Yibin road, Huli District, Xiamen, 361006, Fujian province, China.
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Huang L, Peng S, Li R, Huang D, Xie D. Case Report: Fatal Neurotoxicity Following Resmethrin Poisoning in a Child. Front Pediatr 2021; 9:746950. [PMID: 34869104 PMCID: PMC8639587 DOI: 10.3389/fped.2021.746950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Resmethrin, a type I pyrethroid insecticide, can activate sodium channels, causing neurotoxicity in both mammals and insects. Possible routes of poisoning include inhalation, dermal contact and ingestion. There are no specific symptoms for resmethrin poisoning. Until now, no antidote has been available for resmethrin. Resmethrin poisoning is rarely reported in children. Here, we report a fatal case of resmethrin poisoning that might have been caused by accidental ingestion by a 26-month-old child. He presented with neurotoxic symptoms that included vomiting, recurrent seizures, and coma. The cranial CT showed extensive lesions of low intensity in the bilateral white matter, thalamus, brainstem, and cerebellum. Lumbar punctures showed increased intracranial pressure (ICP > 25 mmHg). Cerebrospinal fluid (CSF) tests revealed that protein was elevated to 289.2 mg/dL without pleocytosis. Resmethrin was detected in his blood by liquid chromatography-mass spectrometry, which confirmed the diagnosis of resmethrin poisoning. The child developed brain stem herniation and then was declared brain dead at the 77th h after admission. Resmethrin poisoning can be fatal, and it requires immediate diagnosis and treatment. Previous studies reported that cranial CT and CSF analyses were all normal in patients with pyrethroid poisoning. This case might extend the knowledge of neuroimaging and CSF analysis in children with resmethrin poisoning.
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Affiliation(s)
- Lilin Huang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shumei Peng
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ronghan Li
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Dongping Huang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Danyu Xie
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
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Caustic effects of chemicals: risk factors for complications and mortality in acute poisoning. MONATSHEFTE FUR CHEMIE 2017. [DOI: 10.1007/s00706-016-1900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Azab M, Khabour OF, Alzoubi KH, Hawamdeh H, Quttina M, Nassar L. Assessment of genotoxicity of pyrethrin in cultured human lymphocytes. Drug Chem Toxicol 2016; 40:251-255. [PMID: 27461411 DOI: 10.1080/01480545.2016.1209679] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pyrethrin is an insecticide that is obtained from the Chrysanthemum flower (Pyrethrum). In this study, we examined the genotoxic effects of pyrethrin on cultured human lymphocytes using sister chromatid exchanges (SCEs) and 8-hydroxy deoxyguanosine (8-OHdG) assays. Cultures were treated with different concentrations of pyrethrin (25, 50, and 100 μg/mL), which was dissolved in in dimethyl sulfoxide (DMSO). The results showed that treatment of cultured lymphocytes with pyrethrin at 50 μg/mL and 100 μg/mL induced significant elevation in SCEs (p < 0.05). In addition, the 100 μg/mL concentration significantly affected both mitotic and proliferative indices (p < 0.05). Finally, pyrethrin induced significant elevation in the oxidative stress marker 8-OHdG in a dose-dependent manner (p < 0.001). In conclusion, the results suggest that pyrethrin is genotoxic as measured by two independent assays on genetic toxicity.
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Affiliation(s)
- Mohammad Azab
- a Department of Basic Medical Sciences , Faculty of Medicine, The Hashemite University , Zarqa , Jordan
| | - Omar F Khabour
- b Department of Medical Laboratory Sciences , Faculty of Applied Medical Sciences, Jordan University of Science and Technology , Irbid , Jordan
| | - Karem H Alzoubi
- c Department of Clinical Pharmacy , Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan , and
| | - Hasan Hawamdeh
- a Department of Basic Medical Sciences , Faculty of Medicine, The Hashemite University , Zarqa , Jordan
| | - Maram Quttina
- b Department of Medical Laboratory Sciences , Faculty of Applied Medical Sciences, Jordan University of Science and Technology , Irbid , Jordan
| | - Liliana Nassar
- d Department of Applied Biological Sciences , Faculty of Science and Arts, Jordan University of Science and Technology , Irbid , Jordan
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Basiri K, Mohaghegh MR, Teimouri SS, Okhovat AA. Clinical and electrodiagnostic findings in cyhalothrine poisoning. Adv Biomed Res 2016; 5:32. [PMID: 27099845 PMCID: PMC4815519 DOI: 10.4103/2277-9175.178793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/08/2014] [Indexed: 11/05/2022] Open
Abstract
Acute onset bulbar symptoms with respiratory failure and descending paralysis may occur in several neuromuscular disorders including variants of Guillain-Barre syndrome (GBS), diphtheria, botulism and toxins. We present a 51-year-old man who presented with complains of ptosis and dyspnea following pyrethroids spraying in an enclosed area for eradication of flea. Within 5-6 days of admission limb weakness, dysphagia, dysarthria, blurred vision, diplopia, tremor and respiratory distress added to previous symptoms. Temporal profile of events after exposure, development of similar symptoms in patient's son, electrodiagnostic findings and exclusion of other etiologies confirms intoxication etiology. We reviewed the literature and provide an extensive electrodiagnostic overview.
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Affiliation(s)
- Keivan Basiri
- Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Mohaghegh
- Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayyeh Sadat Teimouri
- Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asghar Okhovat
- Department of Neurology, Kashani Hospital, Shahre-Kord University of Medical Sciences, Shahre-Kord, Iran
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Saldarriaga W, Lein P, González Teshima LY, Isaza C, Rosa L, Polyak A, Hagerman R, Girirajan S, Silva M, Tassone F. Phenobarbital use and neurological problems in FMR1 premutation carriers. Neurotoxicology 2016; 53:141-147. [PMID: 26802682 DOI: 10.1016/j.neuro.2016.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 12/23/2022]
Abstract
Fragile X Syndrome (FXS) is a neurodevelopmental disorder caused by a CGG expansion in the FMR1 gene located at Xq27.3. Patients with the premutation in FMR1 present specific clinical problems associated with the number of CGG repeats (55-200 CGG repeats). Premutation carriers have elevated FMR1 mRNA expression levels, which have been associated with neurotoxicity potentially causing neurodevelopmental problems or neurological problems associated with aging. However, cognitive impairments or neurological problems may also be related to increased vulnerability of premutation carriers to neurotoxicants, including phenobarbital. Here we present a study of three sisters with the premutation who were exposed differentially to phenobarbital therapy throughout their lives, allowing us to compare the neurological effects of this drug in these patients.
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Affiliation(s)
- Wilmar Saldarriaga
- Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS),Universidad del Valle, Cali, Colombia; Departments of Morphology and Obstetrics & Gynecology, Universidad del Valle, Hospital Universitario Del Valle, Cali, Colombia.
| | - Pamela Lein
- Department of Molecular Biosciences, University of California, Davis School of Veterinary Medicine, Davis, CA, USA; MIND Institute, University of California, Davis School of Medicine, Sacramento, CA, USA
| | | | - Carolina Isaza
- Department of Morphology, Universidad del Valle, Cali, Colombia
| | - Lina Rosa
- La Misericordia International Clinic, Barranquilla, Colombia; Instituto Superior de Estudios Psicológicos, Barcelona, Spain; Autonomous University of Barcelona-Sant Joan de Déu Hospital, Barcelona, Spain
| | - Andrew Polyak
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Randi Hagerman
- Department of Pediatrics and the MIND Institute, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Santhosh Girirajan
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Marisol Silva
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Davis, CA, USA
| | - Flora Tassone
- MIND Institute, University of California, Davis School of Medicine, Sacramento, CA, USA; Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Davis, CA, USA
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Abstract
INTRODUCTION One in eight of all total hip replacements requires revision within 10 years, 60% because of wear-related complications. The bearing surfaces may be made of cobalt/chromium, stainless steel, ceramic, or polyethylene. Friction between bearing surfaces and corrosion of non-moving parts can result in increased local and systemic metal concentrations. OBJECTIVES To identify and systematically review published reports of systemic toxicity attributed to metal released from hip implants and to propose criteria for the assessment of these patients. METHODS Medline (from 1950) and Embase (from 1980) were searched to 28 February 2014 using the search terms (text/abstract) chrom* or cobalt* and [toxic* or intox* or poison* or adverse effect or complication] and [prosthes* or 'joint replacement' or hip or arthroplast*] and PubMed (all available years) was searched using the search term (("Chromium/adverse effects"[Mesh] OR "Chromium/poisoning"[Mesh] OR "Chromium/toxicity"[Mesh]) OR ("Cobalt/adverse effects"[Mesh] OR "Cobalt/poisoning"[Mesh] OR "Cobalt/toxicity"[Mesh])) AND ("Arthroplasty, Replacement, Hip"[Mesh] OR "Hip Prosthesis"[Mesh]). These searches identified 281 unique references, of which 23 contained original case data. Three further reports were identified from the bibliographies of these papers. As some cases were reported repeatedly the 26 papers described only 18 individual cases. Systemic toxicity. Ten of these eighteen patients had undergone revision from a ceramic-containing bearing to one containing a metal component. The other eight had metal-on-metal prostheses. Systemic toxicity was first manifest months and often several years after placement of the metal-containing joint. The reported systemic features fell into three main categories: neuro-ocular toxicity (14 patients), cardiotoxicity (11 patients) and thyroid toxicity (9 patients). Neurotoxicity was manifest as peripheral neuropathy (8 cases), sensorineural hearing loss (7) and cognitive decline (5); ocular toxicity presented as visual impairment (6). All these neurological features, except cognitive decline, have been associated with cobalt poisoning previously. Type of prosthesis and blood metal concentrations. Where blood or serum metal concentrations were reported (n = 17 for cobalt and n = 14 for chromium), the median cobalt concentration was 398 (range, 13.6-6521) μg/L and the median chromium concentration was 48 μg/L (in whole blood) (range, 4.1-221 μg/L including serum and blood values). Those patients reported to have systemic features who had received a metal-on-metal prosthesis (n = 8) had a median peak blood cobalt concentration of 34.5 (range, 13.6-398.6) μg/L; those with a metal-containing revision of a failed ceramic prosthesis (n = 10) had a median blood cobalt concentration of 506 (range, 353-6521) μg/L. Management. The most common treatment was removal of the metal-containing prosthesis, undertaken in all but 2 patients. This was usually associated with a fall in circulating cobalt concentration and improvement in some or all features. Clinical and toxicological assessment of systemic features. We propose the following criteria for assessing the likelihood that clinical features are related to cobalt toxicity: clinical effects consistent with the known neurological, cardiac, or thyroidal effects of cobalt, and for which any other explanation is less likely; increased blood cobalt concentrations (substantially higher than those in patients with well-functioning prostheses) several months after hip replacement; a fall in the blood cobalt concentration, usually accompanied by signs of improvement in features. When judged by these criteria, the systemic features in 10 of the reported cases are likely to be related to cobalt exposure from a metal-containing hip prosthesis. CONCLUSIONS Rarely, patients exposed to high circulating concentrations of cobalt from failed hip replacements develop neurological damage, hypothyroidism and/or cardiomyopathy, which may not resolve completely even after removal of the prosthesis. The greatest risk of systemic cobalt toxicity seems to result from accelerated wear of a cobalt-containing revision of a failed ceramic prosthesis, rather than from primary failure of a metal-on-metal prosthesis.
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Affiliation(s)
- S M Bradberry
- West Midlands Poisons Unit, City Hospital , Birmingham , UK
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