Pulmonary complications of chemical warfare 15 years after exposure

ABSTRACT

Chemical weapons, [mainly mustard gas-MG] were heavily used by Iraq against Iranian soldiers between 1984-1986. It has acute effects on respiratory tract in the form of tracheobronchitis and ARDS, whereas chronic respiratory complications include chronic bronchitis, bronchiectasis, asthma and pulmonary fibrosis. There are few reports about human victims. Some of them describe acute effects while our purpose is to define chronic sequelae and their microbiologic, radiologic and physiologic behavior. Fourty four chemical weapon injured patients with moderate to severe disability were selected by AMA criteria [1]. All of them underwent history taking and physical examination, ABG, spirometry, CXR, HRCT, bronchoscopy and BAL for cytology and quantitative culture. Of fourty four patients; 29[66%] had diagnosis of chronic bronchitis by ATS criteria [2], 8 [18%] and 7 [16%] had diagnosis of bronchiectasis and asthma respectively. The most common HRCT finding was ground glass appearance. In one-fourth of patients BAL culture was positive and revealed unusual organisms [S.aureus, S.coagulase negative, E.coli]., BAL neutrophils were increased in bronchiectatic group [258 136 hpf] vs. [96 49 hpf], [148 133 hpf] [p<0.01 p]. Bronchiectatic patients were younger than the other groups [35.5 6.1 yr] vs. [43.5 5.2 yr], and [42.3 5.2 yr] [p<0.01]. The most common respiratory complication of MG is chronic bronchitis. Unusual microorganisms should be considered in the treatment of pulmonary infections. Persons who are exposed to mustard gas at younger age maybe more prone to development of bronchiectasis