Severe acute illness in a toddler exposed to multiple agricultural pesticides and an insect repellent.

Acute severe pesticide-related illness among farm worker children is rarely reported. The authors report a toddler with acute onset of apnea, cyanosis, somnolence, hypotonia, tachycardia, and miosis who required hospitalization. Health care providers suspected pesticide poisoning, but were unable to determine the causal agent. Investigation by a public health program documented four pesticide exposures that occurred within one-half hour of acute illness. This case illustrates the importance of a thorough environmental/occupational exposure history and obtaining biological samples. It also documents the need to strengthen the Worker Protection Standard for agricultural workers and the importance of reporting and investigating pesticide-related illness.

Pyrethrin and pyrethroid illnesses in the Pacific northwest: a five-year review.

OBJECTIVE: Pyrethrin and pyrethroid insecticides are commonly applied in homes and businesses and on some agricultural crops. This research used a two-state regional approach to analyze reports of acute pesticide poisonings due to pyrethrin and pyrethroid insecticides. METHODS: The Washington State Department of Health and the Oregon Public Health Division collected pesticide poisoning surveillance data from 2001 through 2005. Cases were included if they involved exposure to at least one pyrethrin or pyrethroid insecticide. Descriptive statistics were calculated; differences between categories were assessed using Chi-square analysis. RESULTS: A total of 407 cases fit our definition. Overall, the rate of poisoning in Oregon was significantly higher than in Washington (incidence rate ratio 1.70, 95% confidence interval 1.40, 2.07), and rates for both states generally increased during the time period. For both states, most exposures resulted in low severity illnesses (92%), and most were classified as possible cases (73%). Only about one-fourth of cases were related to a person's work. The most common category of clinical signs and symptoms of illness was respiratory (52% of cases), followed by neurological (40% of cases). Exposure route was predominantly inhalation; there was no association between route and case severity. There was a significant association between illness severity and losing time from work or regular activities (p<0.0001). CONCLUSIONS: Although the majority of pyrethrin and pyrethroid poisoning cases were low in severity, adverse reactions have occurred, as transpired in Oregon in 2005. Regional analysis has the potential to improve the surveillance system and provide unique opportunities for targeting preventive interventions.