Ethion food poisoning outbreak in Pereira, Colombia, 2022.

INTRODUCTION: Ethion is an organophosphate used as an acaricide and insecticide, that is restricted worldwide. In Colombia, pesticide poisoning is the third most common cause of chemical intoxication. On 9 October 2022, an outbreak of ethion poisoning occurred in Pereira. The aim of this study was to describe the clinical and epidemiological characteristics of the outbreak. METHODS: This is a descriptive study of an outbreak of organophosphate poisoning. The onset of symptoms occurred on 9 October 2022, following the consumption of empanadas. Information was collected on sociodemographic characteristics and clinical manifestations, as well as from paraclinical examinations. Data were obtained from clinical histories, field epidemiological investigations, and inspection visits. Food samples were collected for analysis by gas chromatography-mass spectrometry. Attack rates, proportions, and measures of central tendency, dispersion, and position were calculated. RESULTS: The case definition was met by 37 individuals with a median age of 30 years; all presented with muscarinic symptoms, 29 patients presented with nicotinic symptoms, and 20 patients presented with neurological symptoms. Males were the most affected (57%), and the most common time of symptom onset was 10:00 am. Twenty-three patients (62%) required intensive care unit admission, of whom 14 (38%) required mechanical ventilation. No deaths were reported. Erythrocyte acetylcholinesterase activity was reduced in all patients. Ethion was detected in mass-prepared maize and empanadas at concentrations greater than 0.1 mg/kg. The consumption of empanadas was identified as the common source. DISCUSSION: In Colombia, pesticide poisonings are the third most common type of poisoning caused by chemical substances reported to the National Health Institute through the National Public Health Surveillance System. In the present outbreak, ethion was in empanadas, likely due to contamination of cooking oil. CONCLUSIONS: We describe a large ethion-contaminated food poisoning outbreak reported in Colombia. The main symptoms were muscarinic, and the main treatment measures employed were atropine and respiratory support. Increased awareness of pesticide poisoning and training for food handlers are needed.

760 ampollas de atropina utilizadas para tratar a un paciente con intoxicación grave por plaguicidas en un entorno de bajos recursos / 760 ampollas de atropina utilizadas 760 atropine ampules used to treat a patient with severe pesticide intoxication in a low resources setting

We reported the case of a 24-year-old male patient that arrived unconscious; with no identifable vital signs, a complete lack of response to pain stimuli and presented an extremely myotic pupils. Due to the report of his relatives we diagnosed an acute self-induced organophosphate (OP) intoxication through the ingestion of a full bottle of malathion. Endotracheal intubation, chest compressions, and manual ventilation were performed until the heart monitor showed slow myocardial activity. The patient was treated with atropine in the absence of specifc antidote (pralidoxime). A continuous peripheral IV infusion of atropine was started at a rate of 2 mg IV every 3 min. Given the constant decline in the patient's heart rate, the dose was constantly increased according to the vital sign chart until complete atropinization was achieved (heart rate over 120'). After administering a total of 760, 1 mg/ml ampules within 12 hours, a signifcant improvement was observed. The patient was discharged from the hospital 8 days later with no further complications

Intoxicação aguda por agrotóxicos anticolinesterásicos na cidade do Recife, Pernambuco, 2007-2010 / Acute anticholinesterase pesticide poisoning in Recife, Pernambuco State, Brazil, 2007-2010 / Intoxicación aguda por agrotóxicos anticolinesterásicos en la ciudad de Recife, Pernambuco, 2007-2010

Objetivo: descrever as características epidemiológicas e a distribuição espacial dos casos de intoxicações agudas por agrotóxicos anticolinesterásicos na cidade do Recife, estado de Pernambuco, Brasil, no período 2007-2010. Métodos: estudo descritivo das notificações registradas no Sistema de Informação de Agravos de Notificação (Sinan), para levantamento do perfil epidemiológico e geoprocessamento. Resultados: foram identificados 549 casos de intoxicações agudas por agrotóxicos anticolinesterásicos, sendo as maiores frequências observadas no sexo feminino (60,3 por cento), na faixa etária de 15 a 29 anos (42,3 por cento) e naqueles de cor ou raça parda (95,3 por cento); o "chumbinho" representou o principal agente tóxico envolvido (92,2 por cento) e o principal motivo das intoxicações foi a tentativa de suicídio (79,4 por cento). Conclusão: a intoxicação por agrotóxicos anticolinesterásicos acometeu principalmente mulheres, jovens e pardos; o achado de que a grande maioria dos casos estava relacionada a tentativa de suicídio indica a necessidade de ações de prevenção focadas na população detectada como vulnerável.

Objective: to describe the epidemiological characteristics and spatial distribution of acute anticholinesterase pesticide poisoning cases in the city of Recife Pernambuco State, Brazil, 2007-2010. Methods: this was a descriptive study of cases reported on the Notifiable Diseases Database (Sinan) to obtain their epidemiologic profile and perform geoprocessing. Results: 549 cases were identified. The highest frequencies occurred among females (60.3 percent), the 15-29 age group (42.3 percent) and brown-skinned individuals (95.3 percent). "Rat poison" was the main poisoning agent found (92.2 percent) and attempted suicide was the main reason for poisoning (79.4 percent). Conclusion: anticholinesterase pesticide poisoning is a serious public health problem with a high proportion of cases concentrated in youth, women and brown-skinned people. The finding that the vast majority of cases were related to attempted suicide indicates the need for prevention actions focusing vulnerable populations.

Objetivo: describir las características epidemiológicas y la distribución espacial de los casos de intoxicaciones agudas por agrotóxicos anticolinesterásicos en la ciudad de Recife, estado de Pernambuco, Brasil, en el período 2007-2010.Métodos: estudio descriptivo de las notificaciones registradas en el Sistema de Información de Agravamientos de Notificación (Sinan), para analizar el perfil epidemiológico y el geoprocesamiento.Resultados: se identificaron 549 casos de intoxicaciones agudas por agrotóxicos anticolinesterásicos, siendo observadas las mayores frecuencias en el sexo femenino (60,3%), en la franja de edad de 15 a 29 años (42,3%) y en las personas de color o raza parda (95,3%); el rodenticida ("chumbinho") fue el principal agente tóxico involucrado (92,2%) y el principal motivo de las intoxicaciones fue el intento de suicidio (79,4%). Conclusion: la intoxicación por agrotóxicos anticolinesterásicos acometió principalmente a mujeres, jóvenes y a pardos; el hallazgo de que en la gran mayoría de los casos estaba relacionada al intento de suicidio indica la necesidad de acciones de prevención dirigidas a la población detectada como vulnerable.

Intoxicação por organofosforado em bovinos no Rio Grande do Sul / Poisoning by organophosphate in cattle in southern Brazil

An outbreak of organophosphate (ORF) poisoning in cattle occurred in the central-midwestern region of Rio Grande do Sul, Brazil. The water available for 49 cattle was contaminated with ORF and carbamate (CM). Twenty cows died after a clinical course that lasted for few hours. The classical clinical signs of over stimulation of the parasympathetic nervous system were observed, including motor incoordination, aggressiveness, drooling, muscle tremors and, on occasion, diarrhea. Significant morphological changes were not observed at necropsy or at histopathological examination. ORF e CM were detected by thin layer chromatography in tissue samples of two affected cattle and in a sample from the water consumed by the affected cattle. Additionally, two other water samples accessed by the affected cattle were positive for ORF. A quantitative analysis carried out by gas chromatography in the abomasum contents of an affected cow revealed 0.93µg/g of mancozebe (CM) and 0.07µg/g of phorate (ORF).(AU)

Descreve-se um surto de intoxicação por organofosforado (ORF) em bovinos na mesorregião centro ocidental do Rio Grande do Sul. A água fornecida a 49 bovinos foi contaminada com ORF e carbamato (CM). Vinte bovinos morreram após quadro clínico de poucas horas. Foram observados os clássicos sinais clínicos de hiperestimulação do sistema parassimpático incluindo incoordenação motora, agressividade, sialorreia, tremores musculares e, em alguns casos, diarreia. Na necropsia e histopatologia não foram observadas alterações morfológicas significativas. ORF e CM foram detectados por cromatografia em camada delgada em amostras de tecido de dois bovinos afetados. Adicionalmente, uma amostra da água consumida pelos bovinos foi positiva para ORF e CM e outras duas foram positivas para ORF. Uma análise quantitativa realizada por cromatografia gasosa no conteúdo do abomaso de um bovino afetado, revelou 0,93µg/g de mancozebe (CM) e 0,07 µg/g de forato (ORF).(AU)

Intoxicação por organofosforado em bovinos no Rio Grande do Sul / Poisoning by organophosphate in cattle in southern Brazil

An outbreak of organophosphate (ORF) poisoning in cattle occurred in the central-midwestern region of Rio Grande do Sul, Brazil. The water available for 49 cattle was contaminated with ORF and carbamate (CM). Twenty cows died after a clinical course that lasted for few hours. The classical clinical signs of over stimulation of the parasympathetic nervous system were observed, including motor incoordination, aggressiveness, drooling, muscle tremors and, on occasion, diarrhea. Significant morphological changes were not observed at necropsy or at histopathological examination. ORF e CM were detected by thin layer chromatography in tissue samples of two affected cattle and in a sample from the water consumed by the affected cattle. Additionally, two other water samples accessed by the affected cattle were positive for ORF. A quantitative analysis carried out by gas chromatography in the abomasum contents of an affected cow revealed 0.93µg/g of mancozebe (CM) and 0.07µg/g of phorate (ORF).

Descreve-se um surto de intoxicação por organofosforado (ORF) em bovinos na mesorregião centro ocidental do Rio Grande do Sul. A água fornecida a 49 bovinos foi contaminada com ORF e carbamato (CM). Vinte bovinos morreram após quadro clínico de poucas horas. Foram observados os clássicos sinais clínicos de hiperestimulação do sistema parassimpático incluindo incoordenação motora, agressividade, sialorreia, tremores musculares e, em alguns casos, diarreia. Na necropsia e histopatologia não foram observadas alterações morfológicas significativas. ORF e CM foram detectados por cromatografia em camada delgada em amostras de tecido de dois bovinos afetados. Adicionalmente, uma amostra da água consumida pelos bovinos foi positiva para ORF e CM e outras duas foram positivas para ORF. Uma análise quantitativa realizada por cromatografia gasosa no conteúdo do abomaso de um bovino afetado, revelou 0,93µg/g de mancozebe (CM) e 0,07 µg/g de forato (ORF).

Espontánea reversibilidad de un síndrome de parkinson tardío y de alteraciones cognitivas frontales; después de una intoxicación aguda con órganofosforados / Reversible parkinson syndrome and cognitive impairments due organophosphate acute poisoning

Clásicamente, la intoxicación aguda por órganofosforados produce una crisis colinérgica, que con frecuencia es continuada con un cuadro de debilidad muscular, expresión de un síndrome intermedio. La génesis de estos cuadros está relacionada con la inactivación de la acetilcolinesterasa por el insecticida. Mecanismos diferentes darían origen a polineuropatías y síndromes extrapiramidales tardíos. Se describe un paciente intoxicado agudamente con órganofosforados, que desarrolló una florida crisis colinérgica, que requirió ventilación mecánica invasiva. Después de tres semanas, ya recuperado de una neumonía y del síndrome colinérgico, se pudo definir un daño cognitivo de apariencia frontal, y se apreció la progresiva aparición de hipomimia, rigidez generalizada, bradikinesia y temblor, que configuraron un síndrome de Parkinson. Esta condición clínica se mantuvo al menos por dos semanas, siendo seguida de manera espontánea por una progresiva y completa mejoría del cuadro extrapiramidal y cognitivo. La literatura ha reportado, sólo por excepción casos similares, en los que se destacó tanto la aparición tardía del cuadro parkinsoniano, como su completa y espontánea remisión. Aunque la patogenia del cuadro parkinsoniano no está completamente establecida, existen evidencias experimentales que demuestran que los órganofosforados producen modificaciones en el transporte y en la recaptación de la dopamina. En este paciente se confirmó la doble acción patogénica de los órganofosforados, que habiéndose iniciado con un síndrome colinérgico agudo, finalizó con un compromiso dopaminérgico tardío. La completa recuperación de ambos efectos, permite encasillar a estos insecticidas como generadores de alteraciones funcionales, más que de gestores de daños o cambios estructurales.

Acute organophosphate poisoning usually produces a cholinergic crisis followed by muscular weakness or intermediate syndrome. The basis for these clinical manifestations is inactivation of acetylcholinesterase at the nicotinic and muscarinic nerve terminals and junctions. Different mechanism might lead to polyneuropathy and late extrapyramidal syndromes. We report a case of a male patient who ingested organophosphate with suicidal intentions. He developed a typical cholinergic crisis and required invasive mechanical ventilation. Three weeks later, frontal cognitive impairment was noticed and masklike face, generalized rigidity, bradykinesia and tremor progressively developed until a Parkinson syndrome was established. After his clinical condition had remained stable for at least two weeks, overt spontaneous improvement in motor and cognitive functions was observed. Similar reports in literature are infrequent. Although the pathophysiology that underlies extrapyramidal manifestations due organophosphate poisoning remains unclear, experimental evidence demostróte that organophosphate compounds impair dopamine transport and uptake. This case report suggests that organophosphate might act through a double pathogenic action i.e an initial acute cholinergic syndrome and a delayed disfunction in dopaminergic pathways. Complete spontaneous resolution of both effects allow us to classify organophosphate substances as a cause of functional impairment in the basal ganglia.