Systemic manifestations in chronic arsenic toxicity in absence of skin lesions in West Bengal.

BACKGROUND & OBJECTIVE: Pigmentation and keratosis are the prerequisites to diagnose arsenicosis. However, many systemic manifestations occur in association with pigmentation and keratosis in people exposed to chronic drinking of arsenic contaminated water. The present study aim to find out whether systemic manifestations occur in significant number of cases in arsenic exposed people in the absence of skin lesions in an affected district in West Bengal, India. METHODS: A cross-sectional study was carried out in South 24 Parganas, an arsenic affected district of West Bengal, India. Both dermatological and systemic manifestations were recorded and water samples collected for arsenic analysis from 7683 participants. A correlation of systemic manifestations in relation to arsenic exposure was carried out in subjects having no arsenical skin lesion. Prevalence odds ratio (POR) was calculated for each outcome comparing those with high arsenic exposure with those with lowest exposure. RESULTS: The frequency of occurrence of various clinical manifestations like weakness, anaemia, diarrhoea, hepatomegaly and lung disease was found to be significantly higher among participants drinking water having arsenic concentration > or = 50 microg/l in comparison to those taking water with arsenic content below this level. Further, there was increased occurrence of these manifestations with increasing concentration of arsenic level in drinking water, and this followed a dose-response relationship. INTERPRETATION & CONCLUSION: It appears that it is worthwhile to include people with systemic manifestations in absence of skin lesions with evidence of arsenic exposure as suspected cases of arsenicosis for case detection and in surveillance programme.

Occurrence of arsenicosis in a rural village of Cambodia.

Ninety-seven subjects belonging to 40 families in a village in Cambodia were examined in a health camp where all the cases with skin disease assembled. These people had evidences of chronic arsenic exposure from reports of testing of water samples and of hair and/or nail studied. Seventy cases were diagnosed to be suffering from arsenicosis (Clinically and laboratory confirmed according to WHO criteria) as all these cases had evidences of pigmentation and/or keratosis characteristic of arsenicosis and history of exposure of arsenic contaminated water and/or elevated level of arsenic in hair and/or in nail. Highest number of cases belonged to age group of 31 to 45 yrs, both the sexes are more or less affected equally. Evidence of both pigmentation and keratosis were found in 60 cases (85.7%) while only pigmentation and only keratosis was found in 6 (8.5%) and 4 (5.7%) cases respectively. It was interesting to find 37.04% of children below the age of 16 years had skin lesions of arsenicosis. The youngest child having definite evidence of keratosis and pigmentation was aged 8 years, though two children aged 4 and 5 yrs had feature of redness and mild thickening of the palms. The minimum and maximum arsenic values detected in the nails were 1.06 and 69.48 mg/Kg respectively and the minimum and maximum arsenic values in hair were 0.92 and 25.6 mg/Kg respectively. No correlation was observed between arsenic concentration in drinking water and arsenic level in nail and hair. This is the first report of clinical and laboratory confirmed cases of arsenicosis in Cambodia.