RESUMO
BACKGROUND: Pyrethroid-based mosquito repellents are widely used to control mosquito-borne diseases. Liquid mosquito-repellent vaporisers are effective modes of pyrethroid delivery but can also pose significant health risks if ingested or used improperly. OBJECTIVE: This systematic review was performed to assess the demographic distribution, clinical presentation, management strategies and outcomes in children resulting from accidental ingestion of liquid mosquito repellent vaporiser. METHODS: The study adheres to the reporting standards outlined in the PRISMA Statement for Systematic Reviews and was prospectively registered with PROSPERO (record # CRD42023413937) to enhance transparency and minimise reporting bias. A comprehensive search was conducted on PubMed, Scopus and Google Scholar using specific MeSH terms related to insecticides, mosquito repellents, pyrethroids, ingestion, poisoning, toxicity and prevention. The reference lists of the included studies were also reviewed for additional relevant articles. The inclusion criteria involved studies published in peer-reviewed journals between 2000 and 2023 that focused on children under 18 years old with a history of mosquito-repellent ingestion based on primary data. RESULTS: Twelve studies met the inclusion criteria; these were primarily case reports from India, China and the UAE. Male children were predominantly affected, and symptoms included vomiting, convulsions, cough and respiratory distress. Management primarily involved supportive and symptomatic measures, including atropine for salivation and antiepileptic drugs for seizures. Respiratory support was provided for respiratory complications. CONCLUSION: Despite the known risks and diverse presentations of pyrethroid poisoning caused by liquid mosquito repellent vaporiser in children, the limited substantial evidence in the literature underscores the urgent need for comprehensive research to refine management approaches and enhance preventive measures.
Assuntos
Repelentes de Insetos , Humanos , Repelentes de Insetos/intoxicação , Repelentes de Insetos/administração & dosagem , Repelentes de Insetos/efeitos adversos , Criança , Nebulizadores e Vaporizadores , Piretrinas/intoxicação , Piretrinas/efeitos adversos , Pré-Escolar , LactenteRESUMO
BACKGROUND: Pica is a poorly understood psychiatric disorder that presents with the ingestion of non-nutritious substances for unclear reasons. A high index of suspicion for unusual toxin exposure aids in the diagnosis of pica patients presenting with unexplained neurodegenerative features. METHODS: We present a 47-year-old female with worsening gait over the past year. Prior to this, she was fully independent with activities of daily living, but is now mostly housebound due to frequent falls. Past medical history is significant for menorrhagia, iron deficiency anemia and pica. CBC and iron studies revealed iron deficiency with microcytic hypochromic anemia. MRI brain demonstrated symmetrical T2 hyperintensities within the middle cerebellar peduncles. RESULTS: Differential diagnoses for her clinical deficits and imaging, including Spinocerebellar Ataxia, Multiple System Atrophy and Fragile X Tremor-Ataxia Syndrome, were excluded based on neurological assessment, family history and genetic PCR testing. Collateral history revealed a regular habit of mothball ingestion and serum paradichlorobenzene levels were elevated to 15mcg/mL. The patient was treated with iron replacement therapy and her symptoms gradually improved over several months. CONCLUSION: Iron deficiency anemia is commonly associated with pica, which can lead to toxin ingestion. A high index of suspicion for toxin ingestion in pica patients can immensely aid in the diagnosis. Mothball abuse secondary to pica may affect the CNS and can present with nonspecific neurodegenerative changes. To our knowledge, there have been no reported cases in the literature with paradichlorobenzene neurotoxicity predominantly affecting the middle cerebellar peduncles.
Assuntos
Clorobenzenos/toxicidade , Repelentes de Insetos/intoxicação , Síndromes Neurotóxicas/diagnóstico , Pica/complicações , Anemia Ferropriva/etiologia , Clorobenzenos/sangue , Clorobenzenos/intoxicação , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagemRESUMO
N, N-diethyl-meta-toluamide (DEET) is an insect repellent currently used by millions of people since 1956. DEET has an excellent safety profile and has remarkable protection against mosquitoes, ticks and various other arthropods. Toxicity is unusual, and is generally associated with incorrect, or overuse of the product. We report a patient with severe toxicity following inhalational exposure to a "bug bomb". containing 98% DEET.
Assuntos
DEET/intoxicação , Exposição por Inalação/efeitos adversos , Repelentes de Insetos/intoxicação , Idoso , Humanos , MasculinoRESUMO
In the United States, there is limited literature on occupational pesticide exposures despite being associated with adverse health outcomes, including in large states such as Texas. The purpose of this article is to characterize occupational pesticide poison center exposures in Texas. Descriptive statistics were used to describe exposures (eg, exposure routes, type of pesticide, medical outcome, clinical effects, and temporal/seasonal patterns). From 2000 to 2015, there were 2,303 occupational pesticide poison center exposures. Common types of reported pesticides were insecticides (67.3%), herbicides (17.7%), and repellents (5.8%). The highest proportion of exposures were among those aged 20 to 29 years (24.9%). The top clinical effect categories were gastrointestinal (25.8%), neurological (19.2%), and dermal (14.9%). Characterizing occupational pesticide poison center exposures can support improved surveillance systems and guide future research or interventions.
Assuntos
Exposição Ocupacional/estatística & dados numéricos , Praguicidas/intoxicação , Centros de Controle de Intoxicações/estatística & dados numéricos , Intoxicação/epidemiologia , Fatores Etários , Herbicidas/intoxicação , Repelentes de Insetos/intoxicação , Inseticidas/intoxicação , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/classificação , Intoxicação/etiologia , Texas/epidemiologiaRESUMO
INTRODUCTION: Unintentional mothball ingestions may cause serious toxicity in small children. Camphor, naphthalene, and paradichlorobenzene mothballs are difficult to distinguish without packaging. Symptoms and management differ based on the ingested compound. Previous studies have used a variety of antiquated, impractical and potentially dangerous techniques to identify the mothballs. The goal of this study is to discover a simplified identification technique using materials readily available in an emergency department. METHODS: Mothballs made of naphthalene and paradichlorobenzene along with camphor tablets were tested. Each material was tested both intact and after being fragmented to simulate a partially ingested mothball. Each of these six sample types were then immersed in 40 ml each of 11 fluids: water, 0.45% NaCl, 0.9% NaCl, lactated Ringer's, 5% dextrose in water, 5% dextrose in 0.9% NaCl, 50% dextrose in water, 8.4% NaHCO3, 3% H2O2, 70% isopropanol, and 91% isopropanol. All tests were conducted in standard urinalysis sample cups to replicate available materials. Three toxicologists blinded to the identities of samples and solutions visually evaluated each sample. Observations included assessing response to immersion: sink, float, or dissolve. RESULTS: All evaluators agreed in their description of 62/66 (94%) of the samples, with all four disagreements being on sinking and dissolving versus sinking only. A two-fluid algorithm utilizing 50% dextrose and water was sufficient to distinguish the sample types. Camphor will float in water while both paradichlorobenzene and naphthalene will sink. In 50% dextrose, both naphthalene and camphor will float while paradichlorobenzene will sink. CONCLUSION: Mothball materials can be distinguished by immersion in water and 50% dextrose. Limitations of this study include using camphor tablets as a substitute for mothballs given lack of availability.
Assuntos
Algoritmos , Cânfora/análise , Clorobenzenos/análise , Glucose/química , Repelentes de Insetos/análise , Mariposas , Naftalenos/análise , Água/química , Animais , Cânfora/intoxicação , Clorobenzenos/intoxicação , Liberação Controlada de Fármacos , Repelentes de Insetos/intoxicação , Naftalenos/intoxicação , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Solubilidade , Gravidade Específica , ComprimidosRESUMO
We report a case who presented with dark brown urine and malaise after mothballs powder ingestion.
Assuntos
Cor , Hemoglobinúria/urina , Hemólise/efeitos dos fármacos , Repelentes de Insetos/intoxicação , Naftalenos/intoxicação , Intoxicação/urina , Tentativa de Suicídio , Urina/química , Hidratação , Hemoglobinúria/induzido quimicamente , Hemoglobinúria/diagnóstico , Hemoglobinúria/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação/diagnóstico , Intoxicação/etiologia , Intoxicação/terapia , Pós , Resultado do Tratamento , UrináliseRESUMO
We report a case of necrosis caused by the use of prallethrin (mosquito repellent) on the skin in a 67-year-old diabetic female patient suffering from delusions of parasitosis. Cutaneous toxicity due to pyrethroids is less known or reported, despite well-documented pyrethroid poisoning involving the gastrointestinal, respiratory, cardiac, and nervous systems. Skin irritation has been described after acute accidental exposure but, as far as we know, no data have been published on the effects of pyrethroids when applied directly to the skin.
Assuntos
Repelentes de Insetos/intoxicação , Inseticidas/intoxicação , Necrose/induzido quimicamente , Pele/patologia , Idoso , Feminino , Humanos , Piretrinas , Pele/efeitos dos fármacosAssuntos
Antibacterianos/administração & dosagem , Ciclopropanos/intoxicação , Fluorbenzenos/intoxicação , Síndromes Neurotóxicas , Pneumonia Aspirativa , Hidratação/métodos , Humanos , Lactente , Repelentes de Insetos/intoxicação , Masculino , Síndromes Neurotóxicas/complicações , Síndromes Neurotóxicas/diagnóstico , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/fisiopatologia , Síndromes Neurotóxicas/terapia , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/fisiopatologia , Resultado do TratamentoRESUMO
A 37-year-old male with prior medical history of profound developmental delay experienced seizure and cardiac arrest following ingestion of 6 ounces of a 40% N, N-diethyl-meta-toluamide (DEET) containing solution. The patient was unresponsive, acidemic, tachycardic and hypotensive on presentation. Over three hospital days, the patient's vitals recovered to baseline but he remained unresponsive and areflexic with fixed and dilated pupils. Non-contrast brain magnetic resonance imaging showed cerebral edema, transtentorial and tonsillar herniations. A rapid, simple and sensitive high-performance liquid chromatography (HPLC) method was utilized for the analysis of postmortem plasma blood and urine samples of a lethal case of DEET intentional ingestion. The method combined the use of C18 SepPak cartridges for solid phase extraction and reversed-phase HPLC. One urine and five blood samples from this patient were analyzed for DEET concentration. Mixtures of serum/urine postcentrifuge were eluted and reduced to 1 mL using a solvent evaporator. Blood in ethylenediaminetetraacetic acid (EDTA), whole blood, serum, blood with heparin and urine DEET concentrations were 9.84, 9.21, 10.18, 8.66dl and 0.642 mg/dL, respectively. All samples were collected <1 h postingestion. Although seizures and cardiac toxicity have been described in other case reports, this case is atypical due to the exceptional dose ingested and the timing of the fluid test samples being drawn so soon following exposure. Although a widely used and extremely safe insect repellent, DEET can be highly toxic in large but easily obtainable doses.
Assuntos
DEET/intoxicação , Repelentes de Insetos/intoxicação , Adulto , Cromatografia Líquida de Alta Pressão , DEET/urina , Relação Dose-Resposta a Droga , Ácido Edético/urina , Evolução Fatal , Heparina/sangue , Humanos , Repelentes de Insetos/urina , Masculino , Extração em Fase SólidaRESUMO
A 35-year-old female was referred to our hospital with bilateral loss of vision of two days duration. She gave history of consumption of about 150 ml of neem oil five days back.Examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. Her fundus examination showed bilateral hyperemic, edematous discs and also edema extending along the superior and inferior temporal vascular arcade. Magnetic resonance imaging (MRI) scan showed bilateral putaminal regions with altered signal, hypointensities in T1-weighted images, hyperintensities on T2-weighted, images and hyperintense on Fluid Attenuation Inversion Recovery (FLAIR) images suggestive of cytotoxic edema due to tissue hypoxia. Her vision improved to 20/200 in both eyes with treatment after two months. This is the first case report of such nature in the literature to the best of our knowledge.
Assuntos
Glicerídeos/intoxicação , Disco Óptico/patologia , Neurite Óptica/induzido quimicamente , Terpenos/intoxicação , Adulto , Encéfalo/patologia , Deglutição , Feminino , Seguimentos , Humanos , Repelentes de Insetos/intoxicação , Imageamento por Ressonância Magnética , Disco Óptico/efeitos dos fármacos , Neurite Óptica/diagnóstico , Neurite Óptica/fisiopatologia , Acuidade VisualRESUMO
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.
Assuntos
Exposição Ambiental/efeitos adversos , Repelentes de Insetos/intoxicação , Praguicidas/intoxicação , Agricultura , Carbaril/intoxicação , DEET/intoxicação , Humanos , Lactente , Masculino , PrunusRESUMO
Hemolytic anemia and methemoglobinemia are well-known adverse effects that follow ingestion of naphthalene mothballs. They are only rarely reported in association with ingestion of paradichlorobenzene mothballs. An asymptomatic boy presented to our pediatric emergency department after ingesting paradichlorobenzene mothballs. Three daysafter the ingestion, the boy returned with hemolysis and mild methemoglobinemia.
Assuntos
Anemia Hemolítica/induzido quimicamente , Clorobenzenos/intoxicação , Repelentes de Insetos/intoxicação , Metemoglobinemia/induzido quimicamente , Anemia Hemolítica/etiologia , Anemia Hemolítica/terapia , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Emergências , Transfusão de Eritrócitos , Predisposição Genética para Doença , Humanos , Lactente , Obstrução Intestinal/etiologia , Masculino , Metemoglobinemia/etiologia , Metemoglobinemia/terapia , Naftalenos , Intoxicação/terapia , Traço Falciforme/complicaçõesAssuntos
Doença de Depósito de Glicogênio Tipo I/induzido quimicamente , Repelentes de Insetos/intoxicação , Naftalenos/intoxicação , Criança , Pré-Escolar , Qualidade de Produtos para o Consumidor , Doença de Depósito de Glicogênio Tipo I/epidemiologia , Hemólise , Humanos , Singapura/epidemiologiaAssuntos
Clorobenzenos/intoxicação , Doenças em Gêmeos , Toxidermias/etiologia , Repelentes de Insetos/intoxicação , Síndromes Neurotóxicas/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Feminino , Humanos , Ictiose/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/diagnósticoRESUMO
PURPOSE OF REVIEW: In many United States households, there are many substances used to control the exposure of our children to mosquitoes, mice and rats. This review provides information on common mosquito repellents and rodenticides used in households and discusses their toxicity, in order to help pediatricians better advise their patients of their proper use. RECENT FINDINGS: A recent study has demonstrated that many continue to have practices of applying DEET (N,N-diethyl-3-methylbenzamide) based repellents that may lead to undesirable effects. Picaridin and oil of lemon eucalyptus are two products that have recently been shown to have an efficacy similar to that of DEET-based repellents. Studies within the last five years show that most unintentional superwarfarin ingestions can be managed at home with close outpatient follow-up. There does not appear to be a benefit of prophylactic vitamin K or gastrointestinal decontamination in patients with relatively small ingestions of superwarfarins. SUMMARY: With education and correct usage, mosquito repellents and the superwarfarin rodenticides can help protect children from significant vector-borne diseases. Not all exposures lead to significant morbidity or mortality. With recognition of the current literature, most of these exposures can be managed safely at home or as an outpatient, ultimately saving healthcare costs.
Assuntos
4-Hidroxicumarinas/intoxicação , DEET/intoxicação , Repelentes de Insetos/intoxicação , Rodenticidas/intoxicação , Criança , DEET/administração & dosagem , Eucalyptus , Humanos , Fitoterapia , Piperidinas/uso terapêuticoRESUMO
This is a case report of central nervous system toxicity associated with paradichlorobenzene (PDCB) ingestion. The patient had ingested mothballs composed of 99.99% PDCB for a period of 7 months. She was admitted for depression and had no neurologic symptoms. Later she developed an acute cerebellar syndrome followed by stupor and coma. An extensive workup was negative except for decreasing levels of PDCB in her serum. Imaging revealed a diffuse leukoencephalopathy. Her clinical picture was attributed to PDCB toxicity.