Abnormal neuronal migration, deranged cerebral cortical organization, and diffuse white matter astrocytosis of human fetal brain: a major effect of methylmercury poisoning in utero.

Detailed clinical and neuropathological studies have been made in two fullterm newborn human infants who were exposed to methylmercury in utero as a result of maternal ingestion of methylmercury-contaminated bread in early phases of pregnancy. High levels of mercury were detected in various regions of the brain at autopsy. Study of the brains revealed a disturbance in the development in both cases, consisting essentially of an incomplete or abnormal migration of neurons to the cerebellar and cerebral cortices, and deranged cortical organization of the cerebrum. There were numerous heterotopic neurons, both isolated and in groups, in the white matter of cerebrum and cerebellum and the laminar cortical pattern of the laminar cortical pattern of the cerebrum was disturbed in many regions as was shown by the irregular groupings and the deranged alignment of cortical. Prominent in the white matter of the cerebrum and the cerebellum was diffuse gemistocytic astrocytosis accompanied by an accumulation of mercury grains in their cytoplasm. These findings indicate a high degree of vulnerability of human fetal brain to maternal intoxication by methylmercury. A major effect appears to be related to faulty development and not to destructive focal neuronal damage as has been observed in mercury intoxicaiton in adults and children exposed postnatally.

Fetal methylmercury poisoning. Relationship between concentration in single strands of maternal hair and child effects.

Pregnant women consumed bread that was prepared from methylmercury-treated wheat. Single strands of maternal head hair were analyzed by x-ray fluorescence spectrometry. The index of fetal exposure was the maximum hair mercury concentration during gestation. Effects were measured by the frequency of psychomotor retardation, seizures, and neurological signs in the children. A dose-response relationship was demonstrated for fetal effects of methylmercury. Analysis of single hair strands provides a better index of acute or subacute fetal exposure than analysis of bundles of hair; the duration and degree of exposure are more accurately defined. A sex difference in response is discussed.

Evidence for a neuromuscular disorder in methylmercury poisoning.

Data suggestive of a neuromuscular disorder responsive to neostigmine was uncovered in the course of electrophysiological testing of Iraqi patients poisoned by methylmercury. Subsequent neostigmine therapy produced a remarkable clinical improvement of the patients. Placebo substitution resulted in a substantial loss of testable strength that was restored when drug therapy was resumed.

Glucose-6-phosphate dehydrogenase deficiency among ethnic groups in Iraq.

A total of 889 cord blood samples collected from newborn infants of both sexes and 563 samples of venous blood collected from adult males in Iraq were examined for evidence of glucose-6-phosphate dehydrogenase (G6PD) deficiency. The deficiency was proved to exist in all ethnic groups in Iraq and in both adult males and infants. The overall incidence of the deficiency was 8.9% in the adults and 8.4% in the infants. The difference is not statistically significant. Evidence is given to suggest that favism ("khsaissa") is known to the people of southern Iraq.

Methylmercury poisoning in Iraqi children: clinical observations over two years.

The clinical features of 49 children who had eaten bread contaminated with methylmercury in rural Iraq were reviewed. Symptoms and signs relating to the nervous system--varying degrees of ataxia, weakness, and visual and sensory changes--dominated the clinical picture. The severity of poisoning was related to the blood mercury concentration, as was the degree of recovery. Follow-up over two years showed that children who had had mild or moderate poisoning slowly but steadily improved, some of them recovering normal function, though all had a residual generalized hyperreflexia. In some patients ataxia and motor weakness disappeared. Visual changes also improved, though less completely, and of 17 blind children, only five had recovered partial sight by the end of two years. Seven of the 18 children who suffered very severe poisoning were left physically and mentally incapacitated. The degree of clinical progress shown by these children was better than that shown by some other groups of patients, possibly because the poisoning was relatively acute and mercury consumption was stopped immediately after its effects had become obvious.

An outbreak of methylmercury poisoning due to consumption of contaminated grain.

An outbreak of methylmercury poisoning took place in the fall and winter of 1971-72 in Iraq. Six thousand five hundred and thirty cases were admitted to hospitals throughout the country and 459 died in hospital. The outbreak was the result of eating homemade bread prepared from wheat treated with a methylmercury fungicide. The wheat was intended for planting purposes only. Signs and symptoms of poisonings in adults indicate that the major site of action of this form of mercury is the central nervous system. Severe brain damage also resulted from prenatal exposure when the mother ingested large amounts of the contaminated bread. The frequency of signs and symptoms in an exposed population was found to be related to the estimated maximum blood levels, i.e., the concentration in blood at the end of exposure. A small percentage of the population exhibited a significant increase in complaints of paresthesia at maximum blood levels in the range of 240 to 480 ng Hg/ml. At higher blood levels a greater proportion of the population complained of paresthesia and other signs and symptoms became apparent.

Fetal methylmercury poisoning: clinical and toxicological data on 29 cases.

This report describes psychomotor retardation in infants caused by prenatal exposure to methylmercury. A study of 29 mother-infant pairs established a relationship between maximum maternal hair mercury concentration during pregnancy and the frequency of neurological effects in the infants. The latter included delayed achievement of developmental milestones with or without neurological signs. The infants were 4 1/2 to 5 years of age on last examination. Ten infants of mothers who had maximum hair concentrations in the range of 99 to 384 pars per million (ppm) had a significantly higher frequency of abnormal findings than those in two groups having lower maternal hair mercury concentrations (12 to 85 and 0 to 11 ppm). The group sizes were too small to allow identification of a specific "threshold" maternal hair concentration above which such effects can be expected. Transient paresthesias during pregnancy occurred in 80% of the mothers in the higher concentration group (99 to 384 ppm) as compared with 30% and 22% in the lower groups. Neurological abnormalities were found in some children whose mothers had been asymptomatic during pregnancy.

Methylmercury poisoning in the Iraqi suckling infant: a longitudinal study over five years.

In a five-year longitudinal study of mothers and infants exposed to methylmercury during the Iraq epidemic of 1972, the frequencies of signs and symptoms exhibited by the mothers were typical of methylmercury poisoning. When blood concentrations of mercury are corrected to 1 March 1972, mothers with the most severe signs and symptoms had an average blood mercury concentration significantly higher (p less than 0.01) than either the milder or asymptomatic groups. Analytical data indicate that the predominant route of exposure for the infant was through breast milk in which approximately 60% of total mercury was determined, by cold vapor atomic absorption, to be organic mercury. Abnormal neurological signs in these infants became more obvious with time: hyperreflexia was observed in 8 of 22 infants at first examination, and in 17 of 22 at second examination. Delayed motor development became evident at the second and third examinations. The frequency of pathological reflexes and delayed motor developmental milestones was so high as to be considered significant even in the absence of a controlled study. There was no increase in mortality as compared to a control group.

Prenatal methylmercury poisoning. Clinical observations over five years.

Thirty-two infants prenatally exposed to methylmercury and their mothers were examined over a five-year period after the Iraqi methylmercury epidemic. Severity of poisoning in mothers was related to the peak mercury concentration in their hair and in the infants to the maximum concentration in maternal hair during pregnancy. In nine cases of cerebral palsy, methylmercury exposure occurred only during the last trimester. All infants except three (two were orphaned soon after birth and one was bottle-fed) were exposed postnatally via suckling. Whereas the mother's symptoms usually improved, the damage to the fetal nervous system appears to be permanent. Milder cases previously not identified in other studies are reported. The syndrome consists of varying degrees of developmental retardation in addition to exaggerated tendon reflexes and the pathologic extensor plantar reflex (minimal brain damage syndrome).

Dose-response analysis of infants prenatally exposed to methyl mercury: an application of a single compartment model to single-strand hair analysis.

A new method of estimating fetal exposure is used in a dose-response analysis of data from the 1971 outbreak of methyl mercury poisoning in rural Iraq. An X-ray fluorescence instrument for the measurement of single strands of human hair was employed to obtain longitudinal profiles recapitulating fetal exposure. Logit and hockey-stick models as well as nonparametric smoothing are used to describe data on delayed development and central nervous system abnormality.

Exchange transfusion treatment of methylmercury-poisoned children.

Three children, ages 6 months, 13 months and 10 years were treated by exchange transfusions following exposure to methylmercury in the Iraq outbreak in 1971-72. Two had severe signs of poisoning and the other was clinically normal but had a high blood mercury concentration. Exchange transfusion resulted in clearance of mercury not only from blood but also from other tissues. The average amount of mercury removed in a two hour exchange was estimated as 6% of the body burden as compared to 1% of the body burden removed by normal excretion processes in 24 hours. No dramatic improvement in the clinical condition of the two poisoned patients occurred. Some improvement in motor power and function was observed during follow-up visits to their houses.

Dose-response relationship for human fetal exposure to methylmercury.

Eighty-four Iraqi mothers and their infants had been exposed to methylmercury during pregnancy. The methylmercury had been ingested as a fungicide. Peak maternal hair mercury concentrations were related to the frequency of maternal symptoms during pregnancy and to neurological effects in the infants. These include various degrees of psychomotor retardation. Severe neurological deficits were observed in five children whose maternal peak hair mercury concentrations were 165 to 320 ppm. Minimal symptoms were reported for mothers and children when peak maternal hair levels were below 68 ppm. Minimal clinical neurological signs occurred in children when peak maternal hair mercury concentrations were at an undetermined point between 68 and 180 ppm. Greater fetal risk appears to be associated with exposure during the second trimester. This exposure to methylmercury was acute and the results may not be extrapolated to a constant level of exposure throughout pregnancy. The effects of fetal exposure to methylmercury in marine fish may differ.

Tests of efficacy of antidotes for removal of methylmercury in human poisoning during the Iraq outbreak.

Three complexing agents and a thiolated resin were tested for their ability to reduce the T 1/2 of methylmercury in blood during an outbreak of human poisoning. The slope of the line relating the natural logarithm of the blood concentration to time during treatment was calculated by a parametric (linear regression) and a nonparametric (two-point) method. The mean slope for each treatment group was calculated and the T 1/2 was calculated from the mean slope. Both the linear regression and two-point methods yield similar mean values. The "two-point" T 1/2 will be quoted here. The mean T 1/2 in six patients receiving no specific treatment was 65 days and in 10 patients receiving placebo was 61 days, and these values did not differ from those reported in the literature. All four treatments significantly reduced the mean T 1/2 values below the mean for the combined placebo and no treatment groups. Sodium 2,3-dimercaptopropane-1-sulfonate was the most effective agent, reducing the mean T 1/2 in 10 patients to 10 days. The thiolated resin given to eight patients produced a mean T 1/2 of 20 days. The penicillamines also produced a significant reduction in T 1/2 values; the mean T 1/2 for D-penicillamine in 12 patients was 26 days and N-acetyl-DL-penicillamine in 17 patients yielded a mean T 1/2 of 24 days. This is the first report of the effects of sodium 2,3-dimercaptopropane-1-sulfonate and resin in human subjects exposed to methylmercury. No adverse effects were observed in any of the treatment groups. A clinical trial was not possible but it is concluded that agents that reduce blood levels and accelerate excretion are probably clinically useful if given before irreversible damage has occurred.

Perinatal methylmercury poisoning in Iraq.

The signs and symptoms of methylmercury poisoning and the concentrations of mercury in samples of blood, hair, and milk are reported and compared in two infant-mother pairs exposed in the recent Iraq outbreak. In one pair, the infant was born prior to the exposure of the mother, and was exposed only from ingestion of methylmercury in mother's milk. In the other pair, the mother was exposed during pregnancy and did not breast feed the infant, who died 30 days after birth. Both mothers had some signs and symptoms of poisoning, but the infants did not. The infants had maximum estimated blood mercury levels between 500 and 1,000 ng/ml, well above the minimum toxic levels for adults. Hair and blood concentrations of mercury correlated closely, the average hair-blood ratio being about 250. Maternal milk averaged 8.6% of the simultaneous blood level, but the relationship was nonlinear at blood mercury levels below 50 ng/ml. Postnatal exposure by suckling led to substantial infant blood mercury concentration (over 600 ng/ml), and prenatal exposure resulted in blood mercury levels in the infant at birth higher than those in the mother, even after corrections for differences in hematocrit level.