Plants and zootoxins: Toxico-epidemiological investigation in domestic animals.

An epidemiological study on animal poisoning due to plants and zootoxins has been carried out by the Poison Control Centre of Milan (CAV) in collaboration with the University of Milan (Italy). During the period January 2015-March 2019, the CAV received 932 calls on animal poisonings, 12.66% (n = 118) of which were related to plants and zootoxins. Among these, 95 enquiries (80.51%) concerned exposures to plants and 23 (19.49%) to zootoxins. The dog was the species most frequently involved (67.80% of the calls, n = 80), followed by the cat (26.27%, n = 31). As for the plants, several poisoning episodes were related to glycoside-, alkaloid-, oxalate- and diterpenoid-containing species. Cycas revoluta, Euphorbia pulcherrima and Hydrangea macrophylla were the most often reported plants. The outcome has been reported for half of the episodes (51.58%, n = 49) and it was fatal for 3 animals (6.12%). Regarding the zootoxins, the majority of the enquiries were related to asp viper (Vipera aspis), but exposures to pine processionary moth (Thaumetopoea pityocampa), common toad (Bufo), fire salamander (Salamandra), and jellyfish (phylum Cnidaria) were also reported. The outcome was known in 65.22% of the cases with just one fatal episode. This epidemiological investigation depicts an interesting overview on the issue of plant and zootoxin exposures in domestic animals, highlighting the relevance of these agents as causes of animal poisoning and providing useful information for prevention and diagnosis.

Suspected environmental poisoning by drugs, household products and pesticides in domestic animals.

Animal poisoning by chemicals (pesticides and household products) and drugs is a frequent occurrence and special attention should be paid to this phenomenon to improve prevention and treatment strategies and because of the fundamental role that animals may play as bioindicators. From January 2017 to March 2019 the Poison Control Centre of Milan (CAV) in collaboration with the University of Milan, collected and analyzed epidemiological data on animal poisoning. During this period, the CAV received a total of 442 enquiries on domestic animal poisoning episodes and, among these, 80.3 % were related to chemicals and drugs. Pesticides and drugs were the two major causes of poisoning (34.1 % and 33.5 %, respectively), followed by household products (29.3 %) and other causative agents (3.1 %, n = 11). In conclusion, these findings can provide useful information for the identification and monitoring of known and emerging toxicants, with positive repercussions on human, animal and environmental health.

A Case Report of Accidental Intoxication following Ingestion of Foxglove Confused with Borage: High Digoxinemia without Major Complications.

Foxglove (Digitalis purpurea L.) leaves are frequently confused with borage (Borago officinalis L.), which is traditionally used as a food ingredient. Due to the presence of the cardiac glycosides, mostly digitoxin, foxglove leaves are poisonous to human and may be fatal if ingested. A 55-year-old Caucasian woman complaining weakness, fatigue, nausea, and vomiting was admitted to the Emergency Department. Her symptoms started following consumption of a home-made savory pie with 5 leaves from a plant bought in a garden nursery as borage. Digoxinemia was high (10.4 µg/L). The patient was admitted to the cardiac intensive care unit for electrocardiographic monitoring. Two days after admission, a single episode of advanced atrioventricular (AV) block was recorded by telemetry, followed by a second-degree AV block episode. Plasma samples at day 11 were analysed by LC-MS spectrometry, and gitoxin was identified suggesting that this compound may be responsible for the clinical toxicity rather than digoxin. In the case of Digitalis spp. poisoning, laboratory data should be interpreted according to the clinical picture and method of analysis used since a variety of glycosides, which are chemically similar to the cardioactive glycosides but without or with fewer cardiac effects, may be incorrectly recognized as digoxin by the test, giving misleading results.

Surveillance of paediatric exposures to liquid laundry detergent pods in Italy.

OBJECTIVE: To analyse paediatric exposures to pod and traditional laundry detergents in Italy and changes in exposure trends. METHODS: Analyses of a series of patients aged <5 years and exposed to laundry detergents between September 2010 and June 2015, identified by the National Poison Control in Milan. RESULTS: In comparison with patients exposed to traditional laundry detergents (n=1150), a higher proportion of those exposed to pods (n=1649) were managed in hospital (68% vs 42%), had clinical effects (75% vs 22%) and moderate/high severity outcomes (13% vs <1%). Exposure rates were stable over time for traditional detergents (average 0.65 cases/day), but an abrupt decline in major company pods was seen in December 2012, 4 months after the introduction of opaque outer packaging (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/million units sold). The odds of clinical effects was higher for exposure to pods than for traditional detergents (OR=10.8; 95% CI 9.0 to 12.9). Among patients exposed to pods, the odds of moderate/high severity outcomes was four times higher for children aged <1 years than for the other age groups (OR=3.9; 95% CI 2.2 to 7.0). Ten children exposed to laundry detergent pods had high severity outcomes while no children exposed to traditional laundry detergents developed high severity effects. CONCLUSIONS: The study confirms that exposure to laundry detergent pods is more dangerous than exposure to traditional detergents. In Italy, 4 months after the introduction of opaque outer packaging by a major company, product-specific exposure rates decreased sharply, suggesting that reducing visibility of laundry detergent pods may be an effective preventive measure. Further efforts are needed to improve safety.

Development of a new categorization system for pesticides exposure to support harmonized reporting between EU Member States.

OBJECTIVES: European legislation requires reporting from Member States on acute poisoning incidents involving pesticides. However, standard rules for data collection and reporting have not yet been set out. The new categorization system presented in this paper is aimed at enabling Member States to gather comparable data and provide standard reporting on pesticide poisoning exposures. MATERIALS AND METHODS: European Regulations providing separate official categorization of biocidal and plant protection pesticides, were used as a basis to build up a unified pesticide categorization and coding system. Data on selected pesticide exposures collected by Poison Control Centres in six EU countries were reviewed, categorized and reported according to the proposed system. RESULTS: The resulting pesticide categorization system has two dimensions. The first part identifies the main category of use, i.e. biocide/plant protection pesticide/unknown, and the secondary category of use, e.g. Rodenticides, Insecticides and acaricides. The second part of the system is organized into two levels: level one identifies chemical grouping, e.g. Coumarins, Pyrethrins/pyrethroids, while level two identifies the active compound by using its Chemical Abstract Service Registry Number. The system was used to provide a unified categorization to compare exposures to plant protection and biocidal Rodenticides and Pyrethrins/pyrethroids Insecticides and acaricides identified by six EU member states. CONCLUSION: The developed pesticide categorization system was successfully applied to data extracted from different databases and was able to make the required information comparable. The data reported filling in common templates containing a pre-ordinate list of active compounds categorized according the proposed system, highlighted different capabilities in data collection and recording, showing that some of the collaborating centres were not able to distinguish between main categories of pesticide products or provide information on active compounds. The results indicate that a special effort should be dedicated to support detailed data recording at national level. Providing common tools to systematically report to the EU Commission hazardous exposures to pesticides, as well as to other selected categories of products, could allow for data comparability between Member States and greatly improve post marketing surveillance and alerting systems in Europe.

Suspected poisoning of domestic animals by pesticides.

A retrospective study was carried out by reviewing all suspected cases of domestic animal poisoning attributed to pesticides, reported to the Milan Poison Control Centre (MPCC) between January 2011 and December 2013. During this period, pesticides were found to be responsible for 37.3% of all suspected poisoning enquiries received (815). The most commonly species involved was the dog (71.1% of calls) followed by the cat (15.8%), while a limited number of cases involved horses, goats and sheep. Most cases of exposure (47.1%) resulted in mild to moderate clinical signs. The outcome was reported in 59.9% of these cases, with death occurring in 10.4% of them. Insecticides (40.8%) proved to be the most common group of pesticides involved and exposure to pyrethrins-pyrethroids accounted for the majority of calls. According to the MPCC data, there has been a decrease in the number of suspected poisonings cases attributed to pesticides that have been banned by the EU, including aldicarb, carbofuran, endosulfan and paraquat. In contrast, there has been an increase of suspected poisoning cases attributed to the neonicotinoids, imidacloprid and acetamiprid, probably due to their widespread use in recent years. Cases of suspected poisoning that involved exposure to rodenticides accounted for 27.6% of calls received by the MPCC and anticoagulant rodenticides were the primary cause of calls, with many cases involving brodifacoum and bromadiolone. Herbicides were involved in 14.2% of calls related to pesticides and glyphosate was the main culprit in cases involving dogs, cats, horses, goats and sheep. As far as exposure to molluscicides (11.5%) and fungicides (5.9%), most of the cases involved dogs and the suspected poisoning agents were metaldehyde and copper compounds respectively. The data collected are useful in determining trends in poisoning episodes and identifying newly emerging toxicants, thus demonstrating the prevalence of pesticides as causative agents in animal poisonings.

[A rare case of acute renal failure related to amanita proxima ingestion]. / Nefropatia tubulo-interstiziale acuta da amanita proxima.

OBJECTIVE: The first cases of acute renal tubulopathy related to Amanita proxima poisoning were described in 1994; the mushroom contains a toxin responsible for the allenic-norleucine syndrome, characterised by a kidney damage that occur earlier than in Cortinarius orellanus poisoning and generally improve with complete resolution within ten days. CASE REPORT: A 45 years old woman was admitted to the hospital because of nausea, vomiting, and heartburn started the day before. Symptoms occurred eight hours after eating a single big wild mushroom; three friends who had the same meal were all asymptomatic. Twelve hours after the admission the woman became anuric and blood tests showed an impaired renal function: creatinine 13 mg/dL urea 240 mg/dL, AST 240 U / L, ALT 350 U / l. The patient was transferred to the nephrology unit of the Hospital Di Venere of Bari and the PCC of Milan was consulted. The toxicologist supposed a nephrotoxic syndrome caused by the consumption of Amanita proxima and sent a picture of the mushroom ingested to a mycologist who identified the specie as Amanita proxima Dumé, Bull (typical volva reddish-orange, ivory white hat, scaly stalk) sometimes mistaken for Amanita ovoidea. Haemodialysis was performed for five days followed by supportive care. Urine output gradually increased, serum creatinine decreased and Ast - Alt normalized. CONCLUSIONS: Amanita proxima contains an allenic-norleucine toxin (different from orellanine for the absence of inhibition of alkaline phosphatase), responsible for the reversible kidney damage, characterised by tubulointerstitial nephritis with acute tubular necrosis and renal failure. Occurrence and seriousness of symptoms seem to be variable and dependent on the amount ingested.

Inadvertent oral administration of methylergometrine maleate to children in the first months of life: from surveillance to prevention.

PURPOSE: Methylergometrine maleate is an ergot alkaloid frequently used in obstetrics for prevention and treatment of post partum haemorrhage. Accidental administration of this medicine to newborns can cause severe effects and should be carefully prevented. The present paper is aimed at describing the main characteristics of cases accidentally exposed to this medicine in Italy before and after Novartis, the manufacturer of Methergin®, a widely used methylergometrine maleate-containing gynecological medication, decided to withdraw the drop preparation from the European market. METHODS: The study design is a case-series study. The database of the National Poison Control Centre of Milan was searched retrospectively (from 1 January 2005 to 31 December 2011) and prospectively (from 1 January 2012 to 31 December 2013) in order to provide a descriptive analysis of the main characteristics of cases unintentionally exposed to methylergometrine maleate and to document the impact of Novartis' decision. RESULTS: In the first period under study (2005-2011), a total of 642 cases of exposure to methylergometrine maleate were identified. Most of them were children aged <1 year (No. 483, 75%). Patients aged 1-2 and 3-5 years accounted for 13% (No. 85) and 9% (No. 56) of cases, respectively. Among children aged <1 year, about 76% (No. 368) were exposed during the first month of life, including 44% (No. 211) of cases exposed in the first week of life. The main cause of exposure was medication error (No. 432, 89%), mainly due to oral administration of methyltergometrine maleate in place of a paediatric preparation (No. 469, 97%). About 14% of these cases suffered clinical effects as a consequence of the exposure. Severity of poisoning was minor in 45 cases, moderate in 12, and severe in one case. The main cause of exposure among children aged 1-2 and 3-5 years was uncontrolled access to the medicine, accounting for 78% (No. 66) and 77% (No. 43) of cases, respectively. Some 9% (No. 8) of cases aged 1-2 years and 7% (No. 4) of those aged 3-5 years developed signs/symptoms possibly related to the exposure. For all of them, severity of clinical effects was low, but one case suffered moderate effects. Exposure to the medicine in drops was reported for 87% (No. 74) and 84% (No. 47) of cases aged 1-2 and 3-5 years, respectively. In 2012-2013 a total of 25 cases were observed. Among them, two patients were aged <1 year (8%). Both cases occurred in 2012 and were inadvertently administered the medicine in drops still available (present) in the home. Fourteen (56%) and 8 (32%) cases were aged 1-2 and 3-5 years, respectively. All of them were exposed to the tablet formulation following uncontrolled access to the medicine. CONCLUSIONS: The observations here reported indicate that having different formulations for methylergometrine maleate-containing products intended for the mother and paediatric medicines can successfully prevent medication error due to medicine exchange in the first months of life.

[Herbs and cardiotoxic effects]. / Cardiotossicità da erbe selvatiche.

Accidental or deliberate ingestion of poisonous herbs has become an increasingly common phenomenon over the last years. From existing literature data and case reports from emergency room visits or poison control centers, an overview is presented of the potential cardiotoxic manifestations following intoxication by wild herbal plants of the territory. The effects of the consumption of cardiac glycoside-containing plants (e.g., digitalis) are discussed along with tachyarrhythmias induced by Aconitum napellus L., Atropa belladonna L., Mandragora officinarum L. or Ephedra distachya L. herbs, and hypertensive crises associated with licorice abuse. For each plant, a brief historical and botanical background is provided, focusing on pathophysiology of intoxication and cardiotoxic effects on the basis of the most recent literature. Finally, medical management of intoxication, from both a general and cardiological viewpoint, is reviewed.

Evaluation of cosmetic product exposures reported to the Milan Poison Control Centre, Italy from 2005 to 2010.

INTRODUCTION: To the average consumer, "cosmetics" are not considered to cause damage to human health under normal conditions of use. Thus, cosmetic "safety" does not require any particular attention to the possibility that cosmetics may result in a toxic exposure, especially for children. Poison Control Centres (PCCs) provide specialized and rapid information for consumers and health professionals to ensure management of events related to the exposures to different agents, including Cosmetics. Poison Control Centres also represent a unique source of information to investigate the frequency and type of exposures to cosmetic and the related risks. OBJECTIVE: An analysis of cases concerning human exposures to cosmetics collected from 2005 to 2010 by the PCC at the Ospedale Niguarda Ca' Granda (Milan, Italy) was performed. RESULTS: During this period, 11 322 human exposure cases related to cosmetics were collected accounting for 4.5% of the total human clinical cases. Almost, all the requests for assistance came from consumers (53%) and hospitals (40%). The most frequently reported site of exposure was the consumer's own residence (94%). The exposures mainly involved children younger than 4 years (77%). No difference in gender distribution was observed (female 49%, male 51%). Almost, all of the exposures were unintentional (94%). Intentional exposures, mainly related to suicide attempts and accounted for 6% of cases involving persons aged more than 12 years. Personal hygiene products (30%), perfumes and hair care products (excluding hair dyes) (both 13%) were the most frequently involved categories. Symptoms were present only in 26% of the exposures and were mostly gastrointestinal (46%). Most of the cases were managed at home (43%) whereas hospital intervention was required in 38%. CONCLUSION: Since the exposure frequency seems more likely to reflect product availability and accessibility to ingestors, our results call for closer attention to this type of hazard, especially for children younger than 4 years of age.

Oral ingestion of a topical benzydamine hydrochloride-containing gynaecological preparation in association with television advertising in Italy: analysis of cases managed by a National Poison Control Centre.

Objective To evaluate the impact of a television advertising campaign on the risk of oral ingestion of a topical non-prescription gynaecological preparation containing benzydamine hydrochloride. Design An interrupted time series design with data routinely collected. Setting A National Poison Control Centre. Participants 215 cases of hazardous exposure to the preparation under study occurred in Italy from January 2005 to December 2010. Primary and secondary outcome measures Mean daily rate of cases of exposure by gender in three different periods, that is, pre-advertisement period, before the advertisement was broadcast (from 1 January 2005 to 19 December 2009), advertisement period, when the advertisement was repeatedly launched (from 20 December 2009 to 27 February 2010), post-advertisement period (from 28 February 2010 to 6 March 2010); observed/expected ratios of cases, with expected cases based on data from the pre-advertisement period, adjusted for estimated variations in the number of users. Comparison of the distribution of the main characteristics of cases in the three different periods by means of Pearson's χ(2) test or Fisher's exact test. Results The adjusted observed/expected ratio of cases in women was 7.48 (95% CI 5.76 to 9.56) in the advertisement period and 2.97 (95% CI 2.24 to 3.85) in the post-advertisement period. Regarding the characteristics of cases, there was an increased proportion of cases of exposure due to confusion about the correct administration route in the advertisement and post-advertisement periods (81% and 55%, respectively, compared to 16% for the pre-advertisement period.) and of individuals with clinical effects (55%, 52% and 27%, respectively). Conclusions In Italy, an advertisement for a non-prescription medicine seems to have confused consumers regarding the administration route. This effect was observed even after the advertisement had stopped being broadcast. These results highlight the need for the monitoring of medication errors and adverse effects before, during and after advertising.

A case of contact dermatitis to dimethylfumarate in shoes identified in Italy.

The present paper describes a case of shoe contact dermatitis from DMF identified by the Poison Control Centre of Milan (PCCM), Italy, in 2009. A 35 year old woman was affected by irritant reactions while wearing shoes contaminated with DMF. Exposure to these shoes was limited to a 8 hour period and was not repeated. In the following days the patient suffered feet blistering and swelling limited to the area in contact with shoe vamp. Topical application of cortisone did not prevent development of bullous eczema. After 20 days from exposure, the lesions were healed but the skin remained red, dry and very sensitive. Chemical analyses of shoes quantified an average concentration of DMF of 383 mg/kg. The patient refused to be patch tested. The observation here reported confirm that DMF should be considered a possible causal agent in shoe contact dermatitis. Documentation of cases exposed to this chemical provide a relevant support to characterize clinical manifestations and to identifying contaminated articles.

Animal poisoning in Europe. Part 1: Farm livestock and poultry.

The lack of a reference Veterinary Poison Control Centre for the European Union (EU) means that clinicians find it difficult to obtain information on poisoning episodes. This three-part review collates published and unpublished data obtained from Belgium, France, Greece, Italy and Spain over the last decade in order to provide a broader toxicoepidemiological perspective. The first article critically evaluates the national situation in the five European countries and concludes that information for livestock and poultry is limited and fragmentary compared to other animal groups. The analysis has revealed that clinical cases of poisoning are only occasionally studied in depth and that cattle are the species most frequently reported. Several plants and mycotoxins, a few pesticides and metals, together with contaminants of industrial origin, such as dioxins, are responsible for most of the recorded cases.

Animal poisoning in Europe. Part 2: Companion animals.

This is the second in a series of three review articles on animal poisoning in Europe and focuses on cases in pet animals and horses in five European countries (Belgium, France, Greece, Italy and Spain) reported over the last decade. In the participating countries, dogs were the most commonly poisoned species, particularly younger animals. The majority of cases in companion animals resulted from exposure to insecticides, although rodenticides (especially anticoagulants and strychnine) posed a significant risk. In all five countries, horses and cats appeared to be more susceptible to plant toxins. Intoxications with herbicides, metals, household products and drugs for veterinary and human use were reported sporadically. The review demonstrates the importance of increased awareness so as to minimise poisoning episodes and emphasises the need to establish a European system for the recording of poisoning data.

Analytical aspects of diterpene alkaloid poisoning with monkshood.

A sensitive and specific method for aconitine extraction from biological samples was developed. Aconitine, the main toxic alkaloid from plants belonging to Aconitum species (family Ranunculaceae), was determined in plant material by an external standard method, and by a standard addition calibration method in biological fluids. Described here is one fatal case and five intoxications of accidental aconitine poisoning following the ingestion of aconite mistaken for an edible grass, Aruncus dioicus (Walt.) Fernald, "mountain asparagus", and Cicerbita alpina (L.) Wallroth. The aconitine content in urine was in the range 2.94 microg/mL (dead patient)-0.20 microg/mL (surviving patients), which was almost two to four times higher than that in plasma.

[A cluster of methanol-related poisonings in Sicily: case characterization and identification of unexpected sources of exposure]. / Un cluster di intossicazioni da metanolo in Sicilia: descrizione dei casi e identificazione delle fonti di esposizione.

OBJECTIVE: To describe methanol poisoning exposures in Italy and to investigate a cluster of methanol-related deaths due to abuse occurred in Sicily among immigrants from East Europe. DESIGN: the human methanol exposures handled by the Poison Control Centre of Milan, the major national centre for toxicological advise active in Italy, were reviewed retrospectively (January 2004-September 2006) and prospectively (October 2006-October 2008). SETTING: For each case of managed human exposure, the Poison Control Centre of Milan uses a standard format to collect patient information, substance/exposure information, clinical effects, therapy, outcomes. The database arising from that procedure was searched for all cases exposed to methanol and/or reporting selected clinical signs (i.e., metabolic acidosis with ocular effects and/or central nervous system depression and/or respiratory depression). Each case was reviewed and classified according to standard criteria. MAIN OUTCOMES: Three commercial products containing more than 70% methanol available on the market in Sicily and associated with lethal exposures due to abuse among immigrants were identified. RESULTS: In the period under study, the Poison Control Centre of Milan examined 29 methanol poisoning exposures (none in 2004, 6 in 2005, 6 in 2006, 15 in 2007, and 2 in 2008). Among them, 17 occurred in Sicily, with a peak of 11 cases in 2007, and 12 in other regions. The patients included 16 men and 13 women with a median age of 49,5 years (range 1-81 years). Fifteen cases were immigrants from East Europe (14 Rumanian and one Polish). Eleven cases reported minor effects, two cases moderate effects, four cases major effects, and 12 cases died. Twelve cases were accidental exposures (5 occurred at work, 3 at home and 4 in other places), while 17 cases were intentional exposures (14 due to abuse, 2 to attempted suicide and 1 to misuse). Minor effects were reported in 11 cases, moderate effects in two cases, major effects in four cases and death in 12 cases. The most frequently reported clinical effects included: coma (13 cases), metabolic acidosis (10 cases), mydriasis (4 cases), visual loss (3 cases), gastric pyrosis (2 cases), constriction of the visual field (2 cases), and vertigo (2 cases). Blood methanol level was reported for 15 cases (< 50 mg/dL in 2 cases; 50-99 mg/dL in 2 cases; 100-499 mg/dL in 4 cases; >500 mg/dL in 1 case; positive, unknown value in 6 cases). All cases due to abuse (n. 14) and, among them, lethal (n. 12) occurred in Sicily and involved immigrants. On the other hand, all methanol poisonings occurring in the other Italian regions involved Italian citizens unintentionally exposed and with minor effects, except for one case of attempted suicide with consequent major effects. The investigations performed in Sicily lead to identifying three locally produced and marketed detergents containing more than 70% methanol, improperly labelled and packaged. Furthermore, a detergent for domestic use was identified containing 25-30% methanol without any labelling information. Two of the detergents containing more than 70% methanol were withdrawn from the market in November 2007, while the other, that was identified later, was withdrawn in July 2008. The detergent for domestic use, containing 25-30% methanol was withdrawn in December 2007. Starting from July 2008, no new cases of methanol poisonings were observed. CONCLUSION: The availability in Sicily of products containing high concentrations of methanol, improperly packaged and labelled, determined a generalised risk of accidental exposures and favoured voluptuary assumption of methanol among selected groups. The observations highlight the importance of a surveillance system of toxic exposures based on the information collected by the Poison Control Centres and its ability to provide timely identification of unexpected and dangerous events and to support preventive actions.

Surveillance of toxic exposures: the pilot experience of the Poison Control Centers of Milan, Pavia and Bergamo in 2006.

Between 1 February and 31 March 2006, the Poison Control Centers (PPC) active in Lombardy collaborated with an integrated surveillance system carried out in Piedmont during the Olympic Games 2006. The collaborating PPC notified to the system 697 human cases of exposure occurred in Piedmont during the observation period. Among these cases, 70% were exposed accidentally, 40% were 6 years old or younger, and 45% reported at least a clinical effect. The agents more frequently reported were: cleaning substances (household) (110 cases), fumes/gases/vapors (63 cases, comprising 38 cases accidentally exposed to carbon monoxide), and sedative/hypnotics/antipsychotics (53 cases). Although very limited, the available observations focused the attention on specific hazards and were able to highlight the potential of a toxic exposure surveillance system based on the information reported by the Italian PPC.

[Agricultural pesticide-related poisonings in Italy: cases reported to the Poison Control Centre of Milan in 2000-2001]. / Intossicazioni acute da antiparassitari di uso agricolo in Italia: i casi esaminati dal Centro antiveleni di Milano nel 2000 e 2001.

OBJECTIVE: Aim of the present study is to provide a preliminary description of agricultural pesticide-related poisonings in Italy. DESIGN: The study focuses on the cases with at least one sign or symptom due to exposure to agricultural pesticides occurred in 2000-2001 and referred to the Poison control centre of Milan, the Italian centre more frequently consulted nationwide. RESULTS: During the study period, 872 agricultural pesticide-related poisonings were identified. Most of the observed cases occurred in Sicily (n=199), Lombardy (n=100), Apulia (n=99), Veneto (n=75), Emilia-Romagna (n=67) and Campania (n=59). About 86% of the observed cases were unintentional and about 76% of them were men. Children aged 10 or less accounted for about 6% of the total. The poisonings occurred more frequently at home (about 38%) than at workplace (about 24%). The chemical classes of agents more frequently reported were: organophosphates (233 cases), copper and sulphur compounds (140 cases), carbamates (126 cases) and pyrethrins/pyrethroids (102 cases). The top six pesticides associated with poisonings were methomyl (97 cases), dimethoate (59 cases), copper sulfate (58 cases), glyphosate (53 cases), sulphur compounds other than copper sulfate (47 cases), and paraquat dichloride (41 cases). CONCLUSION: The data here presented provide an initial support to identify priorities for prevention in agricultural settings.