Screening and Identification of Probiotic Lactobacilli from the Infant Gut Microbiota to Alleviate Lead Toxicity.

Lead (Pb2+) exposure cause a potential hazard to human health and the ecological environment; however, prevention and treatment of Pb2+ toxicity remain problems. The aim of this study is to isolate a novel probiotic lead (Pb2+)-resistant Lactobacillus strain from the infant gut microbiota and to determine whether they have the probiotic properties and investigate its preventive and therapeutic effects in the early-life Pb2+ exposure mouse model. In the present study, a total of 64 Pb2+-resistant colonies were isolated from the infant gut microbiota. Of these colonies, SYF-08, identified as Lacticaseibacillus casei, exhibited a Pb2+-binding capacity and Pb2+ tolerance. The in vivo study showed that SYF-08 treatment could effectively reduce Pb2+ levels in the blood, alleviate Pb2+ enrichment in bone and brain tissues, and recover the intestinal and brain damage in both dams and offspring. SYF-08 treatment also improved the antioxidant index in the liver and kidney tissues, while increasing the diversity of the intestinal microbiota of the offspring. The results of the in vitro and in vivo studies suggest that SYF-08, isolated from infant fecal samples, is a promising candidate probiotic against Pb2+ toxicity.

Lead ingestion, medical emergency and action plan.

Ingestion of lead material represents a therapeutic challenge involving high toxicity, significant clinical impact, and controversy regarding management. We report the case of a 2-year-old girl, who accidentally ingested a fishing sinker. She remained asymptomatic and first level tests were performed (blood lead levels and x-ray to locate object). Because of sinker location in the jejunum, two rectal enemas and polyethylene glycol (PEG) were administered, serial blood lead level measurements were performed. Because of sinker persistence, a colonoscopy was undertaken. She did not require chelation treatment. However, she required follow-up to monitor long-term toxicity and sequels.

Lead poisoning in children: emergency department recognition and management.

Millions of children continue to be at risk for lead exposure despite a dramatic decline over the past 4 decades, and hundreds present annually to emergency departments with lead poisoning. These patients can be challenging to identify due to their nonspecific presentation and frequent lack of known exposure. This issue will prepare the emergency clinician to identify and care for the lead-poisoned patient, focusing on: (1) identifying key historical features, signs, and symptoms at presentation; (2) the medical management of lead poisoning; and (3) formulation of a safe discharge plan.

Louis Tanquerel des Planches (1810-1862) and the history of discovering lead poisoning in the nervous system.

Louis Tanquerel des Planches (1810-1862) only left us with one significant medical work, his Traité des maladies de plomb ou saturnines (treatise on lead or saturnine diseases), published in 1839. The work served as a reference for diagnosing and treating lead poisoning throughout the second half of the nineteenth century. The word "encephalopathy" that he coined at that time referred to toxic damage to the central nervous system. Whereas for two millennia and for most physicians, lead poisoning was considered lead colic, i.e. paroxysms of abdominal pain, Tanquerel collected seventy-two observations of damage to the central nervous system in workers exposed to lead in Parisian workshops (which no longer exist). He then inventoried and described forms of paralysis, delirium, coma, and convulsions related to lead poisoning. Having no qualms about stepping away from La Charité Hospital where he had treated patients with lead poisoning, he inspected their workplaces and unambiguously presented the deplorable conditions that caused so many patients to die. His "preservative" advice was an initial attempt at medical-social prophylaxis with the goal of helping the working class exposed in workshops without any respect for human life. With support from chemists and pharmacists, Tanquerel showed the presence of lead in brain tissue and thus demonstrated its neurological toxicity as early as 1839. This article is also an opportunity to note the contributions on this topic of some other physicians: François-de-Paule Combalusier (1713-1762), François Victor Mérat de Vaumartoise (1780-1851), Jean-Louis Brachet (1789-1858), Auguste Mirande (1802-1865), Vincent Nivet (1809-1893), Augustin Grisolle (1811-1869), and Ferdinand de Bernard de Montessus (1817-1899).

Guideline for clinical management of exposure to lead

The purpose of the WHO Guideline for clinical management of exposure to lead is to assist physicians in making decisions about the diagnosis and treatment of lead exposure for individual patients and in mass poisoning incidents. The guideline presents evidence-informed recommendations on: the interpretation of blood lead concentrations; use of gastrointestinal decontamination; use of a chelating agent; and use of nutritional supplements.

Lead poisoning due to incense burning: an outbreak in a family.

BACKGROUND: In Asia and some other regions of the world, incense burning is an important folk and cultural activity. However, this ritual can cause health impacts, such as chronic respiratory diseases and neoplasms. Herein, we describe a family with lead poisoning possibly related to the frequent use of incense sticks at home. CASE REPORT: A 65-year-old homemaker with severe anemia, pitting edema of the lower legs, bone pain, abdominal pain, and exertional dyspnea for several months presented to our clinic. Her blood workup indicated severe anemia with basophilic stippling in red blood cells and blood lead level (BLL) of 59.75 µg/dL. Her husband, three children, and four grandchildren who lived with her also had high BLLs. As a Daoist clergy person, she had been exposed to a large amount of smoke from every day use of incense for >30 years. In the field investigation, the chronic dust deposited in hidden corners of their home had considerably higher lead content and other toxic metals. DISCUSSION: Our observations indicated chronic, frequent exposure to smoke from incense burning may be a cause of lead poisoning. Strict avoidance of incense smoke is a significant step toward preventing lead poisoning in children in societies with the custom of incense burning.

Effects and mechanisms of scalp acupuncture on learning and memory in mice with lead poisoning.

OBJECTIVE: To study the effects and mechanism of scalp acupuncture on learning and memory ability in mice with lead poisoning. METHODS: From March 2018 to December 2018, 30 Kunming mice were randomly divided equally into the control group and the intervention group after intraperitoneal injection of lead acetate The intervention group received scalp acupuncture on the first day of the model establishment; the model group only received conventional feeding without treatment. At the same time, a control group of 15 rats was given the intraperitoneal injections of normal saline for 8 consecutive days, and only after routine feeding, no treatment was given. Determination of lead in blood was detected by Graphite Furnace Atomic Absorption Spectrometry, the Morris water maze test was used to detect the learning and memory function of mice, hydroxylamine colorimetric method was used to measure acetylcholinesterase (AChE) activity, and TUNEL staining was used to detect the apoptotic cells in the hippocampus. RESULTS: The results showed that the blood lead level of the model group (231.42±12.53µg/L) was significantly higher than that of the control group (20.43±4.62µg/L) (P<0.05); and there was no significant difference in blood lead content between the intervention group (228.12±5.21µg/L) and the model group. The Morris water maze test showed that from the fourth day of the orientation navigation experiment, the escape latency of the model group (22.2±4.10s) was longer than that of the control group (13.64±2.93s) (P<0.05); besides, from the third day, the escape latency of mice in the intervention group (13.52±9.18s) was significantly shortened compared with the model group (19.95±3.52s). In the space exploration experiment, in terms of passing through the platform, the distance (1.57±0.49m) and time (15.54±3.72s) of mice in the model group were longer than that of mice in the control group (0.73±0.44m, 3.24±2.24s) (P<0.05), the distance (0.41±0.28m) and time (3.0±1.93s) of mice in the intervention group were shorter than that of mice in the model group, and the difference was statistically significant (P<0.05). The apoptosis rate of hippocampus in the model group (8.79±0.37%) was significantly higher than that in the control group (3.56±0.44%) (P<0.05), and the apoptosis rate of hippocampus in the intervention group (4.36±0.12%0 was significantly lower than that in the model group (P<0.05). The expression of AchE in the model group (0.5±0.13U/ug) was significantly higher than that in the control group (0.23±0.04U/ug), but there was no significant difference in the AChE activity between the intervention group and the model group. CONCLUSIONS: In conclusion, scalp acupuncture can improve the learning and memory ability of mice with lead poisoning, and the decrease of hippocampal apoptotic cells may be a possible mechanism for the improvement of learning and memory function.

Rare cases of severe life-threatening lead poisoning due to accident or chronic occupational exposure to lead and manganese: Diagnosis, treatment, and prognosis.

BACKGROUND: Chronic long-term, low-dose environmental and occupational exposure to lead (Pb) has been extensively studied in large cohorts worldwide among general populations, miners, smelters, or battery workers. However, studies on severe life-threatening Pb poisoning due to accidental or chronic occupational exposure to Pb and manganese (Mn) were rarely reported. METHODS: We present one case of acute severe Pb poisoning and compare it with another severe chronic occupational exposure case involving Pb and Mn. A 27-year-old woman mistakenly took a large quantity of pure Pb powder as an herbal remedy; she developed abdominal colic, severe nausea, vomiting, fatigue, and cutaneous and sclera icterus. Laboratory tests showed her blood lead level (BLL) of 173.5 µg dL-1 and urinary lead level (ULL) of 1240 µg dL-1. The patient was diagnosed with acute Pb poisoning and acute liver failure. In another chronic exposure case, a 56-year-old man worked in a Pb and Mn smelting factory for 15 years. He was brought to the emergency room with severe nausea, vomiting, and paroxysmal abdominal colic, which was intolerable during the onset of pain. His BLL was 64.8 µg dL-1 and ULL was 38 µg dL-1, but his blood and urinary Mn levels were normal. The patient was diagnosed with chronic Pb poisoning. Both patients received chelation therapy with calcium disodium ethylene-diamine-tetraacetate (CaNa2EDTA). The woman with acute severe Pb intoxication recovered well and was discharged from the hospital after treatment, and the man who survived severe Pb poisoning was diagnosed with lung cancer. CONCLUSION: Clinical manifestations of acute and chronic severe Pb poisoning are different. Chelation therapy with CaNa2EDTA is proven to be an effective life-saving therapy in both cases by reducing BLL. Occupational exposure to both Pb and Mn does not appear to increase Mn neurotoxicity; however, the probability that co-exposure to Mn may increase Pb toxicity in the same patient cannot be excluded.

Occupational Lead Poisoning in a Patient with Acute Abdomen and Normocytic Anemia.

We herein report a 24-year-old male construction worker with occupational lead poisoning who presented with acute abdomen and normocytic anemia. The levels of urinary delta-aminolevulinic acid and free erythrocyte protoporphyrin were elevated without any increase in the level of urine porphobilinogen. Detection of an elevated blood lead level of 100 µg/dL confirmed a diagnosis of lead poisoning. Chelation therapy with calcium disodium ethylenediaminetetraacetate resulted in prompt improvement of the clinical symptoms and the blood lead level. Clinicians should be aware that lead poisoning caused by occupational exposure can still occur sporadically in construction workers in Japan.

Ameliorative effect of curcumin on lead-induced hematological and hepatorenal toxicity in a rat model.

INTRODUCTION: Lead (Pb) is a ubiquitous toxic heavy metal that inflicts numerous clinical consequences on humans. Curcumin is the principal component of turmeric, which is reported to have antioxidative properties. This study aimed at evaluating the ameliorative effects of curcumin on Pb-induced hepatorenal toxicity in a rat model. METHODS: Thirty-six male Sprague-Dawley rats were randomly assigned into five groups with 12 rats in the control (normal saline) and six rats each for the lead-treated group (LTG) (50 mg/kg lead acetate [Pb acetate] for 4 weeks), recovery group (50 mg/kg Pb acetate for 4 weeks and left with no treatment for another 4 weeks), treatment group 1 (Cur100) (50 mg/kg Pb acetate for 4 weeks, followed by 100 mg/kg curcumin for 4 weeks), and treatment group 2 (Cur200) (50 mg/kg Pb acetate for 4 weeks, followed by 200 mg/kg curcumin for 4 weeks). All the experimental groups received oral treatments via orogastric-tube on alternate days. Pb concentration in the liver and kidney of the rats were evaluated using inductive-coupled plasma mass spectrometry techniques. RESULTS: Pb-administered rats revealed significant alteration in oxidative status and increased Pb concentration in their liver and kidney with obvious reduction of hemogram and increased in leukogram as well as aberration in histological architecture of the liver and kidney. However, treatment with curcumin reduces the tissue Pb concentrations and ameliorates the above mention alterations. CONCLUSIONS: The results in this study suggested that curcumin attenuates Pb-induced hepatorenal toxicity via chelating activity and inhibition of oxidative stress.

Heavy Metal Toxicity in Chronic Renal Failure and Cardiovascular Disease: Possible Role for Chelation Therapy.

Exposure to heavy metals is common. This exposure is related to environmental contamination of air, water and soil, occupational exposure, accumulation in food, tobacco, and other factors. Cadmium and lead are notable for their widespread contamination, long-lasting effects in the body, and renal as well as cardiovascular toxicity. Acute toxicity due to high-level exposure, as well as chronic low-level exposure are now well-established pathogenic entities. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with ethylenediaminetetraacetic acid (EDTA) chelation therapy. In patients with chronic kidney disease (serum creatinine: 1.5-4.0 mg/dL) and increased body lead burden, weekly low-dose chelation with calcium EDTA slowed the rate of decline in renal function in patients with diabetes and in non-diabetic patients. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy study showed that EDTA chelation decreased the likelihood of cardiovascular events, particularly in patients with diabetes. However, heavy metal levels were not measured in this study. It is clear that more research is needed in this area. There is also a need to more frequently consider and test for the possibility of cadmium and lead toxicity in patients with increased risk, such as those with hypertension, diabetes mellitus, and chronic renal disease.

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development.

BACKGROUND: Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis. Shareable electronic clinical decision support (CDS) could improve lead screening and management. However, discrepancies between federal, state and local recommendations could present significant challenges for implementation. METHODS: We identified publically available guidance on lead screening and management. We extracted definitions for elevated lead and recommendations for screening, follow-up, reporting, and management. We compared thresholds and level of obligation for management actions. Finally, we assessed the feasibility of development of shareable CDS. RESULTS: We identified 54 guidance sources. States offered different definitions of elevated lead, and recommendations for screening, reporting, follow-up and management. Only 37 of 48 states providing guidance used the Center for Disease Control (CDC) definition for elevated lead. There were 17 distinct management actions. Guidance sources indicated an average of 5.5 management actions, but offered different criteria and levels of obligation for these actions. Despite differences, the recommendations were well-structured, actionable, and encodable, indicating shareable CDS is feasible. CONCLUSION: Current variability across guidance poses challenges for clinicians. Developing shareable CDS is feasible and could improve pediatric lead screening and management. Shareable CDS would need to account for local variability in guidance.

Treatment of lead and arsenic poisoning in anuric patients - a case report and narrative review of the literature.

BACKGROUND: Heavy metal poisoning can cause debilitating illness if left untreated, and its management in anuric patients poses challenges. Literature with which to guide clinical practice in this area is rather scattered. CASE PRESENTATION: We present a case of symptomatic lead and arsenic poisoning from use of Ayurvedic medicine in a 28-year-old man with end-stage kidney disease on chronic hemodialysis. We describe his treatment course with chelating agents and extracorporeal blood purification, and review the relevant literature to provide general guidance. CONCLUSION: Cumulative clinical experience assists in identifying preferred chelators and modalities of extracorporeal blood purification when managing such patients. However, a larger body of real-world or clinical trial evidence is necessary to inform evidence-based guidelines for the management of heavy metal poisoning in anuric patients.

Analysis of disease profile, and medical burden by lead exposure from hospital information systems in China.

BACKGROUND: Though lead (Pb)-gasoline has been banned for decades in China, Pb continues to be a vital risk factor for various diseases. Traditional studies, without large sample size, were unable to identify explicitly the associations among Pb, its disease profile, and the related medical burden. This study was designed to investigate: 1) current status of blood Pb levels; 2) Pb-associated disease profile, medical burden, as well as impact factors. METHODS: Research subjects were patients who visited military hospitals and were required to test their blood Pb levels by doctors between 2013 and 2017. The large sample size and area coverage may, to a large extent, reveal the characteristics of Pb exposure in the whole Chinese population. Information of patients' electronic medical records was extracted using Structured Query Language (SQL) in Oracle database. The spatial, temporal, and population distribution of their blood Pb levels were tested, to illustrate the association of Pb exposure with diseases' profile, and medical burden. Non-parametric tests were applied to compare the differences of Pb levels among various groups. RESULTS: The blood Pb concentration showed a positively skewed distribution by Kolmogorov-Smirnov test (D = 0.147, p < 0.01). The blood Pb concentration of Chinese patients was 28.36 µg/L, with the lowest blood Pb levels, 4.71 µg/L, found in patients from Guangxi Zhuang Autonomous Region, and the highest, 50 µg/L, in Yunnan province. Han Chinese patients' Pb levels were significantly lower than other minorities groups (z-score = - 38.54, p < 0.01). Average medical cost for Pb poisoning was about 6888 CNY for Chinese patients. Pb levels of patients with malignant neoplasm of lung, 45.34 µg/L, were far higher than malignant neoplasm of other respiratory, and intrathoracic organs, 24.00 µg/L (z-score = - 2.79, p < 0.01). CONCLUSIONS: This study reported current status of blood Pb levels for patients who once visited military hospitals, partially representing the whole Chinese population. The result shows that Pb poisoning is still imposing marked economic burdens on patients under Pb exposure. Association of Pb with lung cancer may open up new areas for Pb-induced toxicology. The research strategy may advance toxicological studies in the aspect of medical data mining.

Lead Poisoning in Children.

Asymptomatic lead poisoning has become more common in children. Blood lead levels of less than 5 µg per dL are associated with impairments in neurocognitive and behavioral development that are irreversible. Risk factors for lead poisoning include age younger than five years, low socioeconomic status, living in housing built before 1978, and use of imported food, medicines, and pottery. The U.S. Preventive Services Task Force released a recommendation in 2019 citing insufficient evidence to assess the balance of benefits and harms of universal screening for elevated blood lead levels in asymptomatic children and pregnant women. Local risk factors can be substantial, and the Centers for Disease Control and Prevention (CDC) recommends that states and cities formulate their own targeted screening guidelines. In the absence of local guidance, the CDC recommends screening all Medicaid-eligible children at 12 months and again at 24 months, or at least once between 36 and 72 months if not previously screened. The CDC also recommends universal screening in areas where more than 27% of the housing was built before 1950, or where at least 12% of children 12 to 36 months of age have blood lead levels greater than 10 µg per dL. Life-threatening lead levels are treated with chelation therapy, and lower levels should prompt case management and environmental investigations to identify and remove the source of exposure. Primary prevention strategies are essential to eliminate the harmful effects of lead on child development.