OP Food Poisoning: Case Study in India
February 26, 1999
In many developing countries, widespread use of organophosphate
insecticides (OPs) has been accompanied by an appreciable
increase in accidental poisoning with these chemicals. A report in
the British Journal of Medicine highlights the dangers of
indiscriminate use of organophosphates and stresses the importance
of early and accurate identification of the cause of food
poisoning outbreaks. According to the report, this increase in
poisonings is often a result of the easy availability of OPs,
indiscriminate handling and storage, and lack of knowledge about
the serious consequences of poisoning. Increased use of OPs as
agricultural and household insecticides without accompanying
public education about proper storage or dangers associated with
their use increases the likelihood of more food poisoning
incidents.
The report calls for health professionals to know the symptoms
associated with organophosphate poisoning so that they can
differentiate between these and neurological symptoms caused by
other forms of poisoning. Based on their research, the authors
believe that skilled, prompt treatment can save lives.
The authors use an incident that occurred in India in July 1997 as
a case study. Sixty men aged 20 to 30 years attended a communal
lunch where they ate chapati, vegetables, pulses and halva. All
sixty developed nausea, vomiting and abdominal pain over the next
three hours. They were taken to a local primary healthcare center
where they received treatment for their symptoms (intravenous
fluids, antiemetics and antibiotics). Fifty-six responded to the
treatment and were discharged the same day. However, the condition
of the remaining four patients deteriorated. Their level of
consciousness decreased and they developed respiratory distress
and muscular weakness. The next day the four men were moved to an
urban emergency hospital.
One of these patients, a 20 year old man admitted with a range of
symptoms (including sweating, impaired consciousness, hypotension
and muscle weakness) began having difficulty breathing on the
second day, and was eventually placed on a ventilator. Despite
continuing treatment of his symptoms, he developed respiratory
failure and muscle paralysis and died of cardiac arrest on the
tenth day. The other three patients responded to treatment and
were discharged a week later.
Detailed questioning of those who had been working in the communal
kitchen where lunch had been cooked revealed that on the morning
of the outbreak the kitchen had been sprayed with malathion, an
organophosphate insecticide. Many of the cooking ingredients used
for the lunch were stored in open jute bags. All 60 people who had
eaten the meal developed symptoms, but the patient who died had
eaten at least eight chapati, while the others had eaten only
three or four. Laboratory testing of leftover food from the shared
lunch revealed the presence of an organophosphate compound, but no
other toxins or chemicals.
Due to the severity of his illness, health care workers initially
suspected botulism as the cause of his symptoms. When test results
for botulism proved negative, hospital staff ordered additional
analysis of the patients' gastric fluids. A positive test for
organophosphate poisoning was obtained nine days after the onset
of illness. All of the men hospitalized developed symptoms more
consistent with organophosphate poisoning than botulism. However,
the early onset of certain intermediate symptoms had not been
described previously with malathion, but rather with other OPs.
This added to the difficulty in making a correct diagnosis. This
delay in diagnosis, evaluation and management of the malathion
poisoning resulted in the death of patient who might otherwise
have survived had he received early appropriate treatment.
The article concludes by issuing a reminder "...to
epidemiologists, toxicologists, and microbiologists that
organophosphate food poisoning is a continuing hazard, especially
in developing countries. Health professionals should be familiar
with the acute illness syndromes associated with organophosphate
poisoning so that they can differentiate between these and the
neurological symptoms caused by other forms of poisoning."
Source: Chaudhry, R., S.B. Lall, B. Mishra and B. Dhawan, "A
foodborne outbreak of organophosphate poisoning: Indiscriminate
use of organophosphates without public education on safety
increases the potential threat of foodborne outbreaks of
poisoning," British Medical Journal, July 25, 1998.
Contact: PANNA.
===========================================
Pesticide Action Network North America (PANNA)
49 Powell St., Suite 500, San Francisco, CA 94102 USA
Phone: (415) 981-1771
Fax: (415) 981-1991
Email: panna@panna.org
Web: www.panna.org
To subscribe to PANUPS, send email to majordomo@igc.org
with the following text on one line: subscribe panups
To unsubscribe, use: unsubscribe panups
===========================================
To Unsubscribe: Email majordomo@ces.ncsu.edu with the command
"unsubscribe sanet-mg".
To Subscribe to Digest: Email majordomo@ces.ncsu.edu with the command
"subscribe sanet-mg-digest".
All messages to sanet-mg are archived at:
http://www.sare.org/htdocs/hypermail