1887
Volume 2023, Issue 4
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Global concern has focused on reducing the potential hazards to public health from unintentional pesticide poisoning. As a result, notorious agents have been banned from the market, and new materials that maintain their effectiveness against harmful insects with low human toxicity have been developed. Despite the development of several recent agents targeting the nervous system of insects, their clinical effects on humans are rarely known. We report a novel human intoxication with a mixture of flonicamid and sulfoxaflor pesticides, which presented with acute stroke manifestations.

An 83-year-old man presented to the emergency department (ED) in a confused mental state and with right-sided hemiparesis for 2 h prior to the visit. The primary evaluation targeted a new onset of hemorrhagic stroke. Clinical manifestations showed no definite interval change for 2 days, and the diagnosis of stroke was ruled out after previous radiologic results revealed the presence of a pre-existing lesion.

After 3 days, the patient recovered with an alert mentality and appropriate orientation. The patient remembered that he took the package of pesticide but flatly denied the intentional intake of toxic agents. The patient was discharged 5 days after admission without any neurological deficits.

We present the first report of human intoxication with flonicamid or sulfoxaflor. Although the total amount of ingestion was not high, the patient showed unique clinical manifestations of stroke. Physicians should be aware of particular toxic materials when a differential diagnosis of stroke is required. Further investigations should be performed to estimate and reveal human toxicity.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2023.32
2023-10-19
2024-11-13
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2023/4/jematac.2023.32.html?itemId=/content/journals/10.5339/jemtac.2023.32&mimeType=html&fmt=ahah

References

  1. Centers for Disease Control and Prevention [CDC]. Accidents or Unintentional Injuries. 2022. Available online at: https://www.cdc.gov/nchs/fastats/accidental-injury.htm (accessed November 23, 2022).
    [Google Scholar]
  2. Centers for Disease Control and Prevention [CDC]. WISQARS Fatal Injury Data Visualization. 2020. Available online at: https://wisqars.cdc.gov/data/lcd/home (accessed November 20, 2022).
    [Google Scholar]
  3. Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021; 59:(12):1282−501. doi: 10.1080/15563650.2021.1989785
    [Google Scholar]
  4. Boedeker W, Watts M, Clausing P, Marquez E. The global distribution of acute unintentional pesticide poisoning: Estimations based on a systematic review. BMC Public Health. 2020; 20:(1):1875. doi: 10.1186/s12889-020-09939-0
    [Google Scholar]
  5. Ko S, Cha ES, Choi Y, Kim J, Kim JH, Lee WJ. The burden of acute pesticide poisoning and pesticide regulation in Korea. J Korean Med Sci. 2018; 33:(31):e208. doi: 10.3346/jkms.2018.33.e208
    [Google Scholar]
  6. Su TY, Lin JL, Lin-Tan DT, Tseng HH, Yen TH. Human poisoning with spinosad and flonicamid insecticides. Hum Exp Toxicol. 2011; 30:(11):1878−81. doi: 10.1177/0960327111401639
    [Google Scholar]
  7. National Library of Medicine. PubChem Compound Summary for CID 16723172, Sulfoxaflor-Toxicity, 2022. Available online at: https://pubchem.ncbi.nlm.nih.gov/compound/16723172#section=Toxicity (accessed November 20, 2022).
    [Google Scholar]
  8. National Library of Medicine. PubChem Compound Summary for CID 9834513, Flonicamid-Toxicity, 2022. Available online at: https://pubchem.ncbi.nlm.nih.gov/compound/9834513#section=Toxicity (accessed November 20, 2022).
    [Google Scholar]
  9. Sparks TC, Watson GB, Loso MR, Geng C, Babcock JM, Thomas JD. Sulfoxaflor and the sulfoximine insecticides: Chemistry, mode of action and basis for efficacy on resistant insects. Pestic Biochem Physiol. 2013; 107:(1):1−7. doi: 10.1016/j.pestbp.2013.05.014
    [Google Scholar]
  10. Babcock JM, Gerwick CB, Huang JX, Loso MR, Nakamura G, Nolting SP, et al. Biological characterization of sulfoxaflor, a novel insecticide. Pest Manag Sci. 2011; 67:(3):328−34. doi: 10.1002/ps.2069
    [Google Scholar]
  11. Insecticide Resistance Action Committee. The IRAC Mode of Action Classification Online. 2022. Available online at: https://irac-online.org/modes-of-action/ (accessed November 23, 2022).
    [Google Scholar]
  12. Chen M, Tao L, McLean J, Lu C. Quantitative analysis of neonicotinoid insecticide residues in foods: Implication for dietary exposures. J Agric Food Chem. 2014; 62:(26):6082−90. doi: 10.1021/jf501397m
    [Google Scholar]
  13. Costas-Ferreira C, Faro LRF. Neurotoxic effects of neonicotinoids on mammals: What is there beyond the activation of nicotinic acetylcholine receptors?-A systematic review. Int J Mol Sci. 2021; 22:(16):8413. doi: 10.3390/ijms22168413
    [Google Scholar]
  14. World Health Organization [WHO]. Guidelines on Highly Hazardous Pesticides, International Code of Conduct on Pesticide Management. 2016. Available online at: https://apps.who.int/iris/bitstream/handle/10665/205561/9789241510417_eng.pdf;jsessionid=C466087F543FFAF8264689D99DAC7A7E?sequence=1 (accessed November 23, 2022).
    [Google Scholar]
  15. Ministry of Environment of Denmark. Fact Sheet: Labelling and Packaging of Pesticide. 2022. Available online at: https://eng.mst.dk/chemicals/chemicals-in-products/legal-framework-for-managing-chemicals/fact-sheets/fact-sheet-labelling-and-packaging-of-pesticide/ (accessed November 23, 2022).
    [Google Scholar]
/content/journals/10.5339/jemtac.2023.32
Loading
/content/journals/10.5339/jemtac.2023.32
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error