Accidental Cymoxanil (TANOS) Pesticide Poisoning (Case Report)

Abstract

Background: Pesticides are a group of chemicals used in agriculture in order to achieve higher and better-quality crops. The vast majority of these are synthetic substances whose effect on the human organism is unfavorable, even toxic. Methods: We provide a brief overview of available Slovak and world literature on these issues. In the next section, we deal with the case of a patient, whose leading symptoms were headache and behavioral changes. After excluding organic lesions, we made a diagnosis „per exclusionem“ and diagnosed cymoxanil poisoning. Conclusions: We consider the relatively low number of recorded poisonings to be a result of strict regulation of pesticide use. Original Articles 28 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Introduction Pesticides are chemicals used to protect vegetables against animal pests, fungi and weeds. These are organic or inorganic substances. They are applied as a spray, powder, granules or mordant. The most important pesticides are insecticide substances used for destroying insects; fungicides substances used to destroy harmful parasitic fungi; herbicide substances used for weed control; rodenticides substances used for destroying rodents1. (1) If one uses pesticides it is important to work with extreme caution. How to use them and health at work are regulated by provisions having the force of law2,3.(2-3) TANOS 50WG is a combined two-component fungicide to protect potatoes against potato blight and potato Alternaria leaf spot, tomatoes against potato blight; cucumbers and zucchini against cucumber Peronospora; vines against Peronospora. Active substance: cymoxanil 250g/kg + famoxadone 250g/kg. Formulated as: dispersible granule Mechanism of action: systemic and contact. Antracol Combi WP 76 is a combined two-component fungicide intended for plant care, with a spectrum of activity similar to the product TANOS 50WG. Active substance: propineb 70% + cymoxanil 6%. Formulated as: dispersible powder4. Characterization of cymoxanil: Chemical characterization: N-ethylaminocarbonyl-2-cyano-2-methoxyiminoacetamide. The substance belongs to the class of acylureas. It acts primarily in systemic, but partly also in contact, fashion on plants. The effects of cymoxanil in plants include inhibition of nucleic acid synthesis, reduction in the permeability of cell membranes, limiting respiration and disruption of serine, glycine and cysteine synthesis. This results in inhibition of mycelial growth, reduction of sporulation and spores germination5. Symptoms of cymoxanil poisoning are presented in Table 1. Case description A 50-year-old, otherwise healthy man was brought into the internal medicine emergency room with a headache lasting 4 days and body temperature up to 38 °C. Beside the headache he complained about dry mucous membranes of the mouth, loss of appetite, fatigue, increased sweating, also at night. Targeted questions specified that four days before admission, i.e. before symptoms started, he sprayed vegetables against fungi. He could not specify the product name. During the spraying he was exposed to direct sunlight and despite knowledge of safety he did not use any respirator. The symptoms started the next morning and persisted during the consultation with a doctor. Objective finding reads that the patient was obese (BMI 33), skin was sweaty, body temperature 36.5 °C, isocoric pupils in middle position, bulbs without nystagmus, injected conjunctiva. Overall, psychomotor restlessness was present. The patient was restless & fussed to find a relief position. Neither neurological focality nor laterality were observed. Signs of meningeal irritation were indicated. The laboratory tests showed neutrophilic leukocytosis, adequate coagulation parameters, a high level of C-reactive protein, a normal procalcitonin, slightly increased GMT activity (Table 2). CT scan of the brain + skull trauma program were indicated. The finding was negative. The condition was evaluated as susp. Meningitis. We indicated parenteral antibiotic therapy. We examined the eye-ground with age-appropriate findings. The patient was IV hydrated and orally hydrated at the same time. During hospitalization the body temperature repeatedly exceeded 38 °C, we took a blood culture but it was completed with negative results. 29 Original Articles Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Family members delivered packaging of the spraying used. It was a TANOS preparation (active substances: cymoxanil + famoxadone). From the available literature we found that symptoms may indicate a cymoxanil poisoning. Tests for focal infection were conducted. Echokg, dental and ENT findings were normal. The eyeground finding was negative. Hydration, antibiotic, anti-edematous (mannitol) and analgesic treatment continued. The patient‘s condition gradually improved. On the fifth day he was in good condition released to outpatient care.