Chapter 5 - Early and Delayed Effects of Sulfur Mustard in Iranian Veterans After the Iraq–Iran Conflict

Abstract

Sulfur mustard (SM) is a chemical warfare agent that was widely used during World War I and during the Iran–Iraq conflict in from 1983 to 1988. It may also be used for chemical terrorism. SM is an alkylating agent that affects DNA synthesis, and delayed complications have been considered since World War I. Delayed complications of SM poisoning in different organs and their severity correlations were studied in Iranian veterans. Hematological and immunological investigations were also performed using a control group of 35 healthy male subjects. Forty male patients (aged 43.8±9.8 years) with confirmed SM poisoning 16–20 years after SM exposure were studied. The most common complications were found in the lungs (95%), peripheral nerves (77.5%), skin (75%), and eyes (65%). White blood cells, red blood cells, hematocrit (HCT), IgM, C3, and the percentages of monocytes and CD3+ lymphocytes were significantly higher (P<0.042), and the percentage of CD16+56 (natural killer) cells was significantly lower (P=0.006) in the patients than in the control group. The severity of respiratory complications revealed a significant correlation with the severity of ocular complications (r=0.322, P=0.043), as well as with hemoglobin (r=0.369, P=0.024) and HCT (r=0.470, P=0.003). Although late complications of SM poisoning in the skin, eyes, and respiratory system are mainly attributable to the direct toxic effects, the neuromuscular, hematological, and immunological complications are probably the result of systemic toxicity. Cardiovascular complications such as myocardial perfusion abnormalities and coronary ectasis have recently been observed in these patients.