Home Use of a Pyrethroid-Containing Pesticide and Facial Paresthesia in a Toddler: A Case Report.

Alexandra Perkins,Catherine Karr,Blaine Rhodes,Jennifer Sievert,Barbara Morrissey,Frederick Walters

doi:10.3390/ijerph13080829

Abstract

Paresthesias have previously been reported among adults in occupational and non-occupational settings after dermal contact with pyrethroid insecticides. In this report, we describe a preverbal 13-month-old who presented to his primary care pediatrician with approximately 1 week of odd facial movements consistent with facial paresthesias. The symptoms coincided with a period of repeat indoor spraying at his home with a commercially available insecticide containing two active ingredients in the pyrethroid class. Consultation by the Northwest Pediatric Environmental Health Specialty Unit and follow-up by the Washington State Department of Health included urinary pyrethroid metabolite measurements during and after the symptomatic period, counseling on home clean up and use of safer pest control methods. The child’s symptoms resolved soon after home cleanup. A diagnosis of pesticide-related illness due to pyrethroid exposure was made based on the opportunity for significant exposure (multiple applications in areas where the child spent time), supportive biomonitoring data, and the consistency and temporality of symptom findings (paresthesias). This case underscores the vulnerability of children to uptake pesticides, the role of the primary care provider in ascertaining an exposure history to recognize symptomatic illness, and the need for collaborative medical and public health efforts to reduce significant exposures in children.

Highlights

Low dose chronic pesticide exposures are common in the United States and around the world given widespread use in homes, gardens, and agricultural settings [1]
A diagnosis of pesticide-related illness due to pyrethroid exposure was made based on the opportunity for significant exposure, supportive biomonitoring data, and the consistency and temporality of symptom findings
While the elevated 3-phenoxybenzoic acid (3-PBA) metabolite in this case report is consistent with increased exposure, it cannot alone confirm that the child’s symptoms were caused by the pyrethroid, nor that the pesticides sprayed in the home were the source of elevated pyrethroids in the child’s urine

Summary

Introduction

Low dose chronic pesticide exposures are common in the United States and around the world given widespread use in homes, gardens, and agricultural settings [1]. A population-based survey of households with young children found that over 80% reported applying some type of insecticide in the previous year [2]. In the U.S, residential applications have been identified as the most important contributor to children’s exposure to pyrethroid insecticides [6]. We describe a case of pyrethroid insecticide toxicity in a toddler resulting from use of a common household insecticide product. Res. Public Health 2016, 13, 829 reported, especially in countries such as the U.S, where regulatory protections have reduced risk. Public Health 2016, 13, 829 reported, especially in countries such as the U.S, where regulatory protections have reduced risk It is likely some pesticide-related toxicity in children goes unrecognized due to the non-specific presentation of these illnesses

Case History

6–11 Years 95th Percentile

Findings

Discussion

Conclusions