A Fatal Case of Severe Acute Organophosphorus Pesticide Poisoning Complicated with Secondary Hemophagocytic Lympho-Histiocytosis, Severe Lower Intestinal Hemorrhage and Intestinal Mucormycosis

A man in his 50’s, under influence of alcohol, accidentally ingested a pesticide, and was referred for further management and admitted to our hospital. An empty can of Curacron® was found at the site in his farm where he took the alleged pesticide. This raised the suspicion of organophosphorus pesticide poisoning and he was managed at two medical centres before getting admitted to our hospital. His hospital course was complicated with multiorgan dysfunction, shock, respiratory failure and intermediate syndrome. On day five he developed secondary hemophagocytic lymphohistiocytosis (sHLH) and had hematochezia on day six. Colonoscopy revealed multiple circumferential ulcerations in descending and sigmoid colon with luminal narrowing. Biopsy of colonic tissue showed evidence of intestinal Mucormycosis. The clinical presentation of organophosphorus pesticide poisoning in this patient was complicated with multiple issues and included sHLH, chemical gastroenteritis, hemorrhagic ulcers and intestinal zygomycosis. The organophosphorus pesticide ingested by the patient was a 50% emulsifiable concentrate of profenofos along with vegetable oil, soyabean oil and polyglycol ether alkyl aryl sulphate calcium salt 5.25% w/w as an emulsifier/spreading agent. The management of the patient is discussed. Due to the possibility of the emulsifier adhering to the gastrointestinal tract and causing mucosal injury, it is necessary to identify the drug composition and ingredients of the pesticide as soon as possible when managing organophosphorus poisoning.

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Plasma cholinesterase: double-edged parameter in the diagnosis of acute organophosphorus poisoning

Medicine Science and the Law ◽

10.1258/msl.2010.100015 ◽

2010 ◽

Vol 50 (3) ◽

pp. 159-160 ◽

Cited By ~ 4

Author(s):

D R Mahadeshwara Prasad ◽

Hareesh S Gouda ◽

Vinay R Hallikeri

Keyword(s):

Biochemical Marker ◽

Organophosphorus Pesticides ◽

Clinical Signs ◽

Organophosphorus Pesticide ◽

Signs And Symptoms ◽

Acute Poisoning ◽

Plasma Cholinesterase ◽

Pesticide Poisoning ◽

Organophosphorus Poisoning ◽

Clinical Signs And Symptoms

Biochemical markers are one of the mainstays in the diagnosis of ill health. Plasma cholinesterase is one such marker of the ill health caused by acute organophosphorus pesticide poisoning. Organophosphorus pesticides are powerful inhibitors of plasma cholinesterase; consequently, the reduced level of this biochemical marker has been used in the diagnosis of cases of acute poisoning. But how dependable is this biochemical marker in the diagnosis of suspected organophosphorus pesticide poisoning without adequate clinical signs and symptoms? In the case reported here, the low level of plasma cholinesterase which was suspected to be due to organophosphorus poisoning was found to be caused by pulmonary Koch's and hepatitis B with associated malnutrition.

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Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning

Open Life Sciences ◽

10.1515/biol-2021-0069 ◽

2021 ◽

Vol 16 (1) ◽

pp. 703-710

Author(s):

Yuhang Mu ◽

Boqi Hu ◽

Nan Gao ◽

Li Pang

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hospital Mortality ◽

Logistic Regression Analysis ◽

Poor Prognosis ◽

Prognostic Value ◽

Organophosphorus Pesticide ◽

Neutrophil To Lymphocyte Ratio ◽

Pesticide Poisoning ◽

Lymphocyte Ratio

Abstract This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

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