Scenario: Nine workers at a veterinary clinic in Cape Girardeau, Missouri, have

Question

Scenario: Nine workers at a veterinary clinic in Cape Girardeau, Missouri, have reported various symptoms such as shooting pains, muscle weakness and numbness, back pain and tingling of the feet and hands, particularly at night. Your team of investigators, working with a team of physicians, has been sent to the area to determine possible exposure Sources. First of all, what body system seems to be the target of the exposure? What information would you want from these eight affected workers? Now that you have concluded the target system, it is important for you to know that the neurologic examinations revealed that the most severely ill worker had ocular muscle weakness and was unable to maintain an upward gaze. In addition, this person had decreased sensation to light touch below the left knee. Otherwise, all other neurologic findings were unremarkable. Results of plasma and red blood cell cholinesterase activity tests were within the normal range for all workers tested. What agent or agents do you feel may be the culprits in this case? If you are still unsure about the agent causing the problem, here is your final clue. Your investigation and questioning has found that there are 22 different preparations of insecticide dips, shampoos, pills, powders, and sprays used in the clinic or dispensed by the clinic. These products include 12 types of pesticides. Employees use no precautions to protect the skin. How might you secure information regarding the operation at the clinic with sick workers and other pesticide usage by other veterinary clinics?

Explanation / Answer

5. Organophosphates (OPs) are chemical substances originally produced by the reaction of alcohols and phosphoric acid. They function as cholinesterase inhibitors, thereby affecting neuromuscular transmission

Fenthion (Pro-Spot), a pesticide, is a product of Bayer, that controls fleas on dogs at the time of treatment and has good residual activity against many of the fleas that may reinfest the dog after treatment. Organophosphate insecticides, such as diazinon, chlorpyrifos, disulfoton, azinphos-methyl, and fonofos, have been used widely in agriculture and in household applications as pesticides. The health effects associated with organophosphate poisoning are a result of excess acetylcholine (ACh) present at different nerves and receptors in the body because acetylcholinesterase is blocked. Accumulation of ACh at motor nerves causes overstimulation of nicotinic expression at the neuromuscular junction. When this occurs symptoms such as muscle weakness, fatigue, muscle cramps, fasciculation, and paralysis can be seen.

6. Yes,it affects. Exposure was also linked to several brain anomalies. This studies used MRI and compared 20 low CPF exposure children to 20 high CPF exposure children. It was found that although overall brain size did not differ between exposure groups, there were signt areas of the brain that were enlarged in children with high exposure. These enlargements were primarily due to an increase of underlying white matter in the high exposure group. Certain reproductive effects in fertility, growth, and development for males and females have been linked specifically to OP pesticide exposure. Most of the research on reproductive effects has been conducted on farmers working with pesticides and insecticdes in rural areas. For those males exposed to OP pesticides, poor semen and sperm quality have been seen, including reduced seminal volume and percentage motility, as well as a decrease in sperm count per ejacuate. In females menstrual cycle disturbances, longer pregnancies, spontaneous abortions, stillbirths, and some developmental effects in offspring have been linked to OP pesticide exposure.

7. By gently cleanse patients suspected of organophosphate exposure with soap and water because organophosphates are hydrolyzed readily in aqueous solutions with a high pH. Consider clothing as hazardous waste and discard accordingly.

Health care providers must avoid contaminating themselves while handling patients. Use personal protective equipment, such as neoprene gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory protection when decontaminating patients who are significantly contaminated.

Irrigate the eyes of patients who have had ocular exposure using isotonic sodium chloride solution or lactated Ringer's solution. Morgan lenses can be used for eye irrigation.

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