Alfaifi Musa S, Alasmari Abrar K, Assiri Abdullah M, Alyahya Bader A, Abdulalem Nafaa A, Albogami Hussein A, Alrougi Hamoud M, Altowairqi Adel M, Saqah Rayyan M, Hamoud Maged A, Ali Hajer F, Al Aseri Zohair A
Department of Emergency Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, KSA.
Assistance Agency for Preventive Health, Saudi Ministry of Health, Riyadh, KSA.
J Taibah Univ Med Sci. 2025 Jan 18;20(1):54-61. doi: 10.1016/j.jtumed.2024.12.012. eCollection 2025 Feb.
Pesticide poisoning remains a major global health concern contributing to an estimated 371,594 deaths annually. Both accidental and deliberate pesticide exposure, particularly in developing countries, pose challenges to public health systems. In KSA, pesticide poisoning is prevalent, and insecticides such as carbamates and organophosphates are the primary culprits.
Four cases of acute poisoning caused by the ingestion of contaminated shawarma sandwiches containing carbofuran and bifenthrin, a carbamate and pyrethroid mixture, respectively, are described. The affected individuals, all siblings, exhibited varying degrees of cholinergic symptoms, including muscle fasciculations, excessive secretions, and respiratory distress. Despite their severe symptoms, three patients had normal or low-normal acetylcholinesterase levels, probably because of individual variability, delayed testing, or improper sample handling. One patient exhibited diminished acetylcholinesterase activity, thus suggesting severe inhibition; pancreatitis was a further complication that contributed to delayed recovery. Early clinical management included atropine, pralidoxime, and botulinum antitoxin, because of initial suspicion for botulism. Toxicological analysis confirmed carbofuran poisoning, and food safety investigations identified improper pesticide use in food preparation areas.
The reported cases underscore the importance of timely toxicological consultation, proper testing, and appropriate sample handling to guide treatment of pesticide-related poisoning. These findings highlight the crucial need for adherence to WHO regulations and monitoring of pesticide use, as well as strict food safety practices to prevent future outbreaks. The successful multidisciplinary approach to managing these cases demonstrates the critical role of coordinated efforts between clinical teams and public health authorities in addressing such public health threats.
农药中毒仍然是一个重大的全球健康问题，估计每年导致371,594人死亡。意外和故意接触农药，尤其是在发展中国家，给公共卫生系统带来了挑战。在沙特阿拉伯，农药中毒很普遍，氨基甲酸盐和有机磷酸盐等杀虫剂是主要罪魁祸首。
描述了4例因摄入分别含有克百威和联苯菊酯（一种氨基甲酸盐和拟除虫菊酯混合物）的受污染沙瓦玛三明治而导致的急性中毒病例。所有受影响的个体都是兄弟姐妹，表现出不同程度的胆碱能症状，包括肌肉震颤、分泌物过多和呼吸窘迫。尽管症状严重，但3名患者的乙酰胆碱酯酶水平正常或略低于正常水平，这可能是由于个体差异、检测延迟或样本处理不当所致。1名患者的乙酰胆碱酯酶活性降低，提示严重抑制；胰腺炎是导致恢复延迟的另一个并发症。由于最初怀疑是肉毒中毒，早期临床治疗包括使用阿托品、解磷定和肉毒抗毒素。毒理学分析证实为克百威中毒，食品安全调查发现食品制备区域存在不当使用农药的情况。
报告的病例强调了及时进行毒理学咨询、正确检测和适当样本处理以指导农药相关中毒治疗的重要性。这些发现突出了严格遵守世界卫生组织法规、监测农药使用以及严格食品安全措施以防止未来疫情爆发的迫切需要。成功的多学科方法处理这些病例表明了临床团队和公共卫生当局之间协调努力在应对此类公共卫生威胁方面的关键作用。
