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Dioxin Poisoning

Dioxin poisoning encompasses toxic effects of acute and chronic exposure to one or more of chemicals belonging to the dioxin group. Although environmental low dose exposure over a long period of time is the most common scenario, an acute, high-dose exposure is the most relevant from a diagnostic point of view, since it shows clear clinical signs, such as chloracne.


Presentation

Dioxin poisoning mostly refers to the effects of short-term exposure to high doses of a single chemical or a mixture of congeners belonging to polychlorinated dibenzodioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) or dioxin-like polychlorinated biphenyls (PCBs), commonly known as dioxins [1]. While long-term, environmental exposure to low doses is more prevalent, it also remains asymptomatic for years; hence, it is not the primary point of concern from a diagnostic point of view [2] [3] [4].

In acute poisoning, symptoms appear in stages and clinical manifestations may develop over months [5]. Chloracne are the most evident sign, but they are not the first to appear. Initially, patients present with symptoms of gastrointestinal as well as hepatic and pancreatic dysfunction [3] [5] [6] [7]. These symptoms, indicating poisoning but not specific for dioxins, subside within six weeks. At the same time patients may start experiencing neuropathic pain [5]. Face is affected in up to two weeks after exposure, starting with severe edema, followed by painful, inflammatory, nodular, cystic lesions - chloracne [5] [8] [9]. Severity of chloracne is dose-dependent. Lesions may spread all over the body (except for palms, soles of the feet and area around the eyes) in the months to follow [5] [8]. In some cases dioxin poisoning was accompanied by anemia and amenorrhea [3].

Both, acute and chronic exposure, are associated with delayed effects including immune effects (suppression or autoimmunity), cancer (sarcoma, gastrointestinal, hematologic etc.), endocrine disruption, diabetes, cardiovascular and respiratory diseases [3] [6] [9] [10] [11] [12] [13]. The risk for development of these conditions depends on exposure levels [9].

Overeating
  • In acute poisoning, symptoms appear in stages and clinical manifestations may develop over months. Chloracne are the most evident sign, but they are not the first to appear.[symptoma.com]
  • It can readily pass through the intestines and tends to accumulate in the fat, building up in the body over time.[wisegeekhealth.com]
  • Over 40 days, he ate the same three meals each day: cooked hamburgers and fish burgers and vegetable and fruit salads.[separationsnow.com]
  • Easily propagated over large distances by the means of air, water, To read the rest of this article log in or subscribe to Student BMJ.[student.bmj.com]
  • Unlock Content Over 75,000 lessons in all major subjects Get access risk-free for 30 days, just create an account. Try it risk-free No obligation, cancel anytime.[study.com]
Acneiform Eruption
  • The most prominent is the chloracne--an acute acneiform eruption, usually appearing on facial skin. There is a solid evidence base that some dioxins are carcinogens.[ncbi.nlm.nih.gov]
Amenorrhea
  • In some cases dioxin poisoning was accompanied by anemia and amenorrhea.[symptoma.com]

Workup

In severe cases, diagnostic procedure starts with checking if the patient may have been exposed to dioxins (occupational exposure is the most common one). As initial symptoms are not specific for dioxins, in cases of unknown exposure, it is important to exclude other types of poisoning to facilitate an accurate diagnosis. Given the gradual symptom development, the patient may have to be monitored over several weeks or even months [5].

Concentration of dioxins is expressed per gram of serum lipids. It is considered that levels lower than 31 pg toxic equivalent quantity (TEQ) of total dioxins per gram of lipids do not warrant a high-priority follow-up, while levels higher than 74 pgTEQ/g require further investigation [14] [15] [16]. However, patients' susceptibility to dioxin exposure varies largely, reducing the diagnostic and prognostic significance of serum level quantification [17]. Furthermore, chemical analysis, in addition to being expensive and slow, has to be aimed at a specific compound, while the toxic effects may be produced by a range of substances, similar in chemical structure [1]. Hence, serum levels of dioxins are not routinely determined nor used for screening [1] [18]. Instead, bioassays, such as chemical-activated luciferase gene expression (CALUX) and ethoxy-resorufin-O-deethylase (EROD), using in vitro cell cultures to determine the overall toxicity of a biological sample, are gaining diagnostic and screening significance [18] [19].

Due to characteristic appearance of chloracne, biopsy is not warranted. If biopsy is performed, samples show loss of sebaceous glands which are replaced by characteristic cysts. These lesions are known as hamartomas [5].

Given the wide range of dioxin toxic effects, results of usual blood analyses (biochemical and complete blood count) may be outside the reference ranges. Since these deviations are non-specific, the diagnosis cannot be established solely on their basis.

Treatment

  • To cope with such a severe and painful disease, with no established specific treatment, we designed a strategy based on an aggressive monitoring of the poison, nature, distribution, and elimination--the subject of this report.[eurekalert.org]
  • Should you be diagnosed, treatment will focus on treating the skin condition, lowering the levels of dioxins in your in the bloodstream and repairing as much liver damage as possible. Can it be Prevented? Dioxin poisoning can be prevented.[cuteinjury.co.uk]
  • What treatment will I need if I have dioxin poisoning? Tests are available to measure dioxins in the blood.[thompsons.law]
  • His initial symptoms not only got worse, but he also started complaining of a backache, and the left side of his face became paralysed.3 On 10 September, five days after the gathering, Mr Yushchenko decided to seek treatment at the Rudolfinerhaus clinic[student.bmj.com]
  • Until now, there is no antidotal cure for dioxins, but only symptomatic treatment combined with techniques that accelerate its excretion rate from the body.[ncbi.nlm.nih.gov]

Prognosis

  • Compensation awards and settlements will vary considerably depending on the resulting conditions, they long-term prognosis, and the impact the illness or illnesses have had on a claimant's life.[quittance.co.uk]

Epidemiology

  • […] major books: (1) Toxicology of Organophosphate and Carbamate Compounds, (2) Veterinary Toxicology: Basic and Clinical Principles, (3) Handbook of Toxicology of Chemical Warfare Agents, (4) Anticholinesterase Pesticides: Metabolism, Neurotoxicity, and Epidemiology[books.google.de]
  • Abnet of the Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics in Rockville, Maryland, dioxin is clearly linked to cancer, especially liver cancer, thyroid cancer, upper digestive tract (stomach) cancer, and skin cancers.[livestrong.com]
Sex distribution
Age distribution

Prevention

  • Can dioxin poisoning be prevented? There are ways in which dioxin poisoning can be prevented. It is the responsibility of an employer to make sure that safety practices are observed.[cllegal.co.uk]
  • Can it be Prevented? Dioxin poisoning can be prevented. In a workplace, it is the employer’s responsibility to ensure that the necessary safety practices are observed and that protective clothing and equipment are supplied to staff as needed.[cuteinjury.co.uk]
  • Department of Preventive and Social Medicine researcher Dr David McBride says blood samples were taken from 346 former and current workers now living in Taranaki who agreed to participate.[sciencealert.com]
  • When the shells are pulverised and deactylated, the chitin is converted to chitosan , a fibrous material that has been claimed to reduce body weight by absorbing fats, so preventing them from being absorbed by the body.[separationsnow.com]
  • How can dioxin poisoning be prevented? All employers are obliged to protect their workers, including from exposure to dioxins and other chemicals, in line with national regulations called “The Control of Substances Hazardous to Health”.[thompsons.law]

References

Article

  1. Srogi K. Levels and congener distributions of PCDDs, PCDFs and dioxin-like PCBs in environmental and human samples: a review. Environmental Chemistry Letters. 2007;6(1):1-28
  2. Geusau A, Abraham K, Geissler K, Sator MO, Stingl G, Tschachler E. Severe 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) Intoxication: Clinical and Laboratory Effects. Environmental Health Perspectives. 2001;109(8):865
  3. Rysavy NM, Maaetoft-Udsen K, Turner H. Dioxins: diagnostic and prognostic challenges arising from complex mechanisms. Journal of Applied Toxicology. 2012;33(1):1-8
  4. Connor KT, Harris MA, Edwards MR, et al. AH receptor agonist activity in human blood measured with a cell-based bioassay: Evidence for naturally occurring AH receptor ligands in vivo. Journal of Exposure Science and Environmental Epidemiology. 2008;18(4):369-380
  5. Saurat JH, Kaya G, Saxer-Sekulic N, et al. The Cutaneous Lesions of Dioxin Exposure: Lessons from the Poisoning of Victor Yushchenko. Toxicological Sciences. 2011;125(1):310-317
  6. Ovando BJ, Ellison CA, Vezina CM, Olson JR. Toxicogenomic analysis of exposure to TCDD, PCB126 and PCB153: identification of genomic biomarkers of exposure to AhR ligands. BMC Genomics. 2010;11(1):583
  7. Macpherson L, Matthews J. Inhibition of aryl hydrocarbon receptor-dependent transcription by resveratrol or kaempferol is independent of estrogen receptor α expression in human breast cancer cells. Cancer Letters. 2010;299(2):119-129
  8. Sorg O, Zennegg M, Schmid P, et al. 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) poisoning in Victor Yushchenko: identification and measurement of TCDD metabolites. The Lancet. 2009;374(9696):1179-1185
  9. Marinković N, Pašalić D, Ferenčak G, Gršković B, Rukavina A. Dioxins and Human Toxicity. Archives of Industrial Hygiene and Toxicology. 2010;61(4).
  10. Stevens EA, Mezrich JD, Bradfield CA. The aryl hydrocarbon receptor: a perspective on potential roles in the immune system. Immunology. 2009;127(3):299-311
  11. International Agency for Research on Cancer (IARC). Polychlorinated dibenzo-para-dioxins and polychlorinated dibenzofurans. IARC monographs on the evaluation of carcinogenic risks to humans, Volume 69. Geneva: IARC; 1997.
  12. Brembilla NCBC, Ramirez J-M, Chicheportiche R, Sorg O, Saurat J-H, Chizzolini C. In Vivo Dioxin Favors Interleukin-22 Production by Human CD4 T Cells in an Aryl Hydrocarbon Receptor (AhR)-Dependent Manner. PLoS ONE. 2011;6(4).
  13. Bertazzi PA. Health Effects of Dioxin Exposure: A 20-Year Mortality Study. American Journal of Epidemiology. 2001;153(11):1031-1044
  14. Lakind JS, Hays SM, Aylward LL, Naiman DQ. Perspective on serum dioxin levels in the United States: an evaluation of the NHANES data. Journal of Exposure Science and Environmental Epidemiology. 2008;19(4):435-441
  15. Passarini B, Infusino SD, Kasapi E. Chloracne: Still Cause for Concern. Dermatology. 2010;221(1):63-70
  16. Aylward LL, Lakind JS, Hays SM. Derivation of Biomonitoring Equivalent (BE) Values for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) and Related Compounds: A Screening Tool for Interpretation of Biomonitoring Data in a Risk Assessment Context. Journal of Toxicology and Environmental Health, Part A. 2008;71(22):1499-1508
  17. Saurat J, Sorg O. Chloracne, a Misnomer and Its Implications. Dermatology. 2010;221(1):23-26
  18. Vanwouwe N. Validation of the CALUX bioassay for PCDD/F analyses in human blood plasma and comparison with GC-HRMS. Talanta. 2004;63(5):1157-1167.
  19. Tsutsumi T, Amakura Y, Nakamura M, et al. Validation of the CALUX bioassay for the screening of PCDD/Fs and dioxin-like PCBs in retail fish. The Analyst. 2003;128(5):486-492

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Last updated: 2018-06-22 07:47