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Introduction: Organochlorine pesticides continue to be used in several developing countries despite concerns regarding their toxicity profile. Endosulfan is an organochlorine recognized as an important agent of acute toxicity., Methods: In this retrospective study, the clinical features, course, and outcomes among patients with acute endosulfan poisoning requiring admission to the hospital during an 8-year period (1999-2007) were reviewed., Results: Among 34 patients hospitalized during this study period for alleged organochlorine poisoning, 16 patients with endosulfan poisoning were identified. The majority (75%) received initial treatment at a primary or secondary center. Neurological toxicity predominated, particularly low sensorium (81%) and generalized seizures (75%), including status epilepticus (33%). Other features observed included hepatic transaminase elevation, azotemia, metabolic acidosis, and leukocytosis. Mechanical ventilation was required in 69% and vasoactive agents in 19%. In-hospital mortality was 19%. There were no gross neurological sequelae at discharge. In three other patients who presented with organochlorine poisoning, the compounds ingested were lindane, endrin, and dicofol (n = 1 each). The course and outcomes in these patients were unremarkable and all three patients survived., Conclusions: Endosulfan is capable of high lethality and significant morbidity. The commonest manifestations are neurological although other organ dysfunction also occurs. In the absence of effective antidotes, restriction of its availability, along with prompt treatment of toxicity, including preemptive anticonvulsant therapy are suggested.

Information in the open literature about the fate and effects of pesticides in small streams from agricultural areas of Argentina is very rare. The objective of the present work was to study the pesticide contamination and potential biological effects in basins that have undergone intense agricultural activity, mainly related to the cultivation of soybeans. Three streams (Maguire, Helves, and Horqueta) with a low-flow discharge (0.1 and 0.2 m3/s) in March close to the city of Arrecifes were studied during the period of maximum insecticide application, between February and April 2001. Various sampling devices were installed to trap suspended particles, runoff, and floodwater plus sediment throughout the study period. The suspended-particle samples were analyzed for the insecticides endosulfan (END), chlorpyrifos, and cypermethrin. Water chemistry and the macroinvertebrate communities were assessed on four occasions and the organismic drift was measured continuously. Following a 184-mm rainfall on March 1, 2001, beta-endosulfan concentrations up to 318 and 43 microg/kg were measured from suspended-particle samples from Horqueta and Helves, respectively. No END contamination was detected in Maguire. Chlorpyrifos and cypermethrin were not detected in any of the streams. A significant decrease in the average macroinvertebrate species density was observed in Horqueta (from 12.8 +/- 0.5 to 9 +/- 0.7 species; ANOVA, p < 0.05) and Helves (from 10.8 +/- 1.7 to 3.3 +/- 1.3 species; p < 0.001) following the same rainfall event at the beginning of March, while the species density in Maguire remained constant at 7.9 +/- 0.3 species. The runoff primarily reduced species abundances of Odonata and Ephemeroptera significantly (p < 0.01) in Horqueta and Helves but not in Maguire. A greater drift of Smicridae (Trichoptera) and Ephemeroptera occurred in Helves and Horqueta during this runoff event, while no changes in the macroinvertebrate drift were detectable in Maguire. This study highlights the potential pesticide effects on macroinvertebrate communities in Argentinian rural streams. It is suggested that a small wetland area formed by Maguire between the agriculturally used catchment and the sampling site contributes to the absence of contamination and effects at this site.

Introduction: A number of families in a rural area of Jabalpur District (Madhya Pradesh), India, were affected by repeated episodes of convulsive illness over a period of three weeks. The aim of this investigation was to determine the cause of the illness., Methods: The investigation included a house-to-house survey, interviews of affected families, discussions with treating physicians, and examination of hospital records. Endosulfan poisoning was suspected as many villagers were using empty pesticide containers for food storage. To confirm this, our team collected blood and food samples, which were transported to the laboratory and analyzed with GC-ECD., Results: Thirty-six persons of all age groups had illness of varying severity over a period of three weeks. In the first week, due to superstitions and lack of treatment, three children died. In the second week, symptomatic treatment of affected persons in a district hospital led to recovery but recurrence of convulsive episodes occurred after the return home. In the third week, 10 people were again hospitalized in a teaching hospital. Investigations carried out in this hospital ruled out infective etiology but no facilities were available for chemical analysis. All persons responded to symptomatic treatment. The blood and food samples analyzed by our team showed presence of endosulfan, which was confirmed by GCMS. One of the food items (Laddu) prepared from wheat flour was found to contain 676 ppm of alpha-endosulfan., Conclusions: Contamination of wheat grains or flour with endosulfan and its consumption over a period of time was the most likely cause of repeated episodes of convulsions, but the exact reason for this contamination could not be determined. This report highlights the unsafe disposal of pesticide containers by illiterate farm workers, superstitions leading to delay in treatment, and susceptibility of children to endosulfan.

There is experimental evidence of adverse effects of endosulfan on the male reproductive system, but there are no human data. Therefore, we undertook a study to examine the relationship between environmental endosulfan exposure and reproductive development in male children and adolescents. The study population was composed of 117 male schoolchildren (10-19 years of age) of a village situated at the foothills of cashew plantations, where endosulfan had been aerially sprayed for more than 20 years, and 90 comparable controls with no such exposure history. The study parameters included recording of clinical history, physical examination, sexual maturity rating (SMR) according to Tanner stages, and estimation of serum levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone, and endosulfan residues (70 study and 47 control subjects). Mean +/- SE serum endosulfan levels in the study group (7.47 +/- 1.19 ppb) were significantly higher (p < 0.001) than in controls (1.37 +/- 0.40 ppb). Multiple regression analysis showed that SMR scoring for development of pubic hair, testes, penis, and serum testosterone level was positively related to age and negatively related to aerial exposure to endosulfan (AEE; p < 0.01). Serum LH levels were significantly positively related to AEE after controlling for age (p < 0.01). The prevalence of congenital abnormalities related to testicular descent (congenital hydrocele, undescended testis, and congenital inguinal hernia) among study and controls subjects was 5.1% and 1.1%, respectively, but the differences were statistically nonsignificant. Our study results suggest that endosulfan exposure in male children may delay sexual maturity and interfere with sex hormone synthesis. Our study is limited by small sample size and nonparticipation.

Unrestricted use of endosulfan, a cyclic chlorinated hydrocarbon insecticide, results in many intentional and unintentional toxicities in Turkey. Due to its chemical stability in the environment, toxicity may be seen even if exposure happens 6-mo after the endosulfan has been sprayed. We discuss a case of 2 patients with unintentional exposure to endosulfan after eating contaminated foods, one of which presented with neurological manifestations and required mechanical ventilation, the other having only mild symptoms. Because of the toxicity to humans and threats for nature, use of endosulfan should be restricted or banned.

Endosulfan poisoning was observed in cattle where the owner applied the insecticide topically as ectoparasitic control. Two of 11 cattle died in 2 d with rapid and difficult breathing, foamy exudates in the mouth, tremors, exophthalmos and coma. At necropsy, hemorrhages were on the serosal membranes of the visceral organs and lungs, and there was severe edema and emphysema in the lungs. The levels of endosulfan in the liver, kidney, lungs and muscle were 13.1, 4.0, 1.6 and 0.8 ppm, respectively.

To commit suicide, three young adults swallowed a relatively small amount of a widely used insecticide containing endosulfan. They developed recurrent epileptic seizures. After hospitalization they were treated and recovered without any sequel. These seizures were classified as acute symptomatic or provoked seizures. We suggest that if one faces acute repetitive seizures, especially in the rural areas, an intoxication such as endosulfan intoxication should be considered when the etiology is uncertain even in the absence of any signs of intoxication.

Background: Endosulfan is not a restricted use organochlorine insecticide and is currently under re-registration review. In 1993, one confirmed case and one possible case of endosulfan poisoning in agricultural workers occurred in two southeastern states., Methods: Two cases of suspected endosulfan poisoning were investigated utilizing record reviews, blood samples, a site visit, and clothing analysis., Results: Case 1 was fatal; Case 2 resulted in permanent neurological impairment. Additionally, Case 1 mixed and applied two less toxic pesticides, acephate and maleic hydrazide to tobacco plants. Both farm owners had ample opportunity for endosulfan exposure while mixing concentrated endosulfan with water and applying the solution to tobacco with boom sprayers pulled by tractors., Conclusions: Estimates of the absorbed dose of endosulfan were not available because methods to determine actual personal exposure that would be found in fat or tissue samples were not used. Health and safety issues associated with endosulfan require a closer examination. A cooperative multi-disciplinary approach to providing timely accurate education is needed to prevent pesticide poisonings., (Copyright 2001 Wiley-Liss, Inc.)

Objectives: The objective of the study is to identify the clinical profile of endosulfan poisoning and also to recognise any biochemical parameters which indicate clinical or subclinical dysfunction of organs so that the offending agent can be easily identified in a given case of poisoning and appropriate treatment instituted promptly., Methods: Forty four individuals who consumed food which was accidentally contaminated by endosulfan in a rural area were the subjects of the present study. Except the one who died, rest 43 were examined by the authors. A details history, regarding the item of food taken and quantity consumed was noted. Routine bio-chemical parameters like CBC, blood urea, serum creatinine, serum electrolytes, LFT, S Calcium, S Phosporus, were estimated, in fourteen of the patients who were admitted into this hospital. In seven of the patients who were available for follow up, laboratory parameters which were abnormal initially were repeated., Results: Examination revealed that vital signs were stable. There was no jaundice, central nervous system examination showed varying grades of altered sensorium, normal sized pupils briskly reacting to light, normal oculocephalic reflex. There were no lateralising signs like hemiparesis. Plantars were bilateral extensor. There were no signs of meningeal irritation. Complete blood counts, blood sugar, urea, serum creatinine, serum electrolytes were all normal. Liver function tests in the form of SGPT, SGOT were abnormal. Serum bilirubin levels were normal. The values of SGOT and SGPT returned to normal at the end of six weeks. All patients were treated symptomatically. A postmortem examination carried out on the individual who died due to status epilepticus confirmed that the death was due to asphyxia., Conclusions: Endosulfan poisoning can be suspected by the primary CNS manifestations with or without clinical or laboratory evidence of other organ dysfunction like liver, kidney and muscle.

Eighteen cases of endosulfan poisoning by accidental overexposure during spray, admitted between October 1995 to September 1997, were observed and analyzed. These accounted for approximately one third of the total number of poisoning cases admitted in our unit during this period. Nausea, vomiting abdominal discomfort, tonic and clonic convulsions, confusion, disorientation, and muscular twitchings were cardinal manifestations. None of the patients succumbed to their illness. Analysis of various incriminating factors revealed that accidental overexposure was due to failure to adhere to the instructions for spray either due to ignorance or due to illiteracy. All the patients avoided preventive measures and developed toxicity both due to inhalation and absorption through skin. Endosulfan (a chlordiene derivative) poisoning is gaining up momentum in this part of world and has become an important matter for public health in India.

Case Report: A case of nonaccidental endosulfan intoxication in a previously healthy 43-year-old male patient is reported. On admission, the patient had few symptoms, but refractory seizures began 1 hour after ingestion. The patient died on the fourth day after admission showing clinical signs of cerebral herniation confirmed at autopsy. Blood, urine, and tissue samples were analyzed for alpha-endosulfan, beta-endosulfan, and endosulfan sulfate by capillary gas chromatography with electron capture detection. Concentration versus time data for endosulfan were fitted using the program MW/Pharm, assuming complete bioavailability although it is recognized that the bioavailability of endosulfan after ingestion may have been low and the calculated clearance was primarily due to redistribution. Hemoperfusion was shown to be ineffective.

We report a teenage girl with acute endosulfan poisoning who developed psychosis, generalized tonic-clonic seizures, myoclonic jerks, cortical blindness and limb rigidity. Serial magnetic resonance imaging (MRI) showed bilateral reversible lesions localized to caudate nucleus, putamen and occipital cortex; internal capsule and thalamus were spared. This selective involvement may have a bearing on mechanisms underlying endosulfan toxicity.

Two cattle died acutely after being sprayed for lice control with a cyclodiene organochlorine insecticide, endosulfan, not labelled for use in cattle. Three other cattle became acutely ill, but survived after symptomatic therapy and removal of the insecticide from their skin and prevention of enterohepatic circulation. These cases illustrated the risk of acute toxicosis when organochlorine insecticides are used off-label and the potential for illegal tissue and milk residues.

Objective: We report the first case of intravenous self-poisoning with Thiodan (30% endosulfan in xylene)., Case Report: A 28-year-old woman with a past history of epilepsy presented with refractory grand mal seizures after injecting 1 mL of Thiodan intravenously. She developed liver dysfunction, proximal myopathy secondary to rhabdomyolysis and renal failure., Interventions and Outcomes: The seizures were terminated with midazolam and thiopentone. Mechanical ventilation was required for nine days. Renal and liver dysfunction resolved with supportive measures only. Hemodialysis was not required. Pulmonary complications and neurological sequelae were minimal with the patient making a full recovery over three months., Conclusion: The intravenous adminis-tration of a small dose of endosulfan in xylene caused the rapid onset of severe grand mal seizures. The absence of pulmonary edema in this case suggests aspiration to be the cause of pulmonary toxicity due to oral endosulfan poisoning.