Outbreak of carbofuran and bifenthrin poisoning in siblings after ingestion of contaminated food in KSA: Clinical management and public health implications.

Musa S Alfaifi, Abrar K Alasmari, Abdullah M Assiri, Bader A Alyahya, Nafaa A Abdulalem, Hussein A Albogami, Hamoud M Alrougi, Adel M Altowairqi, Rayyan M Saqah, Maged A Hamoud, Hajer F Ali, Zohair A Al Aseri
Author Information
  1. Musa S Alfaifi: Department of Emergency Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, KSA.
  2. Abrar K Alasmari: Assistance Agency for Preventive Health, Saudi Ministry of Health, Riyadh, KSA.
  3. Abdullah M Assiri: Assistance Agency for Preventive Health, Saudi Ministry of Health, Riyadh, KSA.
  4. Bader A Alyahya: Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, KSA.
  5. Nafaa A Abdulalem: Department of ICU, Ahd Rofidah General Hospital, Kamis Mushayt, KSA.
  6. Hussein A Albogami: Public Health Agency, General Directorate of Environmental Health, Ministry of Health, KSA.
  7. Hamoud M Alrougi: Public Health Agency, General Directorate of Environmental Health, Ministry of Health, KSA.
  8. Adel M Altowairqi: Emergency Medicine Department, Alhada Armed Force Gospital, Taif, KSA.
  9. Rayyan M Saqah: Public Health Agency, General Directorate of Environmental Health, Ministry of Health, KSA.
  10. Maged A Hamoud: Pediatric Department, Maternity & Children's Hospital, Bisha, KSA.
  11. Hajer F Ali: Pediatric Department, Maternity & Children's Hospital, Bisha, KSA.
  12. Zohair A Al Aseri: Department of Clinical Sciences, College of Medicine and Riyadh Hospital, Dar Al Uloom University, Riyadh, KSA.

Abstract

Background: 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.
Case presentation: 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.
Conclusion: 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.

Keywords

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Word Cloud

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