Parenteral injection of organophosphate insecticide: apropos of two cases

Abstract

Two cases of parenteral injection of organophosphate insecticide are reported. A 20-year-old man injected himself malathion intramuscularly. The developed necrosis in the injection set and abscess formation, and developed a severe poisoning reaction of late onset that was fully manifested 60 hours after the injection. A 22-year-old girl injected herself subcutaneously a small amount of fenitrothion and had severe swelling of the affected limb and a sterile abscess. In cases of parenteral injection of organophosphates, attention must be paid to the possibility of late onset of the clinical manifestations of the poisoning, and to the fact that usual measures to reduce exposure to the organophosphate, such as induction of vomiting, gastric lavage and use of activated charcoal are probably ineffective. Local complications at the site of the injection, like necrosis and abscesses are also expected findings.

Subcutaneous injection of household spray insecticide: a rare cause of soft tissue damage

“…Contrary to almost all reported cases (except case 2 reported by Nishioka [2]), which consisted of young males (16-40 years old), all with prior history of intravenous drug abuse, our patient was an elderly woman with no prior background of intravenous drug abuse. This suggests an age-related inflammatory response that is attenuated in the elderly or exaggerated in young adults by previous nonsterile parenteral injections.…”

“…In our case abscess formation and fever were not evident until the ninth day of hospitalization. This prolonged course stands in contrast to cases reported earlier, in which abscess formation was evident as soon as the second or third day after admission [1,2,4]. Wedin and Jones [4] further stress the necessity of early decompression, since in their report of a similar case considerable amounts of purulent discharge were evacuated from the affected limb, even in the absence of fluctuation or pustules.…”

“…Subcutaneous, intramuscular, and even intravenous injection of commercially available insecticides has been documented in the literature, but these are extremely rare forms of suicidal attempts [1,2,4]. The active ingredients in household spray insecticides are cholinesterase inhibitors, usually carbamates or pyrethrine derivatives.…”

“…Systemic poisoning is more likely to occur with the intravenous or intramuscular route rather than with a subcutaneous injection as is the case in this presentation. However, one should closely monitor these patients for a few days as poisoning can be fully manifested and may eventually be fatal only 60 h after injection, when plasma levels of cholinesterase inhibitors peak [2]. Care should be taken to monitor the possible late onset of these clinical manifestations.…”

“…The use of tourniquets (lymphatic, venous, or arterial), suction devices (including liposuction), saline infiltration/irrigation, or other forms of immediate treatment are not discussed in the literature reviewed. Nishioka [2] suggest local débridement as a means of removal of the affected tissue. In our view this may be an overly aggressive intervention.…”