Cholinergic syndrome: a case report of acute organophosphate and carbamate poisoning

Petreski, Tadej; Kit, Barbara; Strnad, Matej; Grenc, Damjan; Svenšek, Franc

doi:10.2478/aiht-2020-71-3413

Cited by 5 publications

(4 citation statements)

References 11 publications

(28 reference statements)

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“…The main action mechanism of OP compounds is inhibition of cholinergic enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), causing accumulation of neurotransmitter acetylcholine in the synaptic cleft and inducing an excessive stimulation of nicotinic and muscarinic receptors in the central and peripheral nervous system, leading to a paralysis of cholinergic synaptic transmission 8 , 9 . Organophosphate poisoning ultimately results in cholinergic crisis and a variety of symptoms such as miosis, bronchoconstriction, bradycardia, excessive salivation, muscle fasciculations, respiratory depression, loss of consciousness and epileptic seizures 6 , 8 – 10 . Even when exposed individuals receive proper medical care, long-lasting neurological, behavioural and cognitive changes can occur due to excitotoxic damage to the central nervous system 10 – 12 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of four organophosphorus pesticides as inhibitors of human acetylcholinesterase and butyrylcholinesterase

Čadež

Kolić

Šinko

et al. 2021

Sci Rep

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Toxicity of organophosphorus compounds (OPs) remains a major public health concern due to their widespread use as pesticides and the existence of nerve agents. Their common mechanism of action involves inhibition of enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) which are crucial for neurotransmission. Both chronic and acute poisoning by OPs can leave long-lasting health effects even when the patients are treated with standard medical therapy. Therefore, an increasing urgency exists to find more effective oxime reactivators for compounds which are resistant to reactivation, especially phosphoramidates. Here, we investigated in silico and in vitro interactions and kinetics of inhibition for human cholinesterases with four organophosphate pesticides—ethoprophos, fenamiphos, methamidophos and phosalone. Overall, ethoprophos and fenamiphos displayed higher potency as inhibitors for tested cholinesterases. Our results show that methamidophos-inhibited hAChE was more susceptible to reactivation than hAChE inhibited by fenamiphos by selected oximes. Molecular modelling enabled an evaluation of interactions important for specificity and selectivity of both inhibition and reactivation of cholinesterases. Two newly developed reactivators—bispyridinium triazole oxime 14A and zwitterionic oxime RS194B possess remarkable potential for further development of antidotes directed against pesticides and related phosphoramidate exposures, such as nerve agents tabun or Novichoks.

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Section: Introductionmentioning

confidence: 99%

Assessment of four organophosphorus pesticides as inhibitors of human acetylcholinesterase and butyrylcholinesterase

Čadež

Kolić

Šinko

et al. 2021

Sci Rep

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“…Cognitive deficiencies associated with AChE inhibition can be explained by the overstimulation and persistent activation of muscarinic and nicotinic receptors due to acetylcholine accumulation in the synaptic cleft. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 17 ] Intoxication by this type of anticholinesterase accumulates the neurotransmitter acetylcholine in the synaptic cleft by inhibiting cholinesterase, inducing excessive stimulation of nicotinic and muscarinic receptors in the central and peripheral nervous system and paralyzing cholinergic synaptic transmission. [ 18 ]…”

Section: Introductionmentioning

confidence: 99%

Influence of pesticide exposure on farmers’ cognition: A systematic review

Finhler,

Marchesan,

Corona

et al. 2023

JNRP

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Objectives: Pesticide application has become necessary to increase crop productivity and reduce losses. However, the use of these products can produce toxic effects. Farmers are individuals occupationally exposed to pesticides, thus subject to associated diseases as well as cognitive impairment. However, this relation is not well established in the literature, requiring further investigation. To assess the potential association between farmers’ pesticide exposure and cognitive impairment, we followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, considering participants, interventions, comparators, outcomes, and study strategies. Materials and Methods: This study included articles published between 2000 and 2021 on the Scopus, Web of Science, ScienceDirect, and PubMed databases, retrieved by the terms “pesticides and cognition” and “pesticides and memory.” Results: In total, ten studies fit the established criteria and were included in the sample. All had farmers occupationally exposed to pesticides in their sample and only one study dispensed with a control group. Of the neurobehavioral tests, four studies used mini-mental state examination, six neurobehavioral core test batteries (tests recognized in the area), and the remaining, other tests. We observed that 90% of articles found an association between cognitive impairment and pesticide exposure. Overall, five studies measured the activity of cholinesterases in their sample, of which three found significant differences between groups, confirming intoxication in those exposed. Conclusion: Despite the limited number of trials, we found scientific evidence to support the existence of adverse effects of pesticides on farmers’ cognition. We recommend that future studies research similar projects, expanding knowledge on the subject.

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“…cholinergic symptoms. The clinical picture of OPs intoxication may be differentiated -from cholinergic toxidrome, intermediate syndrome, OP-induced delayed polyneuropathy to chronic OP-induced neuropsychiatric disorder (OPIDN) [7]. Severe cholinergic crisis manifests by salivation, lacrimation, bronchospasm, bradycardia or myosis.…”

Section: Introductionmentioning

confidence: 99%

Assessment of hospitalizations of patients after intoxication with organophosphates used in agriculture

Orzeł¹,

Flieger²,

Szlichta³

et al. 2022

Ann Agric Environ Med.

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Introduction. Clinical manifestation of organophosphates toxicity may be differentiate and include cholinergic toxidrome, intermediate syndrome, OP-induced delayed polyneuropathy to chronic OP-induced neuropsychiatric disorder (OPIDN). Patients symptoms, along with decrease in cholinesterase serum level, determines the possible diagnosis of organophosphate poisoning.Objective. The aim of the study was to present the clinical manifestation and cholinesterase level changes in intoxication with organophosphorus compounds in patients. Materials and method. A data base was created by analysis of the hospital documents of 34 patients hospitalized due to organophosphate intoxication. Statistical analysis involved frequency tables with percentage values, the application of non-parametric Chi-square test and parametric t-Student test (with homogeneity of variance Levine test). The level of static significance was set to p=0.05. Results. In fatal hospitalizations (20.6%), cholinesterase level was significantly lower (265.87 U/l) than in other patients (4254.78 U/l; p<0.05). Similarly, levels of cholinesterase were decreased in group of patients with acute respiratory failure (999.79 U/l vs 4943.86 U/l in other patients; p<0.05), patients with multi-organ dysfunction syndrome (244.13 U/l vs 4914.89 U/l in other patients; p<0.05) and those with cardiac arrest (547 U/l vs 4636.25 U/l in other patients). A statistically significant difference was also observed in cholinesterase level of patients who required mechanical ventilation (548.17 U/l vs 5219.71 U/l in other group). The study revealed that 29.4% of poisonings were suicidal. Conclusions. The management of a patient with organophosphate poisoning remains challenging and requires continuous control. A significant step in the diagnostic process is the assessment changes in both the clinical picture and cholinesterase level.

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Cholinergic syndrome: a case report of acute organophosphate and carbamate poisoning

Cited by 5 publications

References 11 publications

Assessment of four organophosphorus pesticides as inhibitors of human acetylcholinesterase and butyrylcholinesterase

Assessment of four organophosphorus pesticides as inhibitors of human acetylcholinesterase and butyrylcholinesterase

Influence of pesticide exposure on farmers’ cognition: A systematic review

Assessment of hospitalizations of patients after intoxication with organophosphates used in agriculture

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