Mustard gas toxicity: the acute and chronic pathological effects

Abstract

Ever since it was first used in armed conflict, mustard gas (sulfur mustard, MG) has been known to cause a wide range of acute and chronic injuries to exposure victims. The earliest descriptions of these injuries were published during and in the immediate aftermath of the First World War, and a further series of accounts followed the Second World War. More recently, MG has been deployed in warfare in the Middle East and this resulted in large numbers of victims, whose conditions have been studied in detail at hospitals in the region. In this review, we bring together the older and more recent clinical studies on MG toxicity and summarize what is now known about the acute and chronic effects of the agent on the eyes, skin, respiratory tract and other physiological systems. In the majority of patients, the most clinically serious long-term consequences of MG poisoning are on the respiratory system, but the effects on the skin and other systems also have a significant impact on quality of life. Aspects of the management of these patients are discussed.

The generation of 4-hydroxynonenal, an electrophilic lipid peroxidation end product, in rabbit cornea organ cultures treated with UVB light and nitrogen mustard

“…Earlier studies have shown that ocular exposures to UVB or vesicants results in damage to the corneal epithelium, which involves both acute and chronic keratopathies (Bergmanson, 1990; Ghabili et al , 2010). Depending on dose, inflammation and edema are observed as well as increasing corneal thickness, and sloughing of epithelial cells.…”

The effects of various chemicals on lung, skin and eye: a review

“…For the period of use, mustard gas would be fit into a shell and the liquid would be dispersed through the explosion into an aerosol. Signs of exposure of Mustard gas are inflammation and blistering of skin, burning feeling in eyes and blistering in lining of lungs (Ghabili et al, 2010;Graham & Schoneboom, 2013;Solberg et al, 1997). Only 15-20 years after its use were its late-onset, increasingly harmful effects recognized.…”

“…(1) Eye and skin damage after absorption through the integument and the ocular surface, respectively (2) Respiratory damage after inhalation (3) Systemic toxicity after Swallow or high exposures, manifested as gastrointestinal, circulatory, renal, and bone marrow toxicity (Blodi, 1971;Borak & Sidell, 1992;Duke-Elder & McFaul, 1972;Ghabili et al, 2010;Solberg et al, 1997). Lung problems are among the most common chronic complications of SM intoxication and are commonly accompanied by deregulated manufacture of pro-inflammatory cytokines.…”

Importance of updating old cohorts for new findings

“…First of all, the studies that have been published until now lack adequate quantitative data on exposure 2 4. There are two main scenarios for mustard gas exposure: short-term, one-time, high-level exposure in situations like battlefields and chemical industrial accidents; and long-term, low-level exposure in places like production facilities.…”

“…Young men who survived mustard gas poisoning in those battlefields have been reported to have excess mortality from respiratory cancers 5. Veterans exposed to mustard gas during early and more current interventions have also been reported to suffer from chronic bronchitis 2 4 5…”