Reversible Parkinsonism after accidental oral intake of mancozeb

Abstract

Mancozeb is a ethylene-bis-dithiocarbamate (EBDC) fungicide that contains zinc and manganese. 1 In humans, chronic EBDC inhalation has been associated with neurocognitive impairment and parkinsonism 2 while acute intoxication elicit reversible headache, dizziness, and seizures in a few cases, all of which were rapidly reversible. 3 We report a case of severe and reversible parkinsonism in a man after the accidental oral ingestion of mancozeb.A 55-year-old man with history of alcohol abuse was admitted with a 4 days alcohol withdrawal. At examination, he was found to be alert, oriented, and showed postural tremor and diaphoresis. Treatment with tiapride (300 mg/day during 4 days) and thiamine was started. On the fourth day of hospitalization, he was diagnosed of acute cholecystitis and was surgically treated. Seven days later, he was found to be confused. At physical examination, the patient was alert, slow minded, and disoriented. He had a masked facies (video, segment 2) dysarthria and hypophonia resulting in his speech being unintelligible. He was noted to have poverty and slowness of movements (video, segment 2) and generalized cogwheel rigidity (video, segment 1), particularly in the jaw. His posture was stooped and he was unable to walk without assistance (video, segment 3). Bilateral resting tremor and isolated reflex myoclonus were observed. Startle reflex was pathologic. All deep tendon reflexes were brisk. He recognized having intake accidentally 5 g of a vegetable fungicide containing mancozeb.Laboratory test showed normal concentrations of blood glucose, creatinine, alkaline phosphatise, total bilirrubin, aspartate aminotransferase, and alanine aminotransferase level. c-Glutamyl transferase was 112 U/L (normal range 6-38). Hepatitis B and C serologies were negative. Serum ammonium was within normal range but serum or urine manganese was not assessed. Cerebral magnetic resonance (MR) showed moderate generalized atrophy. Electroencephalogram was normal. SPECT examination using [ 123 I]FP-CIT showed a normal dopamine transporter (DAT) uptake in both putamen. Levodopa-carbidopa therapy was initiated with no motor improvement and was interrupted few weeks later. During the following 8 months, the neurological symptoms spontaneously remitted and 16 months later, he was still abstinent and without signs of parkinsonism.

Mancozeb induces testicular dysfunction through oxidative stress and apoptosis: Protective role of N-acetylcysteine antioxidant

“…It is widely utilized for the control of a wide range of diseases in agricultural, horticultural, and ornamental crops. Several studies have shown that exposure to MZB can cause complications, including neurotoxicity (Bailey et al, 2016;Domico et al, 2006;Erro et al, 2011), carcinogenicity (Belpoggi et al, 2002), genotoxicity (Srivastava et al, 2012(Srivastava et al, , 2016, and reproductive toxicity (Bindali and Kaliwal, 2002;Iorio et al, 2015;Joshi et al, 2005;Kackar et al, 1997;Runkle et al, 2017;Girish and Reddy, 2018), which might lead to various degrees of infertility.…”

Acute exposure to a Mn/Zn ethylene-bis-dithiocarbamate fungicide leads to mitochondrial dysfunction and increased reactive oxygen species production in Caenorhabditis elegans

“…Additionally, hydrogen peroxide, which was greatly increased following MZ-treatment, is a well-documented signaling molecule, activating both pro- and anti-survival pathways in cells (Gough and Cotter, 2011; Sies, 2014). Although reports of toxicity resulting from acute MZ exposure of humans generally leads to signs and symptoms associated with the nervous system (Erro et al, 2011; Israeli et al, 1983a, b), others have reported immunomodulatory effects (Corsini et al, 2005; Corsini et al, 2006), neural tube defects (Nordby et al, 2005), and contact dermatitis (Higo et al, 1996; Koch, 1996). In many cases, no mechanism of action is provided.…”

“…Documented cases of movement abnormalities attributed to neurotoxicity following acute exposure to commercially available maneb or mancozeb formulations have been reported for decades (Colosio et al, 1996; Erro et al, 2011; Israeli et al, 1983a, b). Recognition of the potential toxicity of MZ and maneb led to studies involving the active ingredient.…”