Acute Respiratory Distress Syndrome Caused by Mercury Inhalation: A Case Report

Health Impact Assessment of Artisanal and Small-Scale Gold Mining Area in Myanmar, Mandalay Region: Preliminary Research

Increasing artisanal and small-scale gold mining (ASGM) in developing countries has raised health concerns in mining communities. A preliminary health survey was conducted in Thabeikkyin Township, Mandalay Region, Myanmar, in February 2020 to assess the health conditions of an ASGM community. Respiratory function and other clinical assessments were evaluated in miners and non-miners, and participants’ hair was analyzed for heavy metals. Respiratory function of miners was similar to that of non-miners. However, miners’ respiratory function declined with longer mining activity duration. In total, 3 out of 18 miners showed neurological signs and symptoms of chronic mercury intoxication. The median concentration of the hair mercury was significantly higher in miners than non-miners (P = 0.01), and 9 out of 18 miners and 2 out of 11 non-miners showed the warning level of mercury. We found that, despite an association between declining respiratory function and length of time mining, only a minority of miners showed clinical features of chronic mercury intoxication. Further clinical surveys with a larger sample size are necessary to determine the broader health status of this community. In addition, clinical indicators such as pulmonary function tests are recommended as additional criteria for the diagnosis of mercury intoxication.

Mercury intoxication resembling pediatric rheumatic diseases: case series and literature review

Mercury is the only metal that remains in liquid form at the room temperature. It is a very toxic metal and even short-term exposure can lead to poisoning. Mercury intoxication can affect many systems such as skin, cardiovascular, genitourinary, central and peripheral nervous, respiratory, and musculoskeletal system. Consequently, the diagnosis of mercury intoxication can be challenging due to its non-specific and multisystemic presentation. Herein, we report five pediatric cases with mercury intoxication from two families that were initially misdiagnosed as rheumatic disorders. We also performed a literature review about pediatric cases with mercury intoxication to investigate the clinical findings in children, the source of intoxication, and the current treatment preferences. As in our cases, reported patients were previously misdiagnosed as various infectious and/or rheumatic diseases before the diagnosis of mercury intoxication was established. A delay in diagnosis and treatment can cause serious morbidities and even mortality. We report this case series to emphasize the multisystemic presentation of mercury intoxication, and to remind and provide clues for physicians to recognize this rare toxicologic syndrome.

Mercury levels in human hair in South India: baseline, artisanal goldsmiths and coal-fired power plants

India is a major emitter of mercury to the environment, mainly due to emissions from coal-fired power plants. Consumption of fish and rice, two important pathways for human exposure to mercury, is particularly high in South India. Here, we report concentrations of total mercury in hair (THg_hair) in 668 participants from South India. Three cities were covered: (i) a city on the east coast with four active coal-fired thermal power plants (Nellore), (ii) a city on the west coast with no major mercury source (Vasco da Gama), and (iii) a metropolitan city in the interior with no major mercury source (Hyderabad). Geometric mean of THg_hair of the entire study population is 0.14 µg/g (95% confidence interval, CI: 0.13-0.15 µg/g). Significant predictor variables are age, fish consumption, and occupations such as dental studies, subsistence fishing, and artisanal goldsmithing (which is different from artisanal scale gold mining). Our results support the hypothesis that people living in a city with active coal-fired power plants may have higher THg_hair than those in cities with no major mercury source.