Grand rounds: an outbreak of toxic hepatitis among industrial waste disposal workers

Alterations in viscera histoarchitecture and organosomatic index as biomarkers of toxicity induced by Aba-Eku and Olusosun solid waste landfill leachates in Rattus norvegicus

Solid waste disposal generates leachate, a mixture of deleterious chemical, physical and microbial contaminants, which poses risk to human and wildlife health. Leachate toxicity on relative organ weight and histopathology of important viscera in mammalian body is scarce. Leachate induced toxic effects on organosomatic indices and histopathology of vital mammalian organs were investigated. Wister rats were orally exposed to 1 - 25 % of raw and simulated leachates from Aba-Eku and Olusosun landfills for 30 days. At post-exposure, organosomatic index and histoarchitectural assessment of major viscera (heart, spleen, thymus and lungs) were conducted. The physico-chemical and organic compositions of the leachates were analysed using standard protocol. The tested leachates decreased weekly and terminal body weights, and altered organosomatic index of examined viscera in rats. The histoarchitecture of the investigated viscera revealed pathologies that ranged from mild to severe degeneration, cellular infiltration, haemorrhage, congestion, necrosis, disorganization of tissues and vacuolations. Others include increased histiocytes within the bronchial associated lymphoid, lymphoid depletions, haemosiderin deposits and apoptosis were observed in the examined viscera. Physico-chemical analysis of the leachates showed different concentrations of toxic metals, PAHs and PCBs that were higher than national and international permissible limits allowed in wastewaters. The physico-chemical compositions of the leachates are capable of eliciting the observed alterations in organosomatic indices and histopathological lesions in mammalian viscera. Xenobiotic components of the leachates possibly generated free radicals and/or directly disrupted the organ architectures. These findings suggest health risk to wildlife and human population exposed to emissions from waste landfills.

Clinical manifestation score and characterization of cytokines and lymphocytes of dimethylacetamide-induced toxic hepatitis in spandex workers

Occupational exposure to dimethylacetamide (DMAc) has been reported to cause toxic hepatitis. Sixty spandex workers were included in this study to research the clinical manifestations and expression of cytokines and lymphocytes in DMAc-induced toxic hepatitis. Chinese drugs (reduced glutathione and Hugan tablets) were used to treat them. The manifestations including jaundice, asthenia, appetite, nausea, emesis, abdominal distension, yellow urine, and dizziness were scored. The percentages of patients rated as 0-3, 4-6, 7-9, and 10-12 points were 33.3%, 43.3%, 21.7%, and 1.7%, respectively, before treatment, and all patients showed 0-3 points after the treatment. The ultrasonic and CT imaging revealed diffuse intrahepatic hypodensity, intrahepatic calcification, signs of liver injury, and splenomegaly, which improved after therapy. Blood analysis showed that ALT, AST, TBIL, IL-6, IL-10, TNF-α, IFN-γ, CD3⁺%, and CD4⁺/CD8⁺ statistically decreased after drug treatment. Correlation analysis demonstrated positive linear correlations between ALT and TBIL, AST and TBIL, IL-10 and ATL, IL-10 and AST, IL-10 and TBIL, IFN-γ and IL-6, IFN-γ and TNF-α, and CD3⁺% and ALT. Pro-inflammatory cytokines and lymphocytes in DMAc-induced toxic hepatitis reflected an active immune state that decreased after treatment. IL-10 may inhibit the immune response in this disease, as a protective mechanism.

Wild black rats (Rattus rattus Linnaeus, 1758) as zoomonitor of genotoxicity and systemic toxicity induced by hazardous emissions from Abule Egba unsanitary landfill, Lagos, Nigeria

Wild black rats (Rattus rattus) inhabiting Abule Egba landfill (AEL) were used as zoomonitor to assess health risk associated with exposure to hazardous chemicals from landfills. Twenty five R. rattus (16♂ and 9♀) captured within AEL and 15 (9♂ and 6♀) (control) caught from Iyano Ipaja (10 km away from AEL) were examined for bone marrow micronucleated polychromatic erythrocytes (MNPCE) and polychromatic erythrocytes/normochromatic erythrocytes (PCE/NCE) ratio, abnormal sperm morphology, alterations in hematological indices and erythrocyte morphology, and histopathology of the viscera using standard protocols. There was significant (p < 0.05) increase in MNPCE but decrease PCE/NCE ratio in bone marrow cells of exposed rats than the reference site. MNPCE was insignificantly higher in male than females. Cauda epididymal sperms from exposed rats showed significant high frequency of teratozoospermia. Erythrocyte count, hemoglobin concentrations, percentage hematocrits, mean corpuscular hemoglobin concentrations, leucocyte count, and lymphocytes decreased while mean corpuscular volume, neutrophils, and mean corpuscular hemoglobin increased in the exposed rats compared to the control. Also, abnormal erythrocyte morphology: acanthocytes, codocytes (target cells), schizocytes, and tear drops significantly increased in the exposed rats. Marginal sexual dimorphism was observed between males and females in the incidence of hematological indices. Histopathological lesions including interstitial edema, hemorrhage, lymphoid depletion, cellular infiltrations, proliferation of the alveolar pneumocytes, necrosis, tissue degeneration, and reduced germinal epithelium were observed in the testes, liver, lungs, heart, kidney, and spleen from the exposed rats compared to the control. Some physicochemicals and metals analyzed in leachates from the landfill are capable of inducing genome instability and systemic toxicity in the exposed rats. Rattus rattus exposed to hazardous chemicals from AEL harbored somatic and germ cell mutations, and tissue damage compared to the control rats. We suggest that R. rattus are useful sentinel for genotoxicity and system toxicity assessment of landfill-polluted sites.Graphical abstract.

Dimethylacetamide-induced toxic hepatitis in spandex workers: clinical presentation and treatment outcomes

BACKGROUND

Dimethylacetamide (DMAc) exposure has been associated with toxic hepatitis, and no clinical treatment has been reported.

AIM

To investigate the clinical manifestations of DMAc-induced symptoms and how to rescue the functional loss due to occupational exposure.

DESIGN

Clinical observations of 60 spandex factory workers with the exposure to DMAc from January, 2017-19.

METHODS

Chinese drugs (reduced glutathione, polyene phosphatidylcholine, glycyrrhizin compound, Hugan tablets and ornithine aspartate) were used to evaluate the therapeutic improvements in DMAc-exposed patients.

RESULTS

Our data found that 58.3% patients had no distinct clinical symptoms, but 41.7% patients felt fatigue, and 21.7% patients suffered abdominal discomfort and appetite loss, and 8.3% patients had yellow skin and sclera. The ultrasonic and CT imaging revealed that some patients have fatty livers, intrahepatic calcifications, hepatomegaly, gallbladder wall edema and abdominal effusions. Biochemical analysis showed that the alanine aminotransferase (ALT) (P < 0.001), aspartate aminotransferase (AST) (P < 0.001), lactate dehydrogenase (LDH) (P < 0.001) and bilirubin (P < 0.01) statistically decreased after the drug treatment, but alkaline phosphatase (P >0.05) and glutamyl transpeptidase (P> 0.05) did not decrease. Twenty-nine out of the thirty-one patients' abnormal blood ammonia recovered. The risk factor of ALT on hospitalization time was significantly related (P < 0.01).

CONCLUSIONS

The drugs above are sufficient to rescue functional loss in DMAc-induced toxic hepatitis, in part via the regulations of ALT, AST, LDH, bilirubin and ammonia. Workers with the exposure to DMAc should receive specific drugs to maintain the health and prevent functional loss in the long term.

Biochemical changes among municipal solid waste sorting workers: implications for personal protective equipment availability and use

Background. Solid waste management has emerged as one of the greatest challenges facing human and environmental health. Municipal solid waste workers are potentially exposed to a variety of occupational biohazards and safety risks in the workplace. Objective. This study aimed to evaluate the availability and use of personal protective equipment (PPE) and some biochemical changes among solid waste sorting workers. Methods. A group of solid waste sorting workers was interviewed and checked for availability, use and appropriateness of PPE using a structured questionnaire and checklist. Workers were tested for hepatic and renal function parameters and biomarkers of allergy and inflammation. Results. The level of high-sensitivity C-reactive protein (hsCRP) as a biomarker of inflammation was elevated in 12.9% while total serum immunoglobulin E was obviously high among most workers (79.2%). Workers with inadequately available, used or effective PPE were more likely to have morbidities and showed elevated serum levels of serum glutamic pyruvic transaminase, serum glutamic-oxaloacetic transaminase, urea, creatinine, hsCRP and total immunoglobulin E. Conclusions. Elevated biomarkers of allergy and inflammation herald preclinical disease risks that should be included in basic health surveillance. Use of PPE should be emphasized for workers involved in solid waste sorting to effectively protect their health.

Trichloroethylene hypersensitivity syndrome: a disease of fatal outcome

Trichloroethylene is commonly used as an industrial solvent and degreasing agent. The clinical features of acute and chronic intoxication with trichloroethylene are well-known and have been described in many reports, but hypersensitivity syndrome caused by trichloroethylene is rarely encountered. For managing patients with trichloroethylene hypersensitivity syndrome, avoiding trichloroethylene and initiating glucocorticoid have been generally accepted. Generally, glucocorticoid had been tapered as trichloroethylene hypersensitivity syndrome had ameliorated. However, we encountered a typical case of trichloroethylene hypersensitivity syndrome refractory to high dose glucocorticoid treatment. A 54-year-old Korean man developed jaundice, fever, red sore eyes, and generalized erythematous maculopapular rashes. A detailed history revealed occupational exposure to trichloroethylene. After starting intravenous methylprednisolone, his clinical condition improved remarkably, but we could not reduce prednisolone because his liver enzyme and total bilirubin began to rise within 2 days after reducing prednisolone under 60 mg/day. We recommended an extended admission for complete recovery, but the patient decided to leave the hospital against medical advice. The patient visited the emergency department due to pneumonia and developed asystole, which did not respond to resuscitation.

4,4'-Methylenedianiline-induced hepatitis in an industrial worker: case report and review of the literature

4,4'-Methylenedianiline (MDA) is a chemical used in manufacturing and insulation processes and is a well-known hepatotoxin. We report the case of a 42-year-old construction-site worker who was accidentally exposed to large amounts of MDA and developed acute liver damage. The clinical course is described, with particular emphasis on the timely identification of the underlying cause and prompt management that led to an uneventful recovery. We review the relevant literature and discuss the safety measures necessary to minimize similar occupational hazards in industrial workers.