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The manufacture and application of aluminium phosphide fumigants pose risks of inhalation exposure to phosphine gas. This article presents a case report of suspected inhalation exposure to phosphine gas in a manufacturing facility for aluminium phosphide fumigants, which was associated with acute dyspnoea, hypotension, bradycardia and other signs of intoxication. These symptoms resolved within several hours after removal from exposure. A review of the data on human exposures to phosphide fumigants identifies both pesticide applicators and individuals in the vicinity of application to be at risk of accidental exposure and injury from phosphine inhalation. More recent reports have identified risks of phosphine gas inhalation in association with the clandestine production of methamphetamine. Toxicodynamic effects of phosphine result from the inhibition of cytochrome c oxidase and subsequent generation of reactive oxygen species. There remain unanswered questions relating to the toxicokinetics of phosphine, as well as the assessment of human exposure utilizing biomarkers. As initial signs and symptoms of intoxication from phosphine gas may be nonspecific and transient, there is a need for improved recognition of the potential hazards associated with phosphide fumigants and phosphine gas.

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CASE REPORT: A 33-year-old female ingested an unknown quantity of malathion in a suicide attempt. Cholinergic signs consistent with severe organ, phosphate intoxication developed and were treated within 6 hours of ingestion. Intravenous atropine and a continuous infusion of pralidoxime (400 mg/h) were administered. Prolonged depression of plasma and red blood cell cholinesterases were documented. Despite an initial clinical improvement and the presence of plasma pralidoxime concentrations exceeding 4 microg/mL, the patient developed profound motor paralysis consistent with the diagnosis of Intermediate Syndrome. In addition to the dose and frequency of pralidoxime administration, other factors including persistence of organophosphate in the body, the chemical structure of the ingested organophosphate, and the time elapsed between ingestion and treatment may limit the effectiveness of pralidoxime as an antidote in organophosphate ingestions. This case study suggests that these factors should be taken into account in assessing the risk of Intermediate Syndrome after intentional organophosphate ingestions.

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Stachybotrys chartarum is one of several species of filamentous fungi capable of producing mycotoxins under certain environmental conditions. In some observational studies, the growth of this toxigenic mold in the indoor environment has been implicated as a cause of building-related illness. Following reports of a cluster of cases of pulmonary hemosiderosis and hemorrhage associated with exposure to Stachybotrys, public health measures have been recommended which have far-reaching implications. Although the hazards associated with exposure to some mycotoxins have been well studied, the health risks from environmental exposure to Stachybotrys remain poorly defined. The purpose of this review is to critically evaluate the current body of epidemiologic knowledge regarding Stachybotrys and to increase physician awareness regarding this emerging environmental health issue.

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In an investigation of health complaints among employees of a water-damaged office building, the environment showed evidence of fungal contamination with the isolation of Stachybotrys chartarum in one of five bulk samples tested for fungal growth. In response, a public health official recommended that employees be relocated from the building. Employees were subsequently moved to a different environment. A focused environmental investigation of microbial growth within the building followed, revealing moderate to high levels of fungi (Penicillium, Aspergillus versicolor) and bacteria in bulk and surface samples. S. Chartarum was identified in one of 19 (5%) environmental samples using Czapek agar. A health survey of building occupants revealed a high prevalence of multiple symptoms, with the predominance of neurobehavioral and upper respiratory tract complaints. The majority of symptoms were significantly less prevalent after relocation from the water-damaged environment. The initial hypothesis that exposure to toxigenic fungi was responsible for the high prevalence of reported symptoms is difficult to investigate and confirm given the current limits of epidemiological knowledge regarding exposure to these organisms and building-related illness. Future interventions where mycotoxin exposure is suspected should emphasize the importance of risk assessment and risk communication.

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