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Arsenic exposure: Major public health hazard.

Pathology of Arsenic Poisoning

 Dr Sampurna Roy MD                                  June  2016

 

 


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Arsenic is an element which has been widely used for centuries in different fields such as medicine, agriculture or industry.

 

Arsenic-containing compounds are toxic to a broad spectrum of living systems and, therefore, have been widely used as insecticides, weed killers and wood preservatives.

 

This compound has been used, among others, in the industrial production of paints and glass and also for the conservation of leather and wood.

 

Although arsenic trioxide is highly toxic, this compound was shown to have a therapeutic potential as early as the fifteenth century.

 

The period between the seventeenth and nineteenth centuries resulted in the development of new arsenic-based drugs which were applied for the treatment of skin diseases and acute promyelocytic leukemia.

 

The use of arsenicals in human medicine has declined, although they remain in common use in veterinary medicine and in agriculture. 

Pathology of Arsenic Poisoning:

Acute high-dose exposure to arsenic can cause severe systemic toxicity and death.

Lower dose chronic arsenic exposure can result in subacute toxicity that can include peripheral sensorimotor neuropathy, skin eruptions, and hepatotoxicity.

Arsenic compounds contaminate the soil and drinking water as a result of coal burning and the use of arsenical pesticides.

 

As with mercury, there is evidence for bioaccumulation of arsenic along the food chain.

Arsenic intoxication is a true medical emergency with a high fatality rate, characteristic of acute and massive hemolysis.

Inhalation of 250 ppm of arsine gas is instantly lethal.

Exposure to 25 to 50 ppm for 30 minutes is lethal.

Arsine is a colorless gas with a garlic scent, entering the organism by breathing and passing directly into the circulation.

Its hemolytic activity is due to its ability to cause a fall in erythrocyte-reduced glutathione content.

Manifestations are suggestive of a general toxic state with alterations of consciousness, from confusion until delirium, crash, hematuria, jaundice and renal insufficiency. 

Arsenic intoxication must be suspected in electrolysis process workers or those working with lead, copper, zinc, iron, gold, silver and tin.

Acute arsenic poisoning is almost always the result of accidental or homicidal ingestion. Death is due to central nervous system toxicity.

Chronic arsenic intoxication (arsenicosis) is characterized initially by such nonspecific symptoms as malaise and fatigue.

Eventually gastrointestinal disturbances develop, along with changes in the skin and a peripheral neuropathy.

The latter is characterized by paresthesias, motor palsies, and painful neuritis.

Skin: Acute or chronic exposure to arsenic can lead to various dermatological and systemic disorders with a possibe latency over decades.

 

The dermatological signs of arsenic intoxication are important to detect since one of the potential complications is carcinoma.

 

Arsenic in the drinking water has also been related to local increases in the incidence of skin cancer.

 

Skin lesions like hyperpigmentation or depigmentation, hyperkeratosis in palms and soles, and Bowen disease have been reported.

 

The best known effect of chronic arcenism is cutaneous pigmentation. which may be diffuse or "raindrop type".

 

There is increased incidence of multiple skin cancers, which include Bowen's disease, basal cell carcinomas and squamous cell carcinomas.      

 

Visit: Pathology of Bowen's disease

       

                     

 Image of Bowen's disease          Image of Squamous Cell Carcinoma

   

 Image of Basal cell carcinoma

                                                         

Cardiovascular system:         

Blackfoot disease is an endemic arsenic-induced peripheral vascular disease in southern Taiwan.

The main pathologic feature is atherosclerosis, which may relate to imbalances of the adrenergic system.

Chronic arsenic poisoning has been associated with  hypertension, ischemic heart disease, cerebral infarction, microvascular diseases, abnormal peripheral microcirculation, carotid atherosclerosis, QT prolongation and increased dispersion in electrocardiography.

 

Lung: It has been suggested that, in addition to being a cause of lung cancer, ingestion of high concentrations of arsenic in drinking water may be a cause of bronchiectasis.

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Other diseases: Diabetes mellitus, cataract (specifically posterior subcapsular lens opacity), pterygium, slow neural conduction, retarded neurobehavioral development, erectile dysfunction.

Carcinoma: Inorganic arsenic is a well-known human carcinogen recognized by the World Health Organization and the International Agency for Research on Cancer.

Besides skin and lung cancer, industrial and agricultural exposure to arsenic has been implicated in the etiology of cancers of the urinary bladder, kidney, and liver in exposed populations.

Currently, most studies in populations are concerned with drinking water and occupational health hazard related to arsenic.

History: Napoleon Bonaparte (1769 to 1821) is one of the most studied historical figures.

Cause of his death is a medical mystery.

After the defeat at the battle of Waterloo in 1815, Napoleon was exiled to the small island of Saint Helena in the South Atlantic, where he died 6 years later.

The autopsy report stated that stomach cancer was the cause of his death.

Since 1961, it has been demonstrated by various analytical procedures that high concentrations of arsenic were present in Napoleon's hair.

At that time it was suggested that Napoleon had been poisoned by one of his companions in exile. 

According to one study 97% of the arsenic found in the hair of Napoleon is in inorganic form, which is consistent with a chronic intoxication to arsenic.

Chronic exposure continues to be a major public health problem worldwide, affecting hundreds of millions of persons. Locations of high arsenic exposure via drinking water span from India, Bangladesh, Chile, and Taiwan to the United States.

Testing foods and drinking water for arsenic, including individual private wells, should be a top priority to reduce exposure, particularly for pregnant women and children, given the potential for life-long effects of developmental exposure.

                                    

                                                                          

Further reading:

Case report: potential arsenic toxicosis secondary to herbal kelp supplement.

Persistent neuropathy and hyperkeratosis from distant arsenic exposure.

Arsenic pesticides and environmental pollution: exposure, poisoning, hazards and recommendations.

Arsenic intoxication: information and case report].

Arsenic poisoning. Ongoing diagnostic and social problem.

Lead poisoning from Asian traditional remedies in the West Midlands--report of a series of five cases.

Arsenic speciation of two specimens of Napoleon's hair.

 

The medical mystery of Napoleon Bonaparte: an interdisciplinary exposť.

 

Napoleon's autopsy: new perspectives.

The broad scope of health effects from chronic arsenic exposure: update on a worldwide public health problem.

Health hazards and mitigation of chronic poisoning from arsenic in drinking water: Taiwan experiences.

 

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Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

 


 

 

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