• Pesticide Poisoning and the Role of Family Medicine

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    Perc-med

    Physicians play a key role in preventing and mitigating the health effects of pesticide exposures. The COVID-19 pandemic has been accompanied by a sharp increase in the use of antimicrobial pesticides—disinfectants—as infection control measures surge.1,2 This upward trend highlighted the lack of consumer knowledge around common pesticide exposures and the potentially hazardous effects of such products deployed for disinfection purposes. It’s important that family medicine physicians are equipped to not only recognize signs of pesticide poisoning but also to help patients understand when and how they may be exposed to pesticides in everyday settings.

    What Are Pesticides, and Why Can They Be Harmful?

    Pesticides are substances that are used to prevent, kill, and/or mitigate pests and are most often used to prevent illness in humans or damage to crops.3,4 There are hundreds of pesticide active ingredients incorporated into an enormous number of readily available products. Pesticides include insecticides, herbicides, fungicides, rodenticides, molluscicides, nematicides, and others.5 While pesticides are effective because they disrupt biological processes in the targeted pests, they can lack high selectivity, making them potentially hazardous for humans.3,4

    Pesticides can pose health risks to humans through mechanisms of impairing biochemical targets. Targets include enzymes such as acetylcholinesterase (AChE) and cytochrome c reductase, ion channels, and receptors.3 For instance, organophosphorus pesticides are often neurotoxic because of their inhibition of AChE in neuromuscular junctions and other areas of the central nervous system.6,7 Similarly, organochlorine pesticides are toxic because of enzyme inhibition and effects on metabolism and transcription.8 Pesticide type; exposure amount, route, and duration; and the susceptibility of the exposed individual affect health outcomes.7

    Identifying Pesticide Poisoning

    Given the non-specific symptoms associated with pesticide poisoning, it is important that physicians have accurate patient information to assess relevant risk. A pesticide exposure scenario can occur at home, at work, or through hobbies. Recognition and Management of Pesticide Poisonings provides a comprehensive guide to aid clinicians. Family medicine clinicians may consider advising patients who spend time around pesticides—such as gardeners or golfers—how to reduce exposure. Similarly, clinicians in areas known to have higher pesticide usage rates may consider incorporating pesticide exposure prevention education into routine clinical care.

    There are an enormous number of pesticide products on the market ranging from pet flea collars and common household disinfectant wipes to garden-ready herbicides and sprays used across agricultural lands. There are inherent health risks associated with such products. Family medicine physicians who are knowledgeable about the vast array of products and can identify active ingredients may be able to more readily identify pesticide-related health conditions.

    Screening for both acute and chronic exposure provides concrete information for reducing health risks. Screenings could include questions about occupation and hobbies, as well as common household products.

    With known or suspected exposure, treatment is the clear priority. While pesticide reporting requirements for physicians vary across the country, reporting is mandatory in over 60% of states. Learn about requirements in your state of practice.

    References

    1. Nabi G, Wang Y, Hao Y, Khan S, Wu Y, Li D. Massive use of disinfectants against COVID-19 poses potential risks to urban wildlife. Environmental Research. 2020;188:109916. doi:10.1016/J.ENVRES.2020.109916
    2. Dhama K, Patel SK, Kumar R, et al. The role of disinfectants and sanitizers during COVID-19 pandemic: advantages and deleterious effects on humans and the environment. Environmental Science and Pollution Research. 2021;28(26):34211-34228. doi:10.1007/S11356-021-14429-W
    3. Casida JE. Pest toxicology: The primary mechanisms of pesticide action. Chemical Research in Toxicology. 2009;22(4):609-619. doi:10.1021/TX8004949
    4. Costa LG, Giordano G, Guizzetti M, Vitalone A. Neurotoxicity of pesticides: A brief review. Frontiers in Bioscience. 2008;13(4):1240-1249. doi:10.2741/2758
    5. Aktar MW, Sengupta D, Chowdhury A. Impact of pesticides use in agriculture: Their benefits and hazards. Interdisciplinary Toxicology. 2009;2(1):1-12. doi:10.2478/v10102-009-0001-7
    6. Marutescu L, Chifiriuc MC. Molecular mechanisms of pesticides toxicity. New Pesticides and Soil Sensors. 2017:393-435. doi:10.1016/B978-0-12-804299-1.00012-6
    7. Nicolopoulou-Stamati P, Maipas S, Kotampasi C, Stamatis P, Hens L. Chemical pesticides and human health: The urgent need for a new concept in agriculture. Frontiers in Public Health. 2016;4:148. doi:10.3389/FPUBH.2016.00148
    8. Androutsopoulos VP, Hernandez AF, Liesivuori J, Tsatsakis AM. A mechanistic overview of health associated effects of low levels of organochlorine and organophosphorous pesticides. Toxicology. 2013;307:89-94. doi:10.1016/J.TOX.2012.09.011

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