[The intermediate syndrome during organophosphorus pesticide poisoning]

Area of Science:

• Toxicology
• Neurology
• Pesticide Safety

Background:

• Organophosphate pesticide intoxication is a significant public health concern in Morocco.
• Malathion poisoning can lead to severe neurological complications beyond the acute cholinergic crisis.

Observation:

• Two cases of malathion poisoning presented with a delayed neurological syndrome.
• This syndrome emerged 48-96 hours post-intoxication, distinct from the acute phase.

Findings:

• The syndrome is characterized by respiratory paresis, difficulty weaning from mechanical ventilation, and weakness in proximal limbs, neck flexors, and cranial nerves.
• Electromyography revealed a combined pre- and postsynaptic neuromuscular junction dysfunction.
• Prolonged acetylcholinesterase inhibition, not muscle necrosis, underlies these features.

Implications:

• Recognizing this rare intermediate syndrome is crucial for managing severe organophosphate poisoning.
• Intensive care unit monitoring for at least 96 hours is warranted due to potential respiratory failure.
• Understanding the neuromuscular transmission dysfunction aids in targeted patient care and prognosis.