Neuropsychiatric syndromes and occupational exposure to zinc phosphide in Egypt

Eighty-six workers exposed to zinc phosphide (Zn3P2) pesticide were studied for evidence of neuropsychiatric manifestations. They were evaluated clinically, by electroencephalography (EEG), and, in some cases, by electromyography (EMG). All were males (mean age, 35.8 years; mean duration of exposure to zinc phosphide, 11.3 years). Most presented with one (or more) neuropsychiatric symptom(s), including fear of poisoning, anxiety, impotence, and easy fatigue. About half showed evidence of neuropsychiatric signs, including hyperreflexia, polyneuropathy, lumber radiculopathy, and cervical myelopathy, as well as anxious mood, impaired attention, and psychomotor stimulation. EEG recordings showed abnormal findings in 17.4% of the subjects. The mean age in that group was 39.1 years; mean duration of exposure to Zn3P2 was 15.1 years. EMG studies showed evidence of partial denervation of the anterior tibial group of muscles and flexor digiti minimi in 2 of the 30 workers (6.7%) who underwent EMG examination. Serum levels of zinc (Zn) and cadmium (Ca) were significantly higher in exposed workers than in controls (P < 0.005). Serum copper (Cu), iron (Fe), phosphorus (P), and magnesium (Mg) were significantly lower in exposed workers than in controls. Electrophoretic pattern of globulin showed that gammaglobulin fraction was significantly increased (P < 0.005); alpha2 and beta-globulin were decreased (P < 0.005) in exposed workers. Lipoprotein pattern showed that the total lipids, B-lipoprotein, and B/alpha ratio were significantly increased (P < 0.005) in exposed workers; the alpha1 lipoprotein was decreased. Triglycerides and cholesterol were significantly increased (P < 0.001), and phospholipids and phospholipid/cholesterol ratio were significantly decreased (P < 0.005) in exposed workers compared to controls. The study findings indicated that exposure to Zn3P2 not only caused mild acute and subacute liver cell damage, but also affected renal function and perhaps B-cells of the pancreas. A total of 68.6% of the exposed workers had chest symptoms; only 24.4% presented with chest or cardiac signs. Ventilatory functions were abnormal in 70% of the exposed workers; abnormal ECG findings were present in 12.8%.