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Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

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  • #16
    Re: Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

    Send to ProMED.
    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

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    • #17
      Re: Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

      Thank you Gert.

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      • #18
        Re: Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

        Published Date: 2012-12-15 13:15:44
        Subject: PRO/EDR> Undiagnosed respiratory disease - Brazil (02): (PA) resolved
        Archive Number: 20121215.1452878

        UNDIAGNOSED RESPIRATORY DISEASE - BRAZIL (02): (PARA) RESOLVED
        ************************************************** ************
        A ProMED-mail post
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        Date: 13 Dec 2012
        Source: Flutrackers.com [edited[

        via machine translation:



        Exams dismiss infection by viruses, bacteria or fungi in patients
        -----------------------------------------------------------------
        The Secretary of State for Public Health, Helio Franco, reported on Thursday, 13 Dec 2012, at a news conference that the servers and patients of the Curuca Municipal Hospital were victims of poisoning by ammonium thiocyanate, a chemical component of the radiography fixer, where damaged packaging allowed the liquid to leak and spread by the hospital environment. Franco explained that inadequate cleaning of the environment, using bleach and alcohol caused the substance to become volatile and be inhaled by people in the hospital.

        With test results in hand, Helio Franco said it totally ruled out infection by viruses, bacteria or fungus. Tests on samples of blood and urine of patients were performed by the Central Laboratory of the State (Lacen), Instituto Evandro Chagas (IEC) and another lab outside the state. "It is not virus, not fungus, not bacteria," emphasized Helio Franco. "This is an episode restricted to hospital and there is no risk of transmission from one person to another," he said.

        --
        Communicated by:
        Gert van der Hoek
        <gertvanderhoek@gmail.com>

        [As a reminder the original report of this outbreak was on 4 Dec 2012 (see prior posting: Undiagnosed respiratory disease - Brazil: (PA) RFI 20121204.1436678) when the newswires mentioned 5 patients being transferred from Curuca Hospital to a hospital in Belem, the capital of Para State. In addition to these 5 patients, there were another 14 patients, including a 17-year-old female who died. Symptoms at that time were described as: "low fever, shortness of breath, oliguria (reduced urine volume), hypotension, hypoglycemia, bradycardia (slow heart rate), and hemorrhagic manifestations in the digestive system, among others." Initial hypotheses included radiation poisoning, then exposure to chemicals used to develop radiographic films, and finally, when the patients were being transferred to Belem, the hypothesis was this was of infectious origin. From the above newswire, it appears as though the 2nd hypothesis -- exposure to chemicals used to develop radiographic films was correct after all. One wonders what the sequence of events were that led to the varied hypotheses in the beginning. - Mod.MPP

        Generally we see ammonium thiocyanate as a component of herbicides herbicides, or a component of thiourea. This chemical is also found in artificial resins. It has also been found in matches and rustproofing products. Ammonium thiocyanate has been used to stabilize some photographic developing reagents. Other uses include textile dying, printing and tracer components for locating leaks in the oil field industry.

        Acute effects may occur by inhalation. While the product is not necessarily reactive with other products, bleach may be toxic in its own right. Fumes from bleach are irritating to the respiratory system and to mucous membranes.

        According to a Material Safety Data Sheet (MSDS):
        Acute Potential Health Effects: Skin: Causes skin irritation
        Eyes: Causes eye irritation Inhalation:
        Causes respiratory tract and mucous membrane irritation.
        Ingestion: May cause gastrointestinal tract irritation with nausea and vomiting.
        May affect: Behavior, Central Nervous System (hallucinations, distorted perceptions, personality and mood changes, mania, disorientation, weakness, seizures), metabolism.
        Chronic Potential Health Effects: Prolonged exposure may affect the thyroid gland and blood cells, and cause personality and mood changes.

        Therefore it seems possible that irritating bleach fumes and irritating ammonium thoicyanate may have an additive effect at irritating the respiratory system.

        For a map of the state of Para in Brazil, see http://www.v-brazil.com/graphics/para.gif. Belem is to the northeast of the state, with Castanhal to the northeast of Belem.
        For a map of Brazil showing the location of Curuca, see http://www.maplandia.com/brazil/para/curuca/. It is further northeast of both Castanhal and Belem.

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