Long-term hematological consequences of sulfur mustard on civilians of Sardasht 20 years after exposure (original) (raw)
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International Immunopharmacology, 2013
The most important long-term morbidity problem of sulfur mustard (SM) toxicity is pulmonary complications but the pathogenesis of these complications is not clearly understood. This study evaluates the peripheral blood mononuclear sub-sets and their correlation with pulmonary function in SM exposed civilian cases 20 years post-exposure as gathered in the context of the Sardasht-Iran Cohort Study (SICS). Samples were randomly selected from two groups, SM-exposed (n=372) and control (n= 128), with the same ethnicity, culture, and demography. Three color flow cytometry was applied for peripheral blood mononuclear sub-population determination. Results indicated a significant decrease in CD45+/CD3+, CD45+/CD3+/CD4+, and an increase in CD3+/CD16+56+ percentages. It was also found that absolute count of NK cells was highly increased in peripheral blood of exposed cases. There was a significant increase in NK cell count of SM exposed group with pulmonary problems as compared to the same group without pulmonary problems (p-valueb 0.04) based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The findings showed a significant negative correlation between absolute numbers of T lymphocyte and FVC % and positive correlation with FEV1/FVC%. The results also demonstrated that absolute numbers of monocytes had a negative correlation with FVC %. We propose that NK and T cells are probably involved in the pathogenesis or immune reactions to the delayed pulmonary complications induced by SM. This hypothesis should be tested in a more severe pulmonary complicated group.
Toxicology Letters, 2019
Sulfur mustard (SM) is a vesicant chemical warfare agent. Recent studies reported alleged use of SM by non-state actors in Syria and Iraq. It has been shown that SM induced immunological and hematological complications. The aim of this study was to determine acute toxic effects of SM exposure on hematological parameters. Blood samples from a group of Syrian exposed to SM in 2016 were taken daily during the follow-up of the patients in intensive care unit. Initial leukocytosis was observed in all patients (100%) on the first 48 h after exposure. Following leukocytosis, isolated lymphopenia was observed in all patients (100%) between 2 nd and 4 th days. A decrease in hemoglobin level was noted in five patients (62.5%) between 4 th and 5 th days. Thrombocytopenia was observed in 75% of patients between 4 th and 6 th days for mild cases and between 9 th and 11 th days for severe cases. Three patients (37.5%) developed distinct leucopenia/neutropenia on 11 th and 12 th days. It was observed that human exposure to high dose of SM has direct toxic effect on hematological cells and bone marrow. New strategies on treatment of SM-induced myelosuppression could reduce the effects of hematological complications and could increase the survival rate in these patients.
Long-term skin findings of sulfur mustard exposure on the civilians of Sardasht, Iran
Toxin Reviews, 2009
Sulfur mustard (SM) was the most common chemical warfare agent used by Iraqi military forces against Iranian soldiers and civilians in border towns. Studies about late skin complications in SM-exposed people and its comparison with those in a proper control group are limited. The present paper, which is a part of the Sardasht-Iran Cohort Study is concerning with the skin findings of SM exposure 20 years after the chemical bombardment of Sardasht town (Iran) in comparison with the skin findings of the Rabat population. There are two major subgroups of SM exposure: a hospitalized group with moderate to severe problems at exposure time (n = 168), and a not hospitalized group with mild problems (n = 194), and the other is a control group (n = 128) selected from Rabat. Each participant was examined by a dermatologist in the research team. The most common skin lesions in the exposed groups based on their frequency were: eczema (27.6%), xerosis (24.6%), cherry angioma (19.9%), hyperpigmentation (15.5%), mustard scar (14.6%) and seborrheic dermatitis (10.8%), but in the control group, they were: eczema (28.9%), xerosis (11.7%), seborrheic dermatitis (11.7%) and cherry angioma (9.4%). In the exposed group, itching (P < 0.001), burning (P = 0.037), xerosis (P = 0.002), hyperpigmentation (P = 0.002) and cherry angioma (P = 0.007) were seen more often than in the control group and the differences were statistically significant. It is concluded that SM exposure causes significant delayed skin findings. In the exposed group, further follow up was needed for more long-term skin complications such as skin cancers, and there are many questions about the underlying pathophysiology and immunology of SM cutaneous complications that should be investigated.
International Immunopharmacology, 2005
Background: Sulfur mustard (SM) is an alkylating chemical warfare agent that was widely used during World War I and by Iraqi forces against Iranian soldiers. We aimed to study late toxic effects of SM on the blood and the immune system of severely intoxicated Iranian veterans. Methods: All SM-poisoned veterans in the province of Khorasan, Iran who had severe clinical complications were studied. Blood cell count, flow cytometric analysis of immune cells, serum protein electrophoresis, and determination of serum immunoglobulins and complement components levels were performed for the patients and 35 healthy age-matched controls. Hematological and immunological parameters were compared between the patients and the control group, using Mann-Whitney U test. Results: Forty male subjects (aged 43.8 F 9.8 years) who had confirmed SM poisoning 16 to 20 years prior to this study were investigated. Total counts for WBC and RBC, as well as Hct percentage were significantly ( p V 0.042) higher in the patients than in the controls. The percentages of monocytes and CD3 + T-lymphocytes were significantly higher ( p = 0.013 and p = 0.037, respectively) and the percentage of CD16 + 56 positive cells was significantly lower in patients ( p = 0.006). IgM and C3 levels were significantly higher in patients ( p V 0.030). The absolute level of a 1 globulin, as well as absolute levels and the percentages of a 2 and h globulins were significantly higher in patients compared to the control group ( p V 0.024). Conclusions: SM can cause long-term effects on the immune system in patients with severe intoxication. The impaired immunity is probably responsible for the increased risk of infections in these patients. D
Medical science monitor : international medical journal of experimental and clinical research, 2008
Sulfur mustard is a chemical warfare agent that produces cellular damage via alkylation and protein cross-linking. Sulfur mustard affects the skin, lungs, and eyes, as well as the gastrointestinal, endocrinal, and hematologic systems. We studied the potential delayed toxic effects of sulfur mustard on white blood cells and some of its derivatives including polymorphonuclear lymphocytes and lymphocytes (CD4+ and CD8+) among Iranian veterans, approximately 25 years after exposure. One hundred thirteen sulfur mustard-poisoned veterans registered for this prospective study. Hematologic, immunophenotyping, and flow cytometric evaluations were done to samples from patients as well as 20 healthy age- and sex-matched control volunteers. Hematologic and immunologic variables were compared between both groups of subjects. Values for P less than.05 were considered statistically significant. Total white blood cell count and percentage of polymorphonuclear lymphocytes were significantly higher i...
Comparison of Early and Late Toxic Effects of Sulfur Mustard in Iranian Veterans
Basic <html_ent glyph="@amp;" ascii="&"/> Clinical Pharmacology <html_ent glyph="@amp;" ascii="&"/> Toxicology, 2006
Sulfur mustard is an alkylating agent that reacts with ocular, respiratory, cutaneous, and bone marrow tissues, resulting in early and late toxic effects. We compare these effects based on the experience in Iranian veterans exposed to the agent during the Iran-Iraq conflict . The first clinical manifestations of sulfur mustard poisoning occurred in the eyes with a sensation of grittiness, lacrimation, photophobia, blepharospasm, and corneal ulceration. Respiratory effects appeared as rhinorhea, laryngitis, tracheobronchitis, and dyspnoea. Skin lesions varied from erythema to bullous necrotization. Initial leukocytosis and lymphopenia returned to normal within four weeks in recovered patients, but marked cytopenia with bone marrow failure occurred in fatal cases. Late toxic effects of sulfur mustard were most commonly found in lungs, skin and eyes. Main respiratory complications were chronic obstructive pulmonary disease, bronchiectasis, asthma, large airway narrowing, and pulmonary fibrosis. Late skin lesions were hyperpigmentation, dry skin, atrophy, and hypopigmentation. Fifteen of the severely intoxicated patients were diagnosed with delayed keratitis, having corneal vascularization, thinning, and epithelial defect. Respiratory complications exacerbated over time, while cutaneous and ocular lesions decreased or remained constant. Both the severity and frequency of bronchiectatic lesions increased during long-term follow-up. The only deteriorating cutaneous complication was dry skin. The maximum incidence of delayed kaeratitis was observed 15 to 20 years after initial exposure. Being suggested as the main cause ofassociated with malignancies and recurrent infections, natural killer cells were significantly lower 16 to 20 years after intoxication.