Chronic occupational exposure

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A sudden outbreak of illness in the industrial setting may occur because of a change in practice. An example of this is reported by Ohi and Wegman (1978). Acetone was used as a solvent for cleaning equipment in a textile printing plant. When this became temporarily unavailable, EGME was used instead. This was used for cleaning by hand without gloves, and, although air flow in the wash area was reduced, the air concentration of EGME was 8 ppm which did not exceed the TLV (25 ppm). Absorption was thought to be primarily through the skin.

The first patient, a 48 year old male had worked for a number of years in the plant and was admitted to hospital because of confusion. Over the previous three months he had noticed lethargy with unusual sleepiness, decreased hearing, anorexia and weight loss. His family noted that he was agitated. On examination he was found to be grossly disorientated and lapsing in and out of sleep. He responded appropriately to commands and examination was otherwise normal. His haemoglobin and platelet count were low. A white cell count was also low at 2,600 with 27% mature neutrophils, 1% metamyelocytes, 68% lymphocytes, 1% monocytes and 2% eosinophils. Bone marrow aspiration revealed marrow depression with some signs of recovery. The initial diagnosis was encephalopathy due to alcoholism (he was a moderate to heavy drinker) or industrial toxic exposure. He was managed with vitamins and mineral supplements and made a slow recovery over the following weeks.

The second patient, a 45 year old male was admitted because of cough, shortness of breath, pyrexia, lethargy, staggering gait, blurred vision, slurred speech, poor memory, headache, confusion, anorexia, nausea, vomiting and nocturia. These effects had developed over the previous month after he had started working on the same operation as the first patient. Examination revealed only abnormal neurological signs with poor concentration, orientation, reasoning and recent memory. His haemoglobin and haemacrit were low. So was the white cell count at 5,100 with 30% neutrophils, 1% metamyelocytes, 58% lymphocytes, 8% monocytes and 2% eosinophils. A bone marrow aspirate showed marrow damage compatible with a marrow toxin. He recovered within a week without treatment (Ohi and Wegman, 1978).

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