Skip to main content
PMC home page
Journal of Medical Toxicology logoLink to Journal of Medical Toxicology
. 2009 Dec;5(4):191–195. doi: 10.1007/BF03178265

Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans

Soha Namazi 1,✉, Hosein Niknahad 2, Hasan Razmkhah 1
PMCID: PMC3550401  PMID: 19876850

Abstract

Introduction

Sulphur mustard (SM) is an alkylating chemical warfare agent that was widely used during the Iran-Iraq conflict (1980–1988). Delayed complications of SM in different organs were evaluated in this study.

Methods

This cross-sectional study was performed from March 2005 to June 2006. The Veterans Foundation provided us with the files of all chemical warfare-poisoned patients in the province of Fars, Iran. Clinical manifestations, laboratory data, and demographic characteristics of the patients were recorded from their files and a face-to-face interviews. Data analysis was performed by studentt test statistical method.

Results

A total of 134 patients were enrolled in the study. The age range of the patients was 32–45 (37.2±9) years. SM poisoning was confirmed 19.5 ± 1.6 (17–22) years after initial exposure. The duration of exposure in patients was 13.35 ± 8.7 (1.5–48) hours. The most common complication was found in the lungs (100%), skin (82.84%), and eyes (77.61%). The most frequent medications used for the treatment of these complications were: bronchdilators, drugs used for dermatological problems, and drugs used for ocular complications. Analytical study showed no association between the age of exposed patients and the severity of toxic complications (p>.05), but there was a significant association between the duration of exposure and the number of complications (p<.05).

Conclusion

Results of this study indicate that respiratory complications generally increase over time. Therefore, follow-up of veterans exposed to SM is recommended. This may lead to early diagnosis of SM complications and help prevent the late manifestations of this toxicity.

Keywords: sulphur mustard, poisoning, Iranian veterans

Full Text

The Full Text of this article is available as a PDF (73.7 KB).

Footnotes

Note: The authors have no potential financial conflicts of interest to report.

References

  • 1.Kehe K, Szinicz L. Medical aspects of sulphur mustard poisoning. Toxicology. 2005;214:198–209. doi: 10.1016/j.tox.2005.06.014. [DOI] [PubMed] [Google Scholar]
  • 2.Korkmaz A, Tan DX, Reiter RJ. Acute and delayed sulfur mustard toxicity: novel mechanism and future studies. Interdics Toxicol. 2008;1:22–26. doi: 10.2478/v10102-010-0027-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Balali-Mood M, Hefazi M, Mahmoudi M, et al. Long-term complications of sulphur mustard poisoning in severely intoxicated Iranian veterans. Fundam Clin Pharmacol. 2005;19:713–721. doi: 10.1111/j.1472-8206.2005.00364.x. [DOI] [PubMed] [Google Scholar]
  • 4.Khateri S, Ghanei M, Keshavarz S, et al. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med. 2003;45:1136–1143. doi: 10.1097/01.jom.0000094993.20914.d1. [DOI] [PubMed] [Google Scholar]
  • 5.Emad A, Rezaian GR. The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure: analysis of 197 cases. Chest. 1997;112:734–738. doi: 10.1378/chest.112.3.734. [DOI] [PubMed] [Google Scholar]
  • 6.Balali-Mood M. First report of delayed toxic effects of Yperite poisoning in Iranian fighters. In: B Heyndrickx., editor. Proceedings of the Second World Congress on New Compounds in Biological and Chemical Warfare. Ghent, Belgium: Rijksuniversiteit; 1986. pp. 489–495. [Google Scholar]
  • 7.Ghanei M, Harandi AA. Long-term consequences from exposure to sulfur mustard: a review. Inhal Toxicol. 2007;19:451–456. doi: 10.1080/08958370601174990. [DOI] [PubMed] [Google Scholar]
  • 8.Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol. 2006;99:273–282. doi: 10.1111/j.1742-7843.2006.pto_429.x. [DOI] [PubMed] [Google Scholar]
  • 9.Hefazi M, Attaran D, Mahmoudi M, Balali-Mood M. Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol. 2005;17:587–92. doi: 10.1080/08958370591000591. [DOI] [PubMed] [Google Scholar]
  • 10.Mahmoudi M, Hefazi M, Rastin M, Balali-Mood M. Long-term hematological and immunological complications of sulfur mustard poisoning in Iranian veterans. Int Immunopharmacol. 2005;5:1479–1485. doi: 10.1016/j.intimp.2005.04.003. [DOI] [PubMed] [Google Scholar]
  • 11.Ghanei M, Adibi I, Farhat F, Aslani J. Late respiratory effects of sulfur mustard: how is the early symptoms severity involved? Chron Respir Dis. 2008;5:95–100. doi: 10.1177/1479972307087191. [DOI] [PubMed] [Google Scholar]
  • 12.Shohrati M, Peyman M, Peyman A, Davoudi M, Ghanei M. Cutaneous and ocular late complications of sulfur mustard in Iranian veterans. Cutan Ocul Toxicol. 2007;26:73–81. doi: 10.1080/15569520701212399. [DOI] [PubMed] [Google Scholar]
  • 13.Panahi Y, Davoudi SM, Sadr SB, Naghizadeh MM. Mohammadi-Mofrad M. Impact of pruritus on quality of life in sulfur mustard-exposed Iranian veterans. Int J Dermatol. 2008;47:557–561. doi: 10.1111/j.1365-4632.2008.03650.x. [DOI] [PubMed] [Google Scholar]
  • 14.Etezad-Razavi M, Mahmoudi M, Hefazi M, Balali-Mood M. Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous complications. Clin Experiment Ophthalmol. 2006;34:342–326. doi: 10.1111/j.1442-9071.2006.01220.x. [DOI] [PubMed] [Google Scholar]
  • 15.Solberg Y, Alcalay M, Belkin M. Ocular injury by mustard gas. Surv Ophthalmol. 1997;41:461–466. doi: 10.1016/S0039-6257(97)00021-0. [DOI] [PubMed] [Google Scholar]
  • 16.Thomsen AB, Eriksen J, Smidt-Nielsen K. Chronic neuropathic symptoms after exposure to mustard gas: a long-term investigation. J Am Acad Dermatol. 1998;39:187–190. doi: 10.1016/S0190-9622(98)70072-6. [DOI] [PubMed] [Google Scholar]
  • 17.Holisaz MT, Rayegani SM, Hafezy R, Khedmat H, Motamedi MH. Screening for peripheral neuropathy in chemical warfare victims. Int J Rehabil Res. 2007;30:71–74. doi: 10.1097/MRR.0b013e3280143c49. [DOI] [PubMed] [Google Scholar]
  • 18.Balali-Mood M, Hefazi M. The pharmacology, toxicology, and medical treatment of sulphur mustard poisoning. Fundam Clin Pharmacol. 2005;19:297–315. doi: 10.1111/j.1472-8206.2005.00325.x. [DOI] [PubMed] [Google Scholar]
  • 19.Husain K, Dube SN, Sugendran K, Singh R, Das Gupta S, Somani SM. Effect of topically applied sulphur mustard on antioxidant enzymes in blood cells and body tissues of rats. J Appl Toxicol. 1996;16:245–248. doi: 10.1002/(SICI)1099-1263(199605)16:3&#x0003c;245::AID-JAT339&#x0003e;3.0.CO;2-3. [DOI] [PubMed] [Google Scholar]
  • 20.Pant SC, Vijayaraghavan R. Histomorphological and histochemical alterations following short-term inhalation exposure to sulfur mustard on visceral organs of mice. Biomed Environ Sci. 1999;12:201–213. [PubMed] [Google Scholar]
  • 21.Iravani S, Rahnavardi M, Gorouhi F, Gorouhi F. Repeated gastrointestinal malignancies in a victim of sulfur mustard gas attack. Indian J Gastroenterol. 2007;26:102–102. [PubMed] [Google Scholar]
  • 22.Gholamrezanezhad A, Saghari M, Vakili A, Mirpour S, Farahani MH. Myocardial perfusion abnormalities in chemical warfare patients intoxicated with mustard gas. Int J Cardiovasc Imaging. 2007;23:197–205. doi: 10.1007/s10554-006-9122-7. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Toxicology are provided here courtesy of Springer

RESOURCES