Thallium poisoning: Clinical observations through two outbreaks in Basrah

Amaç: Talyum tatsız ve kokusuz olduğu için, kötü amaçlı zehirlemeler için en uygun maddelerden birisi-dir. Bu çalışamını amacı iki ayrı salgında ortaya çıkan talyum zehirlenmesi vakalarının klinik özelliklerini sunmaktır.Gereç ve yöntem: Bu tanımlayıcı vaka çalışmasına Ocak 2009- Şubat 2010 tarihleri arasında Basra Eği-tim Hastanesinde izlenen toplam 32 talyum zehirlenmeli hasta dahil edilmiştir. İlk salgında kek yeme so-nucu, ikinci salgında fare zehiri yeme sonucu zehirlenmeler oluştu. Tüm hastalardan ayrıntılı öykü alındı ve tam bir fizik muayene yapıldı. İdrarda talyum kolorimetrik yöntemle arandı ve tüm hastalarda pozitif bu-lundu.Bulgular: Toplam 32 hasta incelendi. İlk salgında yaş ortalaması 24 yıl olan 17 hasta, ikinci salgında yaş ortalaması 15 yıl olan 15 hasta izlendi. Her iki salgında da ana dermatolojik bulgu, saçlı deri ve ekstremiteleri tutan yamalı veya diffüz tarzda saç ve kıl kaybı idi. İlave olarak yüzde özellikle ağız etrafın-da ve el ve ayak sırtlarında kirli kırmızı ekimotik dermatit benzeri lezyonlar gözlendi. İlk salgında nörolojik bulgular oluşmadı fakat ikinci salgında hastaların %50’sinde başlıca periferik nöropati şeklinde nörolojik bulgular gözlendi. Hastaların çoğu yanlış olarak çinko eksikliği tanısıyla oral çinko-sulfat tedavisi almıştı. Hastalardan 30’u iyileşti, ikisi öldü.Sonuç: Talyum zehirlenmesi kazara alım veya suç amaçlı oluşabilir. Talyum zehirlenmesi karakteristik cilt, nörolojik ve psikolojik belirtilere yol açarak kesin tanı koydurur.

Talyum zehirlenmesi: Basra’daki iki salgın nedeniyle klinik gözlemler

Objectives: Thallium is one of the most suitable agents for criminal poisoning of human as it is tasteless and odorless. The aim of this study was to report clinical features of thallium poisoning in two outbreaks.Materials and methods: This case descriptive study was conducted in Basrah Teaching Hospital from January 2009 to February 2010, where a total of 32 patients with thallium poisoning were enrolled. At the first outbreak, poisoning occurred due to ingestion of cake, while the second outbreak was due to acci-dental ingestion of rat poisons. A detailed history was taken and complete clinical examination was per-formed. Thallium in urine was measured using the colorimetric method and was found as positive in all patients.Results: Thirty two patients were evaluated. The first outbreak included 17 patients (mean age 24 years), and the second outbreak included 15 patients (mean age15 years). Among both outbreaks the derma-tological findings were mainly hair loss in diffuse and patchy pattern affected the scalp and limbs. Also dusky ecchymotic red dermatitis like rash was observed on the face, especially perioral region and dor-sum of hands and legs. Neurologic manifestations, mainly of peripheral neuropathy, were seen in 50% patients of the second group. Patients erroneously had received zinc-sulphate before correct diagnosis. Thirty patients were improved and two died.Conclusion: Outbreak of thallium poisoning may be result of accidental ingestion or criminal purposes. It gives characteristic cutaneous, neurological and psychological features that can lead to the definite diag-nosis.

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