# Pattern and Impact of Pesticide Poisoning: A Review of Published Case Reports

Oche Joseph Otorkpa, Chinenye Oche Otorkpa, Helen Shnada Auta, Andy Anyalewachi Ukah

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Oche Joseph Otorkpa, Chinenye Oche Otorkpa, Helen Shnada Auta, Andy Anyalewachi Ukah. Pattern and Impact of Pesticide Poisoning: A Review of Published Case Reports. TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH, 2024, 12 (2), 10.21522/TIJPH.2013.12.02.Art016. hal-04628849

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# Pattern and Impact of Pesticide Poisoning: A Review of Published Case Reports

Oche Joseph Otorkpa¹*, Chinenye Oche Otorkpa², Helen Shnada Auta³, Andy Anyalewachi Ukah⁴

¹Department of Public Health, School of Public Health, Texila American University, Georgetown, Guyana

²Department of Physiology, College of Health Sciences, Federal University, Lokoja, Nigeria

³Department of Microbiology, School of Life Sciences, Federal University of Technology, Minna, Nigeria

⁴National Institute of Environmental Health, Abuja, Nigeria

## Abstract

Pesticides are essential in agriculture and public health, but their use is associated with many adverse health outcomes. The objective of the current study was to review published case reports to elucidate the pattern and health impacts of exposure to various pesticide classes, including organochlorines, organophosphates, carbamates, pyrethroids, organosulfur, botanicals, and biopesticides. We conducted a review of case reports focusing on the health effects of pesticide exposure across different chemical classes. Searches were performed in major scientific databases, and relevant articles were selected based on predetermined inclusion criteria. Data extraction and synthesis were carried out to identify common health outcomes associated with each pesticide class. Organochlorines, despite being largely phased out, still pose risks due to their persistence and bioaccumulation, with links to neurodegenerative diseases and cancer. Organophosphates, known for cholinergic overstimulation, can lead to respiratory distress and seizures. Carbamates, affecting cholinesterase activity, may cause respiratory paralysis and coma. Pyrethroids disrupt the nervous system and can induce convulsions and alter consciousness. Organosulfur can induce liver damage and renal dysfunction. Botanical pesticides and biopesticides, while generally considered safer, can also cause severe toxicity, including methemoglobinemia and multiorgan failure, as evidenced by rare cases of poisoning. This review highlights the diverse health impacts of pesticide exposure across different chemical classes. It exposes the need for systematic surveillance, longitudinal studies, and comparative assessments between conventional pesticides and biopesticides. Interdisciplinary collaborations are crucial for comprehensive risk assessment and the development of targeted interventions to mitigate these detrimental effects.

**Keywords:** Chemical Classes, Case Reports, Health Effects, Pesticides, Pesticide Poisoning.

## Introduction

Pesticides constitute a diverse array of chemical compounds designed to mitigate the adverse impact of pests on agriculture, public health, and the environment [1]. Pesticides include insecticides (for controlling insects),

herbicides (for controlling weeds), fungicides (for controlling fungi), rodenticides (for controlling rodents), and bactericides (for controlling bacteria), among others [2]. While their efficacy in pest control is well-established, the potential for adverse health effects resulting from pesticide exposure has
garnered increasing attention [3, 4]. According
to updated estimates, over 385 million cases of
unintentional acute pesticide poisoning occur
annually resulting in the death of more than
11,000 people each year [5].

Among the various classes of pesticides,
herbicides represent a significant category by
volume due to their wide spread use in
agriculture and other weed management
practices [6]. Despite stringent regulations and
guidelines governing their use, instances of
pesticide poisoning, both acute and chronic,
continue to pose significant public health
challenges across the globe [7].

Despite numerous studies examining the
health impacts of pesticide poisoning, there
remains a need for a comprehensive review
focusing on the distinct health effects
associated with various chemical classes of
pesticides. In this study, we undertook a
review of published case reports to elucidate
the various health effects that arise from
exposure to different chemical classes of
pesticides. By synthesizing available evidence,
we aim to discern patterns, trends, and
associations between pesticide exposure and
specific health outcomes across different
chemical classes, thereby enhancing our
understanding of the risks posed by pesticide
exposure and helping in the formulation of
evidence-based strategies for prevention,
intervention, management and regulatory
oversight.

Methodology

We conducted an internet search of
electronic databases, including PubMed,
Scopus, Web of Science, and Google Scholar,
to identify relevant case reports and studies
published from 2004 up to the present date.
Keywords such as "pesticides," "pesticide
poisoning," "chemical classes," "health
effects," and "case reports" were used in
various combinations to maximize the retrieval
of relevant articles. The search was limited to
studies published in English, but efforts were

made to include articles from diverse
geographical regions to capture a broad
spectrum of pesticide exposures and associated
health effects. Articles were screened based on
predefined inclusion and exclusion criteria.
Case reports or case series studies
documenting pesticide poisoning in humans as
well as studies reporting specific health effects
associated with the exposure to different
chemical classes of pesticides were included.

Studies focusing solely on acute pesticide
poisoning without documenting specific health
effects, non-human studies or studies not
relevant to human health outcomes were
excluded. The qualities of the included studies
were assessed using established criteria for
case reports and case series studies. Factors
such as clarity of case descriptions, adequacy
of diagnostic criteria, and consideration of
potential confounders were evaluated to
determine the overall reliability and validity of
the evidence presented.

Health Effects Based on Chemical Class

Organochlorines

Organochlorine pesticides (OCPs) are
pesticides that contain carbon, chlorine, and
hydrogen atoms in their chemical structure.
They were widely used in the past but have
been largely phased out in most countries due
to their persistence in the environment and
potential for bioaccumulation [8, 9]. OCPs
have been reported in human body tissues
including blood, breast milk and fatty tissues
where they build up and persist for a long
period and have been implicated in several
chronic conditions including Parkinson's
disease [10].

Exposure to OCPs can cause various
symptoms such as headache, nausea, vomiting,
incoordination, dizziness, tremors, and mental
confusion. In more severe cases, poisoning can
lead to myoclonic jerking movements, often
followed by generalized tonic-clonic
convulsions. Coma and respiratory depression
may ensue after the seizures [11, 12]. OCPs
can disrupt the molecular circuitry of the endocrine system, potentially resulting in various other health issues. They are known to be carcinogenic and neurotoxic and have been associated with increased risks of hormone-related cancers such as breast, prostate, stomach, and lung cancer [13].

According to a published case report, a father and son, aged 52 and 24 years respectively, were brought to the emergency department after mistakenly using Dichlorodiphenyltrichloroethane (DDT) a common OCP instead of flour while preparing fish for a meal. Shortly after ingestion, they developed symptoms including recurrent convulsions and loss of consciousness. Both patients were promptly intubated endotracheally and admitted to the intensive care unit (ICU) for further management. Upon admission, physical examination revealed signs of severe metabolic acidosis in both cases. Laboratory investigations on the second day of admission showed acute oliguric renal failure (ARF) in the sun, with elevated blood urea nitrogen (BUN) levels of 47 mg/dl and creatinine levels of 6.4 mg/dl. Urinalysis performed on the third day disclosed abundant red blood cells (RBCs), indicating renal injury. Both patients received vigorous fluid resuscitation and were closely monitored in the ICU. Over ten days, their clinical condition gradually improved, with the reversal of metabolic acidosis and resolution of renal failure. By the end of the second week, both patients had fully recovered and were discharged from the hospital without any sequelae [14].

A unique case of OCP poisoning involved a 61-year-old woman who was poisoned due to ingestion of endosulfan, an off-patent OCP. She was brought to the state hospital emergency department in an unresponsive state and was pronounced dead upon arrival. According to her husband, she had consumed homemade pastry approximately one hour before the onset of symptoms, which included

nausea, vomiting, and dizziness. Subsequently, she experienced generalized tonic-clonic seizures that persisted for one hour before her demise, approximately four hours after ingesting the pastry. Initial assessment suggested respiratory failure and status epilepticus as potential causes of death. Upon autopsy, external examination of the corpse revealed no traumatic lesions. However, extensive congestion and spotty bleeding areas were observed on the surface and cross-sections of the brain and cerebellum. These findings raised suspicion of an underlying neurological pathology contributing to the patient's demise [15].

Another case of OCP poisoning reported the endosulfan poisoning of a 2.5-year-old child who accidentally ingested an unknown quantity of endosulfan from a 20-ounce soft drink bottle. Shortly after ingestion, the child developed generalized tonic-clonic seizure activity and became unresponsive. He was initially transferred to the local hospital and later to a tertiary children's hospital, where his seizures proved resistant to treatment despite the administration of multiple anticonvulsants. The child's condition deteriorated, resulting in hypotension necessitating vasopressor support. On the third day, an MRI revealed cerebral edema and a nuclear medicine flow scan failed to detect blood flow to the brain. Tragically, the child succumbed to these complications and was pronounced dead [16].

## Organophosphates

Organophosphate pesticides (OP) contain phosphorus and oxygen atoms in their chemical structure, they work by inhibiting the activity of enzymes in the nervous system of pests [17]. The classic symptoms associated with organophosphate poisoning are described by the acronym SLUDGE: Salivation, Lacrimation, Urination, Defecation, Gastric cramps, and Emesis. These manifestations reflect the cholinergic overstimulation caused by OP compounds [18]. In severe cases,
patients may present with additional
symptoms, including unresponsiveness,
muscle fasciculations, pinpoint pupils and
diaphoresis [19].

A 43-year-old male with no significant
medical history presented to the emergency
department with sudden-onset nausea,
vomiting, and diarrhoea, accompanied by
abdominal discomfort. He admitted to self-
applying malathion, an organophosphate
pesticide for scabies over three days before
presentation, with symptoms occurring shortly
after the last application. No excessive
lacrimation or salivation was reported but he
was admitted for observation. Treatment
focused on symptomatic relief, with resolution
of gastrointestinal symptoms within 12 hours.
Diagnostic tests revealed decreased
cholinesterase levels, consistent with pesticide
exposure. The psychiatric evaluation led to a
diagnosis of delusional parasitosis. The patient
was discharged after five days with outpatient
psychiatric follow-up [20].

A rare case of organophosphate (OP)
poisoning in pregnancy involved a 22-year-old
woman in her 29th week of gestation who
presented to King Edward VIII Hospital in
Durban, South Africa, after experiencing
multiple generalized tonic-clonic seizures at
home. Initially, a presumptive diagnosis of
eclampsia was made, and treatment with
intravenous magnesium sulfate was initiated.
However, further assessment revealed signs of
OP toxicity, including a garlic odour,
vomiting, diarrhoea, faecal incontinence,
excessive secretions leading to airway
compromise, diffuse rhonchi, muscle
weakness, fasciculations and pinpoint pupils.
The patient responded to intravenous atropine,
as oximes were not available. While the
mother survived, the infant was born
prematurely and died two days after birth
without exhibiting any signs of OP poisoning.
This case highlights the potential for OP
poisoning to mimic acute complications in
pregnancy, such as eclampsia and seizures,

underscoring the importance of considering
toxicological etiologies in such scenarios [21].

In another published case report, a 51-year-
old farmer was admitted to the hospital after
ingesting an unspecified amount of parathion,
an organophosphorus compound. He had a
history of diabetes managed with oral
hypoglycemic medication for six years but had
no other significant medical conditions or
prior hospitalizations. Upon admission, he
presented himself as drowsy and only partially
responsive, unable to follow commands.
Gastric lavage was performed, and chemical
analysis of the lavage material indicated the
presence of the toxin. Subsequently, he
developed a myocardial infarction, but
unfortunately, he did not respond to treatment
and passed away [22].

A unique case involved a 29-year-old male
who presented to the emergency department
after ingesting 50 to 100mL of methyl
parathion. Despite the substantial dose, the
patient showed almost no clinical effects.
Laboratory analysis revealed delayed and
prolonged suppression of acetylcholinesterase
activity, indicating the toxicological impact of
the ingestion. Absorption of methyl parathion
was predicted to occur over 30 hours,
suggesting a slow release of the toxin into the
bloodstream. However, the bioavailability
appeared to be very low, resulting in minimal
systemic effects despite the significant amount
ingested [23].

Carbamates

Carbamate pesticides also target the
nervous system of pests but act through a
different mechanism than organophosphates,
they inhibit the activity of enzymes called
cholinesterases [24]. Common symptoms of
carbamate pesticide poisoning include
difficulty in breathing, muscle weakness and
twitching but in severe cases, patients may
experience respiratory paralysis, seizures and
coma [25].
Suicidal poisoning by exposure of a 43-year-old farmer with Carbofuran, a carbamate pesticide, was reported. The poisoning resulted in sudden respiratory and cardiac arrest characterized by bradycardia asystole. In addition, he was diagnosed with metabolic acidosis and extensive aspiration pneumonia. Following treatment, the patient's overall condition improved, achieving alignment in the efficiency of both respiratory and circulatory systems [26].

In another case report, a two-year-old child was exposed to pesticide residues following the application of pesticides at home for cockroach control. The child, presenting with a semi-conscious status, was brought to the European Hospital in South Gaza accompanied by his father, who carried the empty container of the pesticide used. Analysis revealed Carbaryl, a carbamate insecticide, as the causative agent of poisoning. Upon admission to the intensive care unit, the child underwent decontamination with clean water, and their clothing was removed to mitigate potential hazards. Blood analysis indicated moderate inhibition of acetylcholinesterase (AChE) activity upon initial testing, which progressed to more severe inhibition over time. Despite administration of several doses of atropine, there was no improvement in AChE activity. Subsequently, the child was administered Obidoxime as an antidote, resulting in significant improvement in AChE activity. Daily administration of Obidoxime was continued until AChE activity returned to the normal range [27].

An analysis of 60 cases involving Aldicarb-related suicide attempts in France spanning from 2012 to 2021 revealed that most cases exhibited pathognomonic symptomatology. Among these cases, 35 victims (58.3%) presented with muscarinic syndrome, 14 (23.3%) with nicotinic syndrome, and 37 (61.7%) with central nervous system impairment. Hospitalization was required for

44 cases (73.3%), resulting in 2 fatalities. Diagnosis relied on blood cholinesterase activities. Among the 25 cases with toxicology results, 45.8% exhibited a moderate decrease in acetylcholinesterase activity, while 87.5% showed a significant decrease in butyrylcholinesterase activity. While the detection of aldicarb and its metabolites in blood or urine may be considered in therapeutic management, its quantification is unlikely to alter emergency medical care [28].

## Pyrethroids

Pyrethroid pesticides are synthetic chemicals derived from natural compounds found in chrysanthemum flowers, they disrupt the nervous system of insects by affecting sodium channels [29]. Reported symptoms of Pyrethroid pesticide poisoning include headache, nausea, vomiting, facial paraesthesia, dizziness, skin itching, skin burning, muscle fasciculations reduced energy, convulsions, changes in awareness and loss of consciousness [30, 31].

A reported case of pyrethroid pesticide poisoning involved a 36-year-old male from a rural town in the Eastern Cape province of South Africa who was diagnosed with intentional cypermethrin poisoning following a suicide attempt. Initially, he was misdiagnosed with suspected organophosphate poisoning, leading to a coma. However, he achieved full recovery after receiving mechanical ventilation and symptomatic treatment with a low dose of the muscarinic antagonist, atropine sulfate [32].

In a similar case report, a 30-year-old male presented with symptoms indicative of organophosphate poisoning, including vomiting, pain, and respiratory distress, following ingestion of a liquid during a family dispute. No other toxins or drugs were ingested, and there were no relevant medical or mental health histories. Clinical examination revealed typical signs of poisoning, such as swollen lips and tremors,
leading to a diagnosis of organophosphate poisoning. Treatment included oxygen therapy and a single dose of atropine. Furthermore, cypermethrin ingestion was later discovered after the patient's wife presented 3 containers of "Danger-10" pesticide containing 10% cypermethrin/100ml. Despite delayed presentation, gastric lavage was performed, and the patient received symptomatic treatment. He showed significant improvement within 24 hours, with subsequent resolution of symptoms and discharge from the hospital [33].

Another case report involved the poisoning of a 12-year-old Afghan girl with permethrin, a type of pyrethroid pesticide. Despite having no previous medical issues, she was brought to the emergency room two hours after ingestion, showing no signs of breathing or heartbeat. Immediate cardiopulmonary resuscitation (CPR) was initiated, and her spontaneous circulation was restored after a few minutes. She was subsequently intubated, received intravenous normal saline for volume resuscitation, and was placed on mechanical ventilation upon transfer to the ICU. The patient remained comatose with bilateral mydriasis, and central diabetes insipidus developed three days later due to apnea and hypoxic brain damage from the insecticide ingestion. Chemical analysis of the insecticide bottle revealed 10% permethrin without organophosphates, contrary to initial expectations. Unfortunately, despite treatment, the patient passed away after seven days due to resistant hypotension and severe brain damage [34].

## Organosulfurs

These are pesticides that contain sulfur atoms in their chemical structure, they work by interfering with various metabolic processes in pests [35]. Studies have shown that cause short- and medium-term human exposure to organosulfur pesticides can cause liver damage and renal dysfunction [36].

A classic case of organosulfur pesticide poisoning is seen in a reported case of a 48-year-old man who presented to the emergency department with fever and widespread skin and mucous lesions, which emerged after using Mancozeb, a dithiocarbamate fungicide on cucumbers in his garden. Despite wearing some protective clothing during application, he experienced severe symptoms including fever, skin itching and pain, swelling of lips and tongue, and extensive skin and mucous membrane damage. Upon admission, he showed signs of dehydration and significant skin and mucosal damage. Lab tests revealed elevated inflammatory markers, hyperglycemia, kidney dysfunction, and electrolyte imbalances. His condition was severe, with a high risk of mortality. Treatment involved supportive care, corticosteroids, antibiotics, and wound management. Despite initial improvement, he experienced a setback with recurrent fever and positive bacterial cultures, necessitating transfer to a specialized burns center for further treatment, including antibiotic adjustment and wound care. Over the following weeks, his condition gradually improved, with complete healing of skin and mucosal lesions. However, he developed fingernail abnormalities and recurrent obstructions in his tear ducts, requiring periodic surgical interventions. After 2 years, while his skin lesions had healed without scarring, he continued to experience nail abnormalities and tear duct issues, highlighting some lasting consequences of the fungicide exposure [37]. While there is a limited number of case reports and studies concerning the toxicological effects of organosulfurs, the available evidence suggests that exposure to this class of pesticide can inhibit vital enzymes responsible for proper physiological function leading to alterations in thyroid hormones, neurotoxicity and teratogenesis [38].
## Botanicals

Botanical pesticides or natural insecticides are a group of pesticides derived from plants and contain natural compounds that have pesticidal properties [39]. The popularity of botanical pesticides in organic farming is on the rise, due to their safety profile in food crop production [40].

However, this has not prevented poisoning-related events with botanical pesticides as was the case with a 47-year-old woman with type 2 diabetes who ingested a significant amount of rotenone a pesticide derived from plants in the Leguminosae family, leading to collapse and unconsciousness. Despite prompt medical intervention, including intubation and ventilation, she developed severe metabolic acidosis, liver dysfunction, and cardiovascular instability. Treatment attempts with intravenous NAC, antioxidants, and other medications were unsuccessful. Her condition deteriorated rapidly, ultimately resulting in multiorgan failure and asystolic cardiac arrest, with postmortem findings indicating extensive organ damage [41].

Another reported case of botanical pesticides poisoning involved 32-year-old woman who was admitted to the emergency department after ingesting an insecticide. Although she was initially stable, she quickly deteriorated, becoming drowsy, agitated, and cyanosed upon arrival in the intensive care unit (ICU). Suspected organophosphorus poisoning led to intubation and mechanical ventilation. Further investigation revealed methemoglobinemia, likely caused by the ingested insecticide "NIMOLIN" a zadirachtin oil-based pesticide. Treatment with Pralidoxamine and atropine was stopped, and conservative management was initiated, including mechanical ventilation and supportive care. Over the following days, her condition gradually improved, with oxygen saturation levels increasing and methemoglobin levels decreasing. She was

successfully weaned off the ventilator and discharged after six days of hospitalization [42].

In addition, some case reports have also implicated plants with pesticidal potential like *Colchicum persicum*, also known as Persian autumn crocus or Persian meadow which was implicated in the death of a 39-year-old man who presented to the emergency room with symptoms of nausea, vomiting, and diarrhoea after ingesting wild garlic, initially attributed to food poisoning. Despite supportive care and discharge, he was readmitted due to severe gastrointestinal symptoms. After a brief period of stability, he suddenly developed respiratory distress and died from cardiopulmonary arrest. Postmortem examination revealed the presence of colchicine, a toxic compound found in plants like *Colchicum persicum*, suggesting accidental poisoning as the cause of death [43].

## Biopesticides

Biopesticides are derived from natural materials such as bacteria, fungi, viruses, or biochemicals. They can control pests through various mechanisms such as microbial activity, interference with insect growth, or attraction and repulsion [44]. In recent times, there has been a growing demand for the prohibition of carcinogens, mutagens, and toxic substances, particularly endocrine disruptors, in pesticides in favour of biopesticides which are considered safer and degrade rapidly in the environment, reducing the risk of pesticide residues in food and lowering the associated risks for consumers [45]. Case reports of biopesticide poisoning are rare because of their low toxicity rate, for example, *Bacillus thuringiensis* (Bt) one of the most common biopesticides is non-toxic and non-infective to vertebrates, including humans [46].

Spinosad a biopesticide derived from the fermentation of the bacterium *Saccharopolyspora spinosa* has an extremely
low risk of toxicity rate on humans [47]. However, a rare case report documented the poisoning of an 80-year-old woman who attempted suicide by ingesting a mixture of Conserve, a Taiwanese brand of Spinosad along with flonicamid. Upon arrival at the hospital, she was unconscious, in shock, and breathing irregularly. Immediate interventions included intubation, gastric lavage, activated charcoal administration, fluid challenge, and dopamine infusion. Blood tests revealed leukocytosis and metabolic acidosis with respiratory compensation. Chest radiography showed lung infiltrations. Successful

resuscitation was achieved, leading to the patient's consciousness recovery and extubation within a few days. Post-extubation, she experienced general malaise, multiple oral ulcerations, pneumonitis, and urinary retention. Endoscopy revealed corrosive esophageal injury. Electroencephalography indicated diffuse cortical dysfunction, while spirometry showed restrictive lung disease. Urodynamic study indicated neurogenic bladder. After an uneventful hospitalization, she was discharged after five weeks without chronic sequelae [48].

## Summary of Results and Effects

<table><caption>**Table 1.** Showing the Summary of Reported Systemic Health Effects of Pesticides Across Chemical Classes</caption><thead><tr><th>Chemical Class</th><th>Summary of Reported Systemic Health Effects</th></tr></thead><tbody><tr><td rowspan="2">Organochlorines</td><td><strong>Neurological:</strong> Headache, nausea, vomiting, incoordination, dizziness, tremors, convulsions, coma</td></tr><tr><td>Endocrine disruption</td></tr><tr><td>Organophosphates</td><td><strong>Carcinogenic</strong><br><strong>Cholinergic Overstimulation:</strong> Salivation, lacrimation, urination, defecation, gastric cramps, emesis</td></tr><tr><td rowspan="4">Carbamates</td><td><strong>Neurological:</strong> Unresponsiveness, muscle fasciculations, pinpoint pupils, diaphoresis</td></tr><tr><td>Respiratory distress</td></tr><tr><td>Cardiovascular complications</td></tr><tr><td><strong>Respiratory:</strong> Difficulty breathing, respiratory paralysis</td></tr><tr><td rowspan="5">Pyrethroids</td><td><strong>Neurological:</strong> Muscle weakness, twitching, seizures, coma</td></tr><tr><td>Cardiovascular complications</td></tr><tr><td>Renal dysfunction</td></tr><tr><td><strong>Neurological:</strong> Headache, nausea, vomiting, dizziness, muscle fasciculations, convulsions</td></tr><tr><td><strong>Dermatological:</strong> Skin itching, burning</td></tr><tr><td rowspan="4">Organosulfurs</td><td>Respiratory distress</td></tr><tr><td><strong>Hepatic:</strong> Liver damage</td></tr><tr><td>Renal dysfunction</td></tr><tr><td><strong>Dermatological:</strong> Skin lesions</td></tr><tr><td rowspan="3">Botanicals</td><td><strong>Respiratory:</strong> Difficulty breathing, pulmonary complications</td></tr><tr><td><strong>Neurological:</strong> Loss of consciousness, seizures</td></tr><tr><td>Respiratory distress</td></tr><tr><td rowspan="2">Biopesticides</td><td>Cardiac complications</td></tr><tr><td>Generally low toxicity rates</td></tr><tr><td></td><td>Rare cases of poisoning may include neurological, respiratory, dermatological, and cardiac effects</td></tr></tbody></table>
Discussion

The findings of this study highlight the
complex and varied health impacts of pesticide
exposure across different chemical classes.
Each class of pesticides—organochlorines,
organophosphates, carbamates, pyrethroids,
organosulfurs, botanicals, and biopesticides—
presents unique risks and manifestations of
toxicity as shown in table 1, which highlights
the importance of understanding these
distinctions for effective risk assessment and
management.

Despite being largely phased out,
organochlorines continue to pose significant
health risks due to their persistence in the
environment and bioaccumulation. They have
been linked to chronic conditions such as
neurodegenerative diseases and various forms
of cancer [49]. However, this is in contrast
with the finding of another study published in
the Journal of the American Cancer Society
which reported that organochlorine exposure is
not believed to be causally related to breast
cancer one of the commonest forms of cancer
[50]. Nevertheless, these findings reinforce the
need for ongoing monitoring of
organochlorine residues in the environment
and in human tissues, even years after their use
has been discontinued.

Similarly, Organophosphates and
Carbamates are known for their cholinergic
effects, but organophosphates tend to cause
more severe symptoms including respiratory
distress and seizures, while carbamates can
lead to respiratory paralysis and coma. The
cases reviewed demonstrate the acute nature of
poisoning incidents, often resulting from either
occupational exposure or misuse [51].
However, this finding is slightly at variance
with the conclusion of a similar study which

reported that the brain and skeletal muscles are
the major target organs [52]. Notwithstanding,
given the high toxicity and potential for severe
outcomes, there is a clear need for stringent
regulations and protective measures for
individuals working with these substances.

Pyrethroids are generally considered safer
than organophosphates and carbamates, yet
they still cause significant health effects,
particularly neurological symptoms such as
convulsions and altered consciousness [53].
The case reports emphasize the importance of
proper handling and awareness of the risks,
considering that they account for more than
one-third of the insecticides currently
marketed in the world with their distinct
biochemical and neurological manifestations
[53].

The reviewed cases relating to organosulfur
pesticides indicate that exposure can lead to
serious health issues, including liver damage
and renal dysfunction [54], but there is
substantial toxicologic evidence that repeated
low-level exposure may affect
neurodevelopment and growth [55]. Although
less commonly discussed than other pesticide
classes, the potential for severe toxicity
warrants more attention and research to fully
understand the long-term health impacts.

Botanicals and Biopesticides are often marketed as safer alternatives to synthetic pesticides, the case reports reveal that they can still cause severe toxicity in rare instances as shown in Fig 1 below and Table 1 above [56]. Cases of poisoning from botanical pesticides and biopesticides like rotenone and Spinosad suggest that despite their natural origins, they require careful handling and regulation to prevent adverse health outcomes.
PATTERN AND IMPACT OF PESTICIDE POISONING

<figure><img src="image_2.png" /><figcaption>**Figure 1.** Displays the Patterns and Impacts of Pesticide Poisoning Across Various Chemical Classes</figcaption></figure>

Further Research Needs

There is a need for more systematic surveillance and reporting of pesticide poisoning cases, particularly in regions with high agricultural activity and pesticide use. Enhanced data collection efforts would facilitate the identification of emerging trends, geographical variations, and high-risk populations vulnerable to pesticide exposure. In addition, longitudinal studies are necessary to assess the long-term health effects of pesticide poisoning, including chronic conditions such as neurodegenerative diseases, cancer, and reproductive disorders. Furthermore, comparative studies evaluating the efficacy and safety profiles of conventional pesticides versus biopesticides are needed to facilitate evidence-based decision-making in pesticide regulation and management.

Finally, interdisciplinary collaborations involving physicians, toxicologists, epidemiologists, agricultural scientists, and public health experts are crucial for conducting comprehensive risk assessments and developing targeted interventions to mitigate the adverse health effects of pesticide exposure.

Conclusion

In conclusion, this review of published case reports sheds light on the diverse and often severe health effects associated with pesticide poisoning across various chemical classes. From organochlorines to biopesticides, each class of pesticide presents unique risks and manifestations of toxicity. Despite the phased-out use of certain pesticides like organochlorines, their ability to persist in the environment and bioaccumulate continues to pose health risks, while newer alternatives such as biopesticides, though generally safer, are not without their instances of poisoning. Addressing the gaps identified in this study, including the need for systematic surveillance and interdisciplinary collaboration, is essential for improving our understanding of pesticide toxicity and developing targeted and effective interventions to mitigate its adverse health effects.

Declarations

Ethics Approval and Consent to
Participate

This study is a review and does not require
ethical approval.
**Consent for Publication**

Not applicable.

**Availability of Data and Material**

All data generated or analyzed during this study are included in this published article and its supplementary information files.

**Reference**

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**Conflicts of Interest**

The authors declare no conflict of interest.

**Funding**

No funds, grants, or other support was received.

**Acknowledgements**

Not applicable.

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