THALLIUM POISONING :CLINICAL OBSERVATIONS THROUGH TWO OUTBREAKS IN BASRAH

Abstract

Background: Thallium is the most suitable agent for criminal poisoning of human being as it is tasteless and odorless. It usually associated with typical clinical features mainly dermatological and neurological manifestations. Objective:To report an two outbreaks of thallium poisoning in Basrah. Patients and Methods:This case descriptive study that was conducted in the Department of Dermatology -Basrah Teaching Hospital  from January 2009 to   February  2010 ,where a total of thirty two patients with thallium poisoning were enrolled in this study. At the first outbreak, 17 patients were seen at January 2009 due to ingestion of cake while 15 patientswere seen at the second outbreak at February 2010 who were accidental ingestion of rat poisons. A detailed history was taken from all patients regarding all demographics points related to this poisoning. Full clinical examination was performed looking for skin manifestationsin addition to other systemic involvement. Thallium in urine has been measured using the colorimetric method and was positive in all of them. Results: Thirty two patients with thallium poisoning were evaluated. The first outbreak including 17 patients ,with 13 males and 4 females, their ages ranged from 11-33 years with a mean of 24 years , all those patients gave history of eating cakes laced with thallium. Whereas the second outbreak that including 15 patients , 8 males and 7 females, their ages ranged from 5-30 years with a mean 15 years ,all those patients gave history of accidental ingestion of rat poisons .  Among both out breaks the dermatological findings were mainly anagen hair loss in diffuse and patchy patternaffected the scalp and limbs. Also dusky ecchymotic red dermatitis like rash was observed on the face especially perioral region and dorsum of  hands and legs.Neurologic manifestations, mainly of peripheral neuropathy, reported in 50%  patients of the second group while no one of the first group showed any of these finding. Conclusion: Outbreak of thallium poisoning is now occurring in recurrent rate which may be lethal to human being as a result of accidental ingestion or for criminal purposes. It gives characteristic cutaneous, neurological and psychological features that can lead to the right diagnosis.