Patho - 4th Asessment - Environmental Diseases I - 2007
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Environmental Diseases I Dr Issam Francis
Environmental Diseases Environmental and occupational health includes: • Diagnosis • Treatment , and • Prevention of injuries and illnesses resulting from exposure to exogenous chemical or physical agents
Environmental Exposure Exposure may occur : 2. Voluntarily: – drug abuse – personal habits
2. Involuntarily: – air pollution – food, water, drug therapy – workplace (occupational exposures)
ESTIMATED OCCUPATIONAL DISEASE MORTALITY IN THE UNITED STATE IN 1992 Cause of Death
Number of Deaths
% Attributed to Occupation
Cancer
517,090
6-10
Cardiovascular and cerebrovascular disease
101,846
5-10
Chronic respiratory disease
91,541
10
Pneumoconioses
1,136
100
Nervous system disease
26,936
1-3
Renal disease
22,957
1-3
Industrial Exposures VOLATILE ORGANIC COMPOUNDS: • Aliphatic Hydrocarbons – the most widely used industrial solvents and dry cleaning agents • Petroleum Products – Gasoline, kerosene, mineral oil, and turpentine • Aromatic Hydrocarbons – Benzene, toluene, and xylene POLYCYCLIC AROMATIC HYDROCARBONS • Polycyclic aromatic hydrocarbons are among the most potent chemical carcinogens PLASTICS, RUBBER, AND POLYMERS
•
e.g.Vinyl chloride, 1,3-butadiene
METALS
Occupational exposure to metals in mining and manufacturing is associated with acute and chronic toxicity, as well as carcinogenicity
TOXIC AND CARCINOGENIC METALS Lead: Occupation: Battery and ammunition workers, spray painting, radiator repair
Disease: • • • • • •
Renal toxicity Anemia colic Peripheral neuropathy Insomnia, fatigue Cognitive deficits
Lead absorption is greater in children and infants and hence they are particularly vulnerable to lead toxicity
The toxicity of lead is related to its multiple biochemical effects: High affinity for sulfhydryl groups. • Inhibition of enzymes involved in the incorporation of iron into heme resulting in anemia. Competition with calcium ions. • lead competes with calcium and is stored in bone. • interferes with nerve transmission and brain development. Inhibition of membrane-associated enzymes • inhibits 5 -nucleotidase activity and sodium-potassium ion pumps, leading to decreased survival of red blood cells (hemolysis), renal damage, and hypertension. Impaired metabolism of 1,25-dihydroxyvitamin D. ( active metabolite of vitamin D).
TOXIC AND CARCINOGENIC METALS Mercury: Occupation: Chlorine-alkali industry Disease: • • • • •
Renal toxicity Muscle tremors dementia Cerebral palsy Mental retardation
TOXIC AND CARCINOGENIC METALS Arsenic Occupation: Miners, oil refinery workers, farm workers • Cancer of skin, lung, liver
Beryllium Occupation: Beryllium refining, aerospace manufacturing, ceramics • Acute lung irritant • Chronic lung hypersensitivity
Cobalt and tungsten carbide Occupation: Toolmakers, grinders, diamond polishers • Lung fibrosis • Asthma
TOXIC AND CARCINOGENIC METALS Cadmium Battery workers, welders, soldering • Renal toxicity • ? Prostate cancer Chromium Pigment workers, smelters, steel workers • Cancer of lung and nasal cavity Nickel Smelters, steel workers, electroplating • Cancer of lung and nasal sinuses
Agricultural Hazards Agricultural pesticides are divided into five categories, depending on the target pest: • Insecticides • Herbicides • Fungicides • Rodenticides • Fumigants
HEALTH EFFECTS OF AGRICULTURAL PESTICIDES
HEALTH EFFECTS OF AGRICULTURAL PESTICIDES
HEALTH EFFECTS OF AGRICULTURAL PESTICIDES
HUMAN DISEASES ASSOCIATED WITH OCCUPATIONAL EXPOSURES Organ
Effect
Toxicant
Cardiovascular System
Heart disease
Carbon monoxide, lead, solvents, cobalt, cadmium
Respiratory system
Nasal cancer
Isopropyl alcohol, wood dust Radon, asbestos, silica, nickel, arsenic, chromium, mustard gas
Lung cancer
Chronic obstructive lung disease
Fibrosis
Grain dust, coal dust, Silica, asbestos, cobalt
HUMAN DISEASES ASSOCIATED WITH OCCUPATIONAL EXPOSURES Organ
Effect
Nervous system
Peripheral
Toxicant
neuropathies
Solvents,, methyl chloride, lead, arsenic, DDT
Ataxic gait
Chlordane, toluene,
CNS depression
Alcohols, ketones, aldehydes, solvents
Cataracts
Ultraviolet radiation
HUMAN DISEASES ASSOCIATED WITH OCCUPATIONAL EXPOSURES Organ
Effect
Toxicant
Urinary system
Toxicity Bladder cancer
Mercury, lead, Naphthylamines, benzidine, rubber products
Reproductive system
Male infertility Female infertility Teratogenesis
Lead, phthalate plasticizers Cadmium, lead Mercury, polychlorinated biphenyls
Hematopoietic system
Leukemia
Benzene, radon, uranium
Skin
Cancer
Ultraviolet radiation
Gastrointestinal tract
Liver angiosarcoma
Vinyl chloride
DISEASES ATTRIBUTABLE TO CIGARETTE SMOKING
Cancer – – – – – – – – – – – –
Trachea Lung Bronchus Larynx Lip oral cavity pharynx Esophagus Bladder and urinary tract Cervix Pancreas Stomach
Ischemic heart disease Cerebrovascular disease Arteriosclerosis Chronic respiratory disease
CARCINOGENS IN TOBACCO SMOKE • • • • • •
Polycyclic aromatic hydrocarbons 4-(Methylnitrosoamino)-1-(3-pyridyl)-1-butanone Polonium 210 N -Nitrosonornicotine 4-Aminobiphenyl 2-naphthylamine
Inhaled carcinogens in cigarette smoke may: 9. Act directly on the mucous membranes 10. Be wallowed in saliva 11. Be bsorbed into the bloodstream
Normal Lung
Emphysema
Tobacco Smoking: •
Cessation of smoking reduces, but does not completely eliminate, the risks of lung cancer and coronary artery disease over time
•
The largest number of deaths attributable to cigarette smoking are due to lung cancer, ischemic heart disease, and chronic obstructive lung disease
• •
Nicotine is responsible for tobacco addiction.
•
30% of all cancer deaths and up to 90% of all lung cancer deaths are attributable to cigarette smoking
•
Maternal smoking leads to feta hypoxia – low birth weight – prematurity – increased incidence of spontaneous abortion
DISEASE CAUSED BY ETHANOL ABUSE Organ
Lesion
Mechanism
Liver
Fatty change Acute hepatitis Alcoholic cirrhosis
Toxicity
CNS
Wernicke syndrome
Thiamine deficiency
Korsakoff syndrome
Toxicity and thiamine deficiency
Cerebellar degenerationNutritional deficiency
DISEASE CAUSED BY ETHANOL ABUSE Organ
Lesion
Mechanism
Cardiomyopathy Hypertension
Toxicity Vasopressor
GIT
Gastritis Pancreatitis
Toxicity Toxicity
Skeletal muscle Reproductive System
Rhabdomyolysis
Toxicity
Cardiovascular system
Fetal alcohol Syndrome
Testicular atrophy Spontaneous abortion
Growth retardation Mental retardation
Toxicity
Mechanism of fatty liver in alcohol abuse Biochemical mechanisms responsible for fat accumulation in hepatocytes are the following: • Increased catabolism of fat by peripheral tissues with increased delivery of free fatty acids to the liver. • Metabolism of ethanol converts the oxidized (NAD+) to the reduced form (NADH); an excess of NADH over NAD stimulates lipid biosynthesis. • Oxidation of fatty acids by mitochondria is decreased. • Decreased transport of lipoproteins from the liver.
ADVERSE DRUG REACTIONS AND THEIR AGENTS Blood Dyscrasias Granulocytopenia, aplastic anemia, pancytopenia Hemolytic anemia, thrombocytopenia Drugs: Antineoplastic agents immunosuppressives Chloramphenicol Penicillin Methyldopa
ADVERSE DRUG REACTIONS AND THEIR AGENTS Blood Dyscrasias Granulocytopenia, aplastic anemia, Pancytopenia Hemolytic anemia, thrombocytopenia
Antineoplastic agents immunosuppressives Penicillin, methyldopa
Cardiac Arrhythmias Cardiomyopathy
Theophylline, hydantoins Doxorubicin, daunorubicin
Renal Glomerulonephritis Acute tubular necrosis Tubulointerstitial disease
Penicillamine Aminoglycoside antibiotics cyclosporine Phenacetin, salicylates
ADVERSE DRUG REACTIONS AND THEIR AGENTS Pulmonary Asthma Acute pneumonitis Interstitial fibrosis
Salicylates Nitrofurantoin Busulfan, nitrofurantoin, bleomycin
Hepatic Fatty change Diffuse hepatocellular damage
Tetracycline Halothane, isoniazid, acetaminophen
Systemic Anaphylaxis Lupus erythematosus syndrome
Penicillin Hydralazine, procainamide
Respiratory depression
Sedatives
•
Ovarian cancer: Oral contraceptives protect against ovarian cancer
•
Thromboembolism: increased risk of venous thrombosis and pulmonary embolism
•
Cervical cancer: some increased risk is correlated with duration of use
•
Endometrial cancer : no increased risk
•
Breast carcinoma: slight increase in breast cancer risk when combined oral contraceptives are used by women younger than 45 years
•
Hepatic adenoma. There is a well-defined association
•
Hypertension: slight increase in blood pressure
ADVERSE DRUG REACTIONS AND THEIR AGENTS Blood Dyscrasias Granulocytopenia, aplastic anemia, pancytopenia Hemolytic anemia, thrombocytopenia Drugs: Antineoplastic agents immunosuppressives Chloramphenicol Penicillin Methyldopa
HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Ozone
Decreased lung function Lung inflammation Decreased exercise capacity
Nitrogen dioxide
Decreased lung function Increased respiratory infection
Sulfur dioxide
Increased respiratory symptom Increased mortality
Acid aerosols
Altered mucociliary clearance respiratory infections Decreased lung function
HEALTH EFFECTS OF INDOOR AIR POLLUTANTS Pollutant
Effects
• • •
Carbon monoxide Nitrogen dioxide Wood smoke infections
Acute poisoning Increased respiratory infections Increased respiratory
• • •
Formaldehyde Radon Asbestos fibers
Eye and nose irritation, asthma Lung cancer Lung cancer; mesothelioma
• •
Mineral fibers Bioaerosols
Skin and airway irritation Allergic rhinitis, asthma
Environmental Diseases Environmental and occupational health includes: • Diagnosis • Treatment , and • Prevention of injuries and illnesses resulting from exposure to exogenous chemical or physical agents
Environmental Exposure Exposure may occur : 2. Voluntarily: – drug abuse – personal habits
2. Involuntarily: – air pollution – food, water, drug therapy – workplace (occupational exposures)
ESTIMATED OCCUPATIONAL DISEASE MORTALITY IN THE UNITED STATE IN 1992 Cause of Death
Number of Deaths
% Attributed to Occupation
Cancer
517,090
6-10
Cardiovascular and cerebrovascular disease
101,846
5-10
Chronic respiratory disease
91,541
10
Pneumoconioses
1,136
100
Nervous system disease
26,936
1-3
Renal disease
22,957
1-3
Industrial Exposures VOLATILE ORGANIC COMPOUNDS: • Aliphatic Hydrocarbons – the most widely used industrial solvents and dry cleaning agents • Petroleum Products – Gasoline, kerosene, mineral oil, and turpentine • Aromatic Hydrocarbons – Benzene, toluene, and xylene POLYCYCLIC AROMATIC HYDROCARBONS • Polycyclic aromatic hydrocarbons are among the most potent chemical carcinogens PLASTICS, RUBBER, AND POLYMERS
•
e.g.Vinyl chloride, 1,3-butadiene
METALS
Occupational exposure to metals in mining and manufacturing is associated with acute and chronic toxicity, as well as carcinogenicity
TOXIC AND CARCINOGENIC METALS Lead: Occupation: Battery and ammunition workers, spray painting, radiator repair
Disease: • • • • • •
Renal toxicity Anemia colic Peripheral neuropathy Insomnia, fatigue Cognitive deficits
Lead absorption is greater in children and infants and hence they are particularly vulnerable to lead toxicity
The toxicity of lead is related to its multiple biochemical effects: High affinity for sulfhydryl groups. • Inhibition of enzymes involved in the incorporation of iron into heme resulting in anemia. Competition with calcium ions. • lead competes with calcium and is stored in bone. • interferes with nerve transmission and brain development. Inhibition of membrane-associated enzymes • inhibits 5 -nucleotidase activity and sodium-potassium ion pumps, leading to decreased survival of red blood cells (hemolysis), renal damage, and hypertension. Impaired metabolism of 1,25-dihydroxyvitamin D. ( active metabolite of vitamin D).
TOXIC AND CARCINOGENIC METALS Mercury: Occupation: Chlorine-alkali industry Disease: • • • • •
Renal toxicity Muscle tremors dementia Cerebral palsy Mental retardation
TOXIC AND CARCINOGENIC METALS Arsenic Occupation: Miners, oil refinery workers, farm workers • Cancer of skin, lung, liver
Beryllium Occupation: Beryllium refining, aerospace manufacturing, ceramics • Acute lung irritant • Chronic lung hypersensitivity
Cobalt and tungsten carbide Occupation: Toolmakers, grinders, diamond polishers • Lung fibrosis • Asthma
TOXIC AND CARCINOGENIC METALS Cadmium Battery workers, welders, soldering • Renal toxicity • ? Prostate cancer Chromium Pigment workers, smelters, steel workers • Cancer of lung and nasal cavity Nickel Smelters, steel workers, electroplating • Cancer of lung and nasal sinuses
Agricultural Hazards Agricultural pesticides are divided into five categories, depending on the target pest: • Insecticides • Herbicides • Fungicides • Rodenticides • Fumigants
HEALTH EFFECTS OF AGRICULTURAL PESTICIDES
HEALTH EFFECTS OF AGRICULTURAL PESTICIDES
HEALTH EFFECTS OF AGRICULTURAL PESTICIDES
HUMAN DISEASES ASSOCIATED WITH OCCUPATIONAL EXPOSURES Organ
Effect
Toxicant
Cardiovascular System
Heart disease
Carbon monoxide, lead, solvents, cobalt, cadmium
Respiratory system
Nasal cancer
Isopropyl alcohol, wood dust Radon, asbestos, silica, nickel, arsenic, chromium, mustard gas
Lung cancer
Chronic obstructive lung disease
Fibrosis
Grain dust, coal dust, Silica, asbestos, cobalt
HUMAN DISEASES ASSOCIATED WITH OCCUPATIONAL EXPOSURES Organ
Effect
Nervous system
Peripheral
Toxicant
neuropathies
Solvents,, methyl chloride, lead, arsenic, DDT
Ataxic gait
Chlordane, toluene,
CNS depression
Alcohols, ketones, aldehydes, solvents
Cataracts
Ultraviolet radiation
HUMAN DISEASES ASSOCIATED WITH OCCUPATIONAL EXPOSURES Organ
Effect
Toxicant
Urinary system
Toxicity Bladder cancer
Mercury, lead, Naphthylamines, benzidine, rubber products
Reproductive system
Male infertility Female infertility Teratogenesis
Lead, phthalate plasticizers Cadmium, lead Mercury, polychlorinated biphenyls
Hematopoietic system
Leukemia
Benzene, radon, uranium
Skin
Cancer
Ultraviolet radiation
Gastrointestinal tract
Liver angiosarcoma
Vinyl chloride
DISEASES ATTRIBUTABLE TO CIGARETTE SMOKING
Cancer – – – – – – – – – – – –
Trachea Lung Bronchus Larynx Lip oral cavity pharynx Esophagus Bladder and urinary tract Cervix Pancreas Stomach
Ischemic heart disease Cerebrovascular disease Arteriosclerosis Chronic respiratory disease
CARCINOGENS IN TOBACCO SMOKE • • • • • •
Polycyclic aromatic hydrocarbons 4-(Methylnitrosoamino)-1-(3-pyridyl)-1-butanone Polonium 210 N -Nitrosonornicotine 4-Aminobiphenyl 2-naphthylamine
Inhaled carcinogens in cigarette smoke may: 9. Act directly on the mucous membranes 10. Be wallowed in saliva 11. Be bsorbed into the bloodstream
Normal Lung
Emphysema
Tobacco Smoking: •
Cessation of smoking reduces, but does not completely eliminate, the risks of lung cancer and coronary artery disease over time
•
The largest number of deaths attributable to cigarette smoking are due to lung cancer, ischemic heart disease, and chronic obstructive lung disease
• •
Nicotine is responsible for tobacco addiction.
•
30% of all cancer deaths and up to 90% of all lung cancer deaths are attributable to cigarette smoking
•
Maternal smoking leads to feta hypoxia – low birth weight – prematurity – increased incidence of spontaneous abortion
DISEASE CAUSED BY ETHANOL ABUSE Organ
Lesion
Mechanism
Liver
Fatty change Acute hepatitis Alcoholic cirrhosis
Toxicity
CNS
Wernicke syndrome
Thiamine deficiency
Korsakoff syndrome
Toxicity and thiamine deficiency
Cerebellar degenerationNutritional deficiency
DISEASE CAUSED BY ETHANOL ABUSE Organ
Lesion
Mechanism
Cardiomyopathy Hypertension
Toxicity Vasopressor
GIT
Gastritis Pancreatitis
Toxicity Toxicity
Skeletal muscle Reproductive System
Rhabdomyolysis
Toxicity
Cardiovascular system
Fetal alcohol Syndrome
Testicular atrophy Spontaneous abortion
Growth retardation Mental retardation
Toxicity
Mechanism of fatty liver in alcohol abuse Biochemical mechanisms responsible for fat accumulation in hepatocytes are the following: • Increased catabolism of fat by peripheral tissues with increased delivery of free fatty acids to the liver. • Metabolism of ethanol converts the oxidized (NAD+) to the reduced form (NADH); an excess of NADH over NAD stimulates lipid biosynthesis. • Oxidation of fatty acids by mitochondria is decreased. • Decreased transport of lipoproteins from the liver.
ADVERSE DRUG REACTIONS AND THEIR AGENTS Blood Dyscrasias Granulocytopenia, aplastic anemia, pancytopenia Hemolytic anemia, thrombocytopenia Drugs: Antineoplastic agents immunosuppressives Chloramphenicol Penicillin Methyldopa
ADVERSE DRUG REACTIONS AND THEIR AGENTS Blood Dyscrasias Granulocytopenia, aplastic anemia, Pancytopenia Hemolytic anemia, thrombocytopenia
Antineoplastic agents immunosuppressives Penicillin, methyldopa
Cardiac Arrhythmias Cardiomyopathy
Theophylline, hydantoins Doxorubicin, daunorubicin
Renal Glomerulonephritis Acute tubular necrosis Tubulointerstitial disease
Penicillamine Aminoglycoside antibiotics cyclosporine Phenacetin, salicylates
ADVERSE DRUG REACTIONS AND THEIR AGENTS Pulmonary Asthma Acute pneumonitis Interstitial fibrosis
Salicylates Nitrofurantoin Busulfan, nitrofurantoin, bleomycin
Hepatic Fatty change Diffuse hepatocellular damage
Tetracycline Halothane, isoniazid, acetaminophen
Systemic Anaphylaxis Lupus erythematosus syndrome
Penicillin Hydralazine, procainamide
Respiratory depression
Sedatives
•
Ovarian cancer: Oral contraceptives protect against ovarian cancer
•
Thromboembolism: increased risk of venous thrombosis and pulmonary embolism
•
Cervical cancer: some increased risk is correlated with duration of use
•
Endometrial cancer : no increased risk
•
Breast carcinoma: slight increase in breast cancer risk when combined oral contraceptives are used by women younger than 45 years
•
Hepatic adenoma. There is a well-defined association
•
Hypertension: slight increase in blood pressure
ADVERSE DRUG REACTIONS AND THEIR AGENTS Blood Dyscrasias Granulocytopenia, aplastic anemia, pancytopenia Hemolytic anemia, thrombocytopenia Drugs: Antineoplastic agents immunosuppressives Chloramphenicol Penicillin Methyldopa
HEALTH EFFECTS OF OUTDOOR AIR POLLUTANTS Ozone
Decreased lung function Lung inflammation Decreased exercise capacity
Nitrogen dioxide
Decreased lung function Increased respiratory infection
Sulfur dioxide
Increased respiratory symptom Increased mortality
Acid aerosols
Altered mucociliary clearance respiratory infections Decreased lung function
HEALTH EFFECTS OF INDOOR AIR POLLUTANTS Pollutant
Effects
• • •
Carbon monoxide Nitrogen dioxide Wood smoke infections
Acute poisoning Increased respiratory infections Increased respiratory
• • •
Formaldehyde Radon Asbestos fibers
Eye and nose irritation, asthma Lung cancer Lung cancer; mesothelioma
• •
Mineral fibers Bioaerosols
Skin and airway irritation Allergic rhinitis, asthma
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