Pediatr Emerg Med J.  2023 Jul;10(3):99-103. 10.22470/pemj.2023.00689.

Acute respiratory distress after metofluthrin insecticide ingestion in a 19-month-old girl

• Choi DY
• Kim KW
• Yoon SH

• KMID: 2543577
• DOI: http://doi.org/10.22470/pemj.2023.00689

Abstract

Metofluthrin is a volatile pyrethroid insecticide. Despite being widely used as a safe household insecticide, it could cause severe systemic symptoms. A 19-month-old girl was taken to the emergency department after ingesting 1 mL of a mosquito repellent containing metofluthrin. After the arrival, the girl developed respiratory distress, which worsened progressively despite the administration of oxygen with nebulized salbutamol and budesonide. Additionally, she underwent application of high-flow nasal cannula, and administration of activated charcoal and systemic steroids. Her dyspnea gradually improved, and she was thus discharged on day 4 with oral prednisolone. All medications were discontinued 10 days after the discharge without any complication. Respiratory distress can develop after the ingestion of even a small amount of metofluthrin. Symptomatic and adjunctive steroid therapies can be effective therapeutic options.

Keyword

Child; Insecticides; Poisoning; Pyrethrins; Respiratory Insufficiency

Figure

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  Fig. 1. Plain radiographs on arrival at the emergency department (A), 1 hour 15 minutes after the arrival (B), 2 hours 50 minutes after the arrival (C), on day 3 (D), on day 4 (E), and 10 days after discharge (F).

Reference

References

1. Buhagiar TS, Devine GJ, Ritchie SA. Metofluthrin: investigations into the use of a volatile spatial pyrethroid in a global spread of dengue, chikungunya and Zika viruses. Parasit Vectors. 2017; 10:270.

2. He F. Synthetic pyrethroids. Toxicology. 1994; 91:43–9.

3. He F, Wang S, Liu L, Chen S, Zhang Z, Sun J. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol. 1989; 63:54–8.

4. Bradberry SM, Cage SA, Proudfoot AT, Vale JA. Poisoning due to pyrethroids. Toxicol Rev. 2005; 24:93–106.

5. Burillo-Putze G, Nogué-Xarau S. Pesticides. In : Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s emergency medicine. 8th ed. New York (NY): McGraw-Hill;2016. p. 1318–26.

6. Cha YS, Kim H, Cho NH, Jung WJ, Kim YW, Kim TH, et al. Pyrethroid poisoning: features and predictors of atypical presentations. Emerg Med J. 2014; 31:899–903.

7. European Commission. Directive 98/8/EC concerning the placing of biocidal products on the market [Internet]. The United Kingdom; c2010 [cited 2023 Apr 17]. Available from: http://dissemination.echa.europa.eu/Biocides/ActiveSubstances/0045-18/0045-18_Assessment_Report.pdf.

8. Panwar M, Usha G, Kumath M. Status epilepticus: an association with pyrethroid poisoning. Indian J Crit Care Med. 2013; 17:119–20.

9. Soderlund DM, Clark JM, Sheets LP, Mullin LS, Piccirillo VJ, Sargent D, et al. Mechanisms of pyrethroid neurotoxicity: implications for cumulative risk assessment. Toxicology. 2002; 171:3–59.

10. Roberts JR, Karr CJ CJ; Council on Environmental Health. Pesticide exposure in children. Pediatrics. 2012; 130:e1765–88.

11. Walters JK, Boswell LE, Green MK, Heumann MA, Karam LE, Morrissey BF, et al. Pyrethrin and pyrethroid illnesses in the Pacific northwest: a five-year review. Public Health Rep. 2009; 124:149–59.

12. Pallavidino M, Arango Uribe D, Baskaran S, Saqib A, Elmesserey M, Onsy A, et al. Accidental pyrethroid ingestion in toddler: near-fatal atypical presentation and successful recovery. Front Pediatr. 2020; 7:542.

13. Ray DE, Forshaw PJ. Pyrethroid insecticides: Poisoning syndromes, synergies, and therapy. J Toxicol Clin Toxicol. 2000; 38:95–101.

14. Spagnolo P, Rossi G, Cavazza A, Bonifazi M, Paladini I, Bonella F, et al. Hypersensitivity pneumonitis: a comprehensive review. J Investig Allergol Clin Immunol. 2015; 25:237–50.

15. Mastrorilli C, Pecoraro L, Arasi S, Barni S, Caminiti L, Castagnoli R, et al. Pediatric hypersensitivity pneumonitis: literature update and proposal of a diagnostic algorithm. Ital J Pediatr. 2022; 48:51.

16. Lacasse Y, Cormier Y. Hypersensitivity pneumonitis. Orphanet J Rare Dis. 2006; 1:25.

17. Wawszczak M, Bielecka T, Szczukocki M. Hypersensitivity pneumonitis in children. Ann Agric Environ Med. 2021; 28:214–9.

18. Fan LL. Hypersensitivity pneumonitis in children. Curr Opin Pediatr. 2002; 14:323–6.

19. Griese M, Stehling F, Schwerk N, Rosewich M, Jerkic PS, Rock H, et al. Hypersensitivity pneumonitis: lessons from a randomized controlled trial in children. Pediatr Pulmonol. 2021; 56:2627–33.

20. George J, Malik R, Gogna A. Hypersensitivity reaction and acute respiratory distress syndrome in pyrethroid poisoning and role of steroid therapy. Asia Pac J Med Toxicol. 2015; 4:91–3.