Abstract
Manganese and its inorganic compounds are widely used in many industries and have been accepted as occupational neurotoxins that have caused a distinct and disabling clinical entity, manganism, in several types of work, notably where exposure is by way of dust. There is inconclusive and inconsistent evidence that, in these occupations, subclinical neurological effects, detectable only by neurobehavioural studies, may be caused by low doses. This has prompted a re-evaluation of occupational exposure limits. Some countries, including the UK, already demand much higher levels of protection against exposure than 5 years ago.
Welding is the most common source of occupational exposure as manganese is an essential component of steel and so its compounds are inevitable components of fume emitted from steel welding processes. There it is found in respirable particles, often as complex oxides (spinels), sometimes within a core protected by a silicon oxide shell — as distinct from the much simpler form of particle formed by disintegration in processes such as mining and ore milling where manganism has been diagnosed convincingly. Millions of workers are at risk of exposure to manganese-containing compounds in fumes from electric arc welding of steel. In recent years it has been asserted that neurological and neurobehavioural disorders may develop consequent to exposure to steel welding fumes and that employment as a welder is associated with the unusually early onset of Parkinson’s disease. Causal relationships have been postulated. Welders have been recorded as having been exposed to high levels of manganese-containing fume, especially where they have worked in confined, unventilated spaces, although this appears from limited data to be the exception rather than the rule. Even then the dose received is generally less than in mining or ore crushing. When care is taken to exclude exposures from hardfacing and burning and cutting arc processes, where manganese may form a high percentage of the fume, manganese compounds usually form a relatively low percentage of the composition of welding fume particles, <2.0%, much outweighed by iron. Although these manganese-compound-containing welding fume particles are insoluble in water, the manganese compounds in particles that are retained in the alveoli may be absorbed, at least in part. Manganese concentrations in biological material samples in some exposed groups reflect this relative to unexposed workers. Some of the transfer systems for absorption and transport, including across the blood-brain barrier, are used in competition with iron which is present in abundance in welding fume. This may reduce absorption of manganese in welders and thus reduce the opportunity for sufficient doses to cause neurotoxicological consequences.
Scrutiny of the literature covering the last 40 years has revealed only five cases that meet sufficient criteria for manganism to just cross the diagnostic threshold, and even then they carry a degree of doubt with them. This low incidence alone gives notice that welders have not been and are not at high risk of clinically apparent damage from exposure to manganese. If this needs to be further emphasised, there is the fact that the literature contains no confirmed cases of manganism in welders. Assertions of abnormal results in neurobehavioural studies of welders have raised the possibility of there being a subclinical form of manganism with loss of fine motor control as one of its features. While observations of such changes in workers in other industries have caused regulators in some countries to apply more stringent controls of exposure, as yet the results lack convincing consistency and there is no indication of any dose-effect relationship. If welding fume can have these motor effects it would be a heavy and perhaps career-ending blow to those affected. It would not be prudent to dismiss the warnings sounded by the results of studies of welders, no matter how flawed these investigations are, but wiser and better to act with vigour to reduce exposure and monitor the effectiveness of this additional protection whilst conducting high quality research to allow sound conclusions to be drawn as to whether there actually is a subclinical disorder.
Idiopathic Parkinson’s disease is a common disorder affecting 1–2% of those in the general population aged >65 years. It has been suggested, on flawed and contested evidence, not that welding causes the disease but rather that employment as a welder carries with it the risk of developing this disease at a younger age than if that trade had not been followed. Manganese in welding fume has been nominated as the neurotoxin. This may be biologically feasible if manganese destroys insufficient receptor cells to produce clinical manganism but sufficient to enhance the effects of a reduced supply of dopamine to give the manifestations of already developing idiopathic Parkinson’s disease earlier in the course of destruction of the substantia nigra than if all receptors were intact.
Similar content being viewed by others
References
Pettifor MJ. Technology driving steel forward. 49th Hatfield Memorial Lecture. Steel World 2002; 7: 11–9
Pekkari B. The future of welding and joining. Svetsarep 2004; 1: 53–9
Aggett PJ. Physiology and metabolism of essential trace elements: an outline. Clin Endocrinol Metab 1985; 14(3): 513–43
Dobson AW, Erikson KM, Aschner M. Manganese neurotoxicity. Ann N Y Acad Sci 2004 Mar; 1012: 115–28
Barceloux DG. Manganese. Clin Toxicol 1999; 37(2): 293–307
National Acadamies Press. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc [online]. Available from URL: http://www.nap.edu/books/0309072794/html/ [Accessed 2004 Dec 16]
Kilburn CJ. Manganese, malformations and motor disorders: findings in a manganese exposed population. Neurotoxicology 1987; 8: 421–9
Kawamura R, Ikuta H, Fukuzumi S, et al. Intoxication by manganese in well water. Kitazato Arch 1940; 18: 145–71
Kondakis XG, Makris N, Leotsinidis M, et al. Possible health effects of high manganese concentration in drinking water. Arch Environ Health 1989 May; 44(3): 175–8
Vieregge P, Heinzow B, Korf G, et al. Long-term exposure to manganese in rural well water has no neurological effects. Can J Neurol Sci 1995; 22(4): 286–9
Degner D, Bleich S, Riegel A, et al. Follow-up study after enterai manganese poisoning: clinical, laboratory and neuroradiological findings [in German]. Nervenarzt 2000 May; 71(5): 416–9
Holzgraefe M, Poser W, Kijewski H, et al. Chronic enterai poisoning caused by potassium permanganate: a case report. J Toxicol Clin Toxicol 1986; 24(3): 235–44
Ejima A, Imamura T, Nakamura S, et al. Manganese intoxication during total parenteral nutrition. Lancet 1992 Feb 15; 339(8790): 426
Fredstrom S, Rogosheske J, Gupta P, et al. Extrapyramidal symptoms in a BMT recipient with hyperintense basal ganglia and elevated manganese. Bone Marrow Transplant 1995; 15: 989–92
Hayashi Y, Shimpo T, Uesugi H, et al. A case of juvenile parkinsonism developed during total parenteral nutrition supplemented by manganese. Neurol Med (Tokyo) 1997; 46: 382–8
Nagatomo S, Umehara F, Hanada K, et al. Manganese intoxication during total parenteral nutrition: report of two cases and review of the literature. J Neurol Sci 1999 Jan 1; 162(1): 102–5
Mehta R, Reilly JJ. Manganese levels in a jaundiced long-term total parenteral nutrition patient: potentiation of haloperidol toxicity — case report and literature review. JPEN J Parenter Enterai Nutr 1990; 14(4): 428–30
Fell JM, Renolds AP, Meadows N, et al. Manganese toxicity in children receiving long-term parenteral nutrition. Lancet 1996; 347(9010): 1218–21
Tjalve H, Henriksson J, Tallkvist J, et al. Uptake of manganese and cadmium from the nasal mucosa into the central nervous system via olfactory pathways in rats. Pharmacol Toxicol 1996; 79: 347–56
Tjalve H, Henriksson J. Uptake of metals in the brain via olfactory pathways. Nerotoxicology 1999 Apr-Jun; 20(2–3): 181–95
Tjalve H, Mejare C, Borg-Neczak K. Uptake and transport of manganese in primary and secondary olfactory neurones in pike. Pharmacol Toxicol 1995; 77(1): 3–31
Drown DB, Oberg SG, Sharma RP. Pulmonary clearance of soluble and insoluble forms of manganese. J Toxicol Environ Health 1986; 17(2–3): 201–12
Hauser RA, Zesiewicz TA, Rosemurgy AS, et al. Manganese intoxication and chronic liver failure. Ann Neurol 1994; 36: 871–5
Versieck J, Barbier F, Speecke A, et al. Manganese, copper and zinc concentration in serum and packed blood cells during acute hepatitis, chronic hepatitis and posthepatic cirrhosis. Clin Chem 1974; 20: 1141–5
Murphy VA, Wadhwani KC, Smith QR, et al. Saturable transport of manganese (II) across the rat blood brain barrier. J Neurochem 1991; 61: 948–54
Rabin O, Hegedus L, Bourre JM, et al. Rapid brain uptake of manganese (II) across the blood brain barrier. J Neurochem 1993; 61: 509–17
Aschner M, Gannon M, Kimelberg HK. Manganese transport across the rat blood-brain barrier: saturable and transferrin-dependent mechanisms. Brain Res Bull 1994; 33: 345–9
Crossgrove JS, Allen DA, Bukaveckas BL, et al. Manganese distribution across the blood-brain barrier I: evidence for carrier-mediated influx of manganese citrate as well as manganese and manganese transferrin. Neurotoxicology 2003; 24: 3–13
Crossgrove JS, Yokel RA. Manganese distribution across the blood-brain barrier: the divalent metal transporter is not the major mechanism mediating brain manganese uptake. Neurotoxicology 2004; 25: 451–60
Takeda A, Ishiwateri S, Okada S. Manganese uptake into rat brain during development and aging. J Neurosci Res 1999; 56: 93–8
Aschner M, Gannon M, Kimelberg HK. Manganese uptake and efflux in cultured rat astrocytes. J Neurochem 1992; 58: 730–5
Aschner M. Manganese: brain transport and emerging research needs. Environ Health Perspect 2000 Jun; 108Suppl. 3: 429–32
Aschner M, Aschner JL. Manganese transport across the blood-brain barrier: relationship to iron homeostasis. Brain Res Bull 1990; 24: 857–60
Yokel RA, Crossgrove JS, Bukaveckas BL. Manganese distribution across the blood-brain barrier II: manganese efflux from the brain does not appear to be carrier mediated. Neurotoxicology 2003; 24: 15–22
Nelson K, Golnick J, Korn T, et al. Manganese encephalopathy: utility of early magnetic resonance imaging. Br J Ind Med 1993; 50: 510–3
Arjona A, Mata M, Bonet M. Diagnosis of chronic manganese intoxication by magnetic resonance imaging. N Engl J Med 1997; 336(13): 964–5
Kim Y, Kim KS, Yang JS, et al. Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed workers. Neurotoxicology 1999; 20(6): 901–7
Lucchini R, Albini E, Placidi D, et al. Brain magnetic resonance imaging and manganese exposure. Neurotoxicology 2000 Oct; 21(5): 769–75
Dietz MC, Ihrig A, Wrazidlo W, et al. Results of magnetic resonance imaging in long-term manganese dioxide-exposed workers. Environ Res 2001; 85(1): 37–40
Kim Y. High signal intensities on Tl-weighted MRI as a biomarker of exposure to manganese. Ind Health 2004 Apr; 42(2): 111–5
Mirowitz SA, Westlich TJ. Basal ganglia signal intensity alterations: reversal after discontinuation of parenteral manganese administration. Radiology 1992 Nov; 185(2): 535–6
Huang CC, Chu NS, Lu CS, et al. Long-term progression in chronic manganism: ten years of follow-up. Neurology 1998 Mar; 50(3): 698–700
Kim Y, Kim JW, Ito K, et al. Positron emission tomography (PET) in differentiating manganism from idiopathic parkinsonism. J Occup Health 1999; 41(2): 91–4
Abe Y, Kachi T, Kato T, et al. Diagnostic utility of positron emission tomography for parkinsonism after chronic manganese exposure [in Japanese]. Rinsho Shinkeigaku 1999 Jul; 39(7): 693–9
Eriksson H, Tedroff J, Thuomas K-A, et al. Manganese induced brain lesions in Macaca fascicularis as revealed by positron emission tomography and magnetic resonance imaging. Arch Toxicol 1992; 66(6): 403–7
Shinotoh H, Snow BJ, Huang CC, et al. Presynaptic and postsynaptic striatal dopaminergic function in manganese intoxication studied by positron emission tomography [abstract]. Can J Neurol Sci 1993; 20Suppl. 4: S236
Calne DB, Snow BJ. PET imaging in Parkinsonism. Adv Neurol 1993; 60: 484–7
Kim Y, Kim JW, Ito K, et al. Idiopathic parkinsonism with superimposed manganese exposure: utility of positron emission tomography. Neurotoxicology 1999 Apr; 20(2–3): 249–52
Shinotoh H, Snow BJ, Hewitt KA, et al. MRI and PET studies of manganese-intoxicated monkeys. Neurology 1995; 45(6): 1199–204
Gwiazda RH, Lee D, Sheridan J, et al. Low cumulative manganese exposure affects striatal GABA but not dopamine. Neurotoxicology 2002; 23(1): 69–76
Couper J. On the effects of black oxide of manganese when inhaled into the lungs. Br Ann Med Pharmacol 1837; 1: 41: 41–2
Rodier J. Manganese poisoning in Moroccan miners. Br J Ind Med 1955 Jan; 12(1): 21–35
Schuler P, Oyanguren H, Maturana V, et al. Manganese poisoning; environmental and medical study at a Chilean mine. Ind Med Surg 1957 Apr; 26(4): 167–73
Penalver R. Diagnosis and treatment of manganese intoxication: report of a case. AMA Arch Ind Health 1957 Jul; 16(1): 64–6
Abd El Naby S, Hassanein M. Neuropsychiatric manifestations of chronic manganese poisoning. J Neurol Neurosurg Psychiatry 1965; 28: 282–8
Mena I, Marin O, Fuenzalida S, et al. Chronic manganese poisoning: clinical picture and manganese turnover. Neurology 1967 Feb; 17(2): 128–36
Balani SG, Umarji GM, Bellare RA, et al. Chronic manganese poisoning: a case report. J Postgrad Med 1967 Jul; 13(3): 116–21
Chandra SV, Seth PK, Mankeshwar JK. Manganese poisoning: clinical and biochemical observation. Environ Res 1974; 7: 374–80
Hochberg F, Miller G, Valenzuela R, et al. Late motor deficits of Chilean manganese miners: a blinded control study. Neurology 1996; 47(3): 788–95
Canavan MM, Cobb S, Drinker CK. Chronic manganese poisoning: report of a case with autopsy. Arch Neurol Psychiatry 1934; 32: 501–12
Flinn RH, Neal PA, Reinhart WH, et al. Chronic manganese poisoning in an ore-crushing mill [public health bulletin no. 247]. Washington, DC: US Government Printing Office, 1940: 1–77
Flinn RH, Neal PA, Fulton WB. Industrial manganese poisoning. J Ind Hyg Toxicol 1941; 23: 374–87
Tanaka S, Lieben J. Manganese poisoning and exposure in Pennsylvania. Arch Environ Health 1969 Nov; 19(5): 674–84
Greenhouse AH. Manganese intoxication in the United States. Trans Am Neurol Assoc 1971; 96: 248–9
Cook DG, Fahn S, Brait KA. Chronic manganese intoxication. Arch Neurol 1974 Jan; 30(1): 59–64
Chia SE, Gan SL, Chua LH, et al. Postural stability among manganese exposed workers. Neurotoxicology 1995; 16(3): 519–26
Emara AM, El-Shawabi SH, Madkour OI, et al. Chronic manganese poisoning in the dry battery industry. Br J Ind Med 1971; 28: 78–82
Hine CH, Pasi A. Manganese intoxication. West J Med 1975 Aug; 123(2): 101–7
Blodgett E. Potters Manganese toxicity 2000 [online]. Available from URL: http://www.ceramic-materials.com/cermat/education/139.html [Accessed 2002 Nov 25]
Smyth LT, Ruhf RC, Whitman NE, et al. Clinical manganism and exposure to manganese in the production and processing of ferromanganese alloy. J Occup Med 1973 Feb; 15(2): 101–9
Saric M, Markicevic A, Hrustic O. Occupational exposure to manganese. Br J Ind Med 1977; 34: 114–8
Jonderko G, Kujawska A, Langauer-Lewowicka H. Problems of chronic manganese poisoning on the basis of investigations of workers at a manganese alloy foundry. Int Arch Arbeitsmed 1971; 28(3): 250–64
Huang CC, Chu NS, Lu CS, et al. Chronic manganese intoxication. Arch Neurol 1989 Oct; 46(10): 1104–6
Wang J-D, Huang C-C, Hwang Y-H, et al. Manganese induced parkinsonism: an outbreak due to an unrepaired ventilation control system in a ferromanganese smelter. Br J Ind Med 1989 Dec; 46(12): 856–9
Hua MS, Huang CC. Chronic occupational exposure to manganese and neurobehavioral function. J Clin Exp Neuropsychol 1991 Jul; 13(4): 495–507
Huang CC, Lu CS, Chu NS, et al. Progression after chronic manganese exposure. Neurology 1993; 43: 1479–83
Huang C-C, Chu N-S, Lu C-S, et al. Cock gait in manganese intoxication. Mov Disord 1997 Sep; 12(5): 807–8
Lander F, Kristiansen J, Lauritsen JM. Manganese exposure in foundry furnacemen and scrap recycling workers. Int Arch Occup Environ Health 1999; 72(8): 546–50
Lim Y, Yim HW, Kim KA, et al. Review on manganese poisoning. Korean J Occup Health 1991; 30(1): 13–8
Beintker E. The effect of manganese during arc welding. Zentralblatt Gewerbehygiene 1932; 9 (Oct–Nov): 207–11
Hoschek R. The causes of symptoms in electric welders [in German]. Arch Gewerbepathol Gewerbehygiene 1955; 14: 58–76
Oltramare M, Tchicaloff M, Desbaumes P, et al. Chronic manganese poisoning in two arc welders. Int Arch Gewerbepathol Gewerbehyg 1965 Mar 29; 21: 124–40
Whitlock Jr CM, Amuso SJ, Bittenbender JB. Chronic neurological disease in two manganese steel workers. Am Ind Hyg Assoc J 1966 Sep; 27(5): 454–9
Whitman NE, Brandt AD. Comments on paper by Dr Whitlock [letter]. Am Ind Hyg Assoc J 1966; (Sep/Oct): 459
Chandra SV, Shukla GS, Srivastava RS, et al. An exploratory study of manganese exposure to welders. Clin Toxicol 1981; 18: 407–16
Rasmussen KH, Jepsen JR. The organic psychosyndrome in electric arc welders: a possible sequela of manganese toxicity [in German]. Ugeskr Laeger 1987 Dec 14; 149(51): 3497–8
Sjögren B, Gustavsson P, Hogstedt C. Neuropsychiatric symptoms among welders exposed to neurotoxic metals. Br J Ind Med 1990; 47(10): 704–7
Angle CR. Dimercaptosuccinic acid (DMSA): negligible effect on manganese in urine and blood. Occup Environ Med 1995; 52(12): 846
Sjögren B, Iregren A, Frech W, et al. Effects on the nervous system among welders exposed to aluminium and manganese. Occup Environ Med 1996; 53(1): 32–40
Kim J-W, Kim Y-H, Cheong H-K, et al. Three cases of manganese induced parkinsonism: differences from idiopathic Parkinsonism. J Kor Neurol Ass 1998; 16(3): 336–40
Barrington WW, Angle CR, Willcockson NK, et al. Autonomic function in manganese alloy workers. Environ Res 1998; 78(1): 50–8
Discalzi G, Pira E, Hernandez EH, et al. Occupational Mn parkinsonism: magnetic resonance imaging and clinical patterns following CaNa2 -EDTA chelation. Neurotoxicology 2000; 21(5): 863–6
Sato K, Ueyama H, Arakawa R, et al. The case of a welder with parkinsonism after chronic manganese exposure [in Japanese]. Rinsho Shinkeigaku 2000; 40(11): 1110–5
Sinczuk-Walczak H, Jakubowski M, Matczak W. Neurological and neurophysiological examinations of workers occupationally exposed to manganese. Int Arch Occup Environ Health 2001; 14: 329–37
Ono K, Komai K, Yamada M. Myoclonic involuntary movement associated with chronic manganese poisoning. J Neurol Sci 2002; 199: 93–6
Sadek AH, Rauch R, Schulz PE. Parkinsonism due to manganism in a welder. Int J Toxicol 2003 Sep; 22(5): 393–401
Josephs KA, Ahlskog JE, Klos KJ, et al. Neurologic manifestations in welders with pallidal MRI T1 hyperintensity. Neurology 2005; 64: 1–7
Calne DB, Chu N-S, Hung C-C, et al. Manganism and idiopathic parkinsonism: similarities and differences. Neurology 1994 Sep; 44(9): 1583–6
Olanow CW. Manganese-induced parkinsonism and Parkinson’s disease. Ann N Y Acad Sci 2004 Mar; 1012: 209–23
Davis JM, Elias RW. Risk assessment of metals. In: Chang LW, editor. Toxicology of metals. Boca Raton (FL): CRC Lewis, 1996
Zatta P, Lucchini R, van Rensburg SJ, et al. The role of metals in neurodegenerative processes: aluminum, manganese, and zinc. Brain Res Bull 2003 Nov 15; 62(1): 15–28
Sassine MP, Mergler D, Bowler R, et al. Manganese accentuates adverse mental health effects associated with alcohol use disorders. Biological Psychiatry 2002; 51(11): 909–21
Yoshikawa K, Matsumoto M, Hamanaka M, et al. A case of manganese induced parkinsonism in hereditary haemorrhagic telangiectasia. J Neurol Neurosurg Psychiatry 2003 Sep; 74(9): 1312–4
de la Fuente-Fernandez R. Portal systemic shunts, manganese, and parkinsonism. J Neurol Neurosurg Psychiatry 2004; 75: 1081
Zheng YX, Chan P, Pan ZF, et al. Polymorphism of metabolic genes and susceptibility to occupational chronic manganism. Biomarkers 2002 Jul; 7(4): 337–46
Mena I, Court J, Fuenzalida S, et al. Modification of chronic manganese poisoning: treatment with L-dopa and 5-OH tryptophane. N Engl J Med 1970; 282: 5–10
Rosenstock HA, Simons DG, Meyer JS. Chronic manganism: neurologic and laboratory studies during treatment with levodopa. JAMA 1971 Sep 6; 217(10): 1354–8
Lu CS, Huang CC, Chu NS, et al. Levodopa failure in chronic manganism. Neurology 1994; 44(9): 1600–2
Koller WC, Lyons KE, Truly W. Effect of levodopa treatment for parkinsonism in welders: a double blind study. Neurology 2004; 62(5): 730–3
Iregren A. Manganese neurotoxicity in industrial exposures: proof of effects, critical exposure level, and sensitive tests. Neurotoxicology 1999 Apr; 20(2–3): 315–23
Anger WK. Neurobehavioural tests and systems to assess neurotoxic exposures in the workplace and community. Occup Environ Med 2003; 60(7): 531–48
Lees-Haley PR, Greiffenstein MF, Larrabee GJ, et al. Methodological problems in the neuropsychological assessment of effects of exposure to welding fumes and manganese. Clin Neuropsychol 2004; 18: 449–464
Siegl P, Bergert KD. A method of early diagnostic monitoring for manganese exposure [in German]. Z Gesamte Hyg 1982 Aug; 28(8): 524–6
Roels H, Lauwerys R, Buchet JP, et al. Epidemiological survey among workers exposed to manganese: effects on lung, central nervous system, and some biological indices. Am J Ind Med 1987; 11: 307–27
Iregren A. Psychological test performance in foundry workers exposed to low levels of manganese. Neurotoxicol Teratol 1990 Nov; 12(6): 673–5
Cizinsky G, Hagman M, Iregren A, et al. Manganese exposure in Swedish steel smelter plants: a health hazard to the nervous system. Scand J Work Environ Health 1991; 17(4): 275–81
Wennberg A, Iregren A, Struwe G, et al. Manganese exposure in steel smelters a health hazard to the nervous system. Scand J Work Environ Health 1991 Aug; 17(4): 255–62
Roels HA, Ghyselen P, Buchet JP, et al. Assessment of the permissible exposure level to manganese in workers exposed to manganese dioxide dust. Br J Ind Med 1992; 49: 25–34
Wennberg A, Hagman M, Johansson L. Preclinical neurophysiological signs of parkinsonism in occupational manganese exposure. Neurotoxicology 1992; 13(1): 271–4
Mergler D, Huel G, Bowler R, et al. Nervous system dysfunction among workers with long-term exposure to manganese. Environ Res 1994; 64(2): 151–80
Lucchini R, Selis L, Folli D, et al. Neurobehavioural effects of manganese in workers from a ferroalloy plant after temporary cessation of exposure. Scand J Work Environ Health 1995; 21(2): 143–9
Lucchini R, Bergamaschi E, Smargiassi A, et al. Motor function, olfactory threshold, and hematological indices in manganese-exposed ferroalloy workers. Environ Res 1997; 73(1–2): 175–80
Bast-Pettersen R, Ellingsen DG, Hetland SM, et al. Neuropsychological function in manganese alloy plant workers. Int Arch Occup Environ Health 2004; 77(4): 277–87
Kristiansen J, Frost P, Lund SP, et al. Occupational manganese exposure in Denmark: a systematic literature review with focus on nervous system impairment and exposure. In: Proceedings of the FORCE Technology International Conference on Health and Safety in Welding and Allied Processes; 2005 May 9–11; Copenhagen
Health and Safety Executive. Chemical Hazard Alert Notice: manganese and its inorganic compounds. CHAN 18 — June 2000 [online]. Available from URL: http://www.hse.gov.uk/pubns/chanl9.htm [accessed 2000 Oct 11]
Health and Safety Executive. Workplace Exposure Limits: containing the list of workplace exposure limits for use with the Control of Substances Hazardous to Health Regulations 2002 (as amended). London: HSE Books; 2005. EH40/2005
Brown KL. Environmental aspects of fume in air and water. Villepinte: International Institute of Welding Document; 1997. Doc. CV111 1804-97
Evans MJ, Ingle J, Molyneux MK, et al. An occupational hygiene study of a controlled welding task using a general purpose rutile electrode. Ann Occup Hyg 1979; 22(1): 1–17
Järvisalo J, Olkinuora M, Kiilunen M, et al. Urinary and blood manganese in occupationally nonexposed populations and in manual metal arc welders of mild steel. Int Arch Occup Environ Health 1992; 63: 495–501
Fairfax RE. Manganese exposure during welding operations. Appl Occup Environ Hyg 1994; 9(8): 537–8
Vasconcelos MTSD, Machado AASC, Silva-Laquipai PAP. Metals and fluoride from electric arc welding fume in real tasks. Part 11: influence of the welding parameters on the pollutant levels. Occup Hyg 1996; 3(5): 331–40
Ulfvarson U. Survey of air contaminants from welding. Scand J Work Environ Health 1981; 7Suppl. 2: 1–28
Willingham DC, Hilton DE. Some aspects of fume emissions from MIG welding stainless steel. Welding Metal Fabrication 1986; 54(5): 226–9
Castner HR, Null CL. Chromium, nickel and manganese in shipyard welding fumes. Welding J 1998; 77(6): 223s–31s
Kobayashi M, Maki S, Hashimoto Y, et al. Investigations on chemical composition of welding fumes. Welding J 1983; 62(7): 1902s–196s
Tandon RK, Ellis J, Crisp PT, et al. Chemical investigation of welding fumes from hard-facing and HSLA steel electrodes. Welding J 1986; 65(9): 231s–6s
Jenkins NT, Eagar TW. Chemical analysis of welding fume particles. Welding J 2005 (Jun); 87s–93s
Ingle J. Device for automatic recording of arcing periods during electric welding. Ann Occup Hyg 1986; 30(1): 123–4
Karlsen JT, Farrants G, Torgrimsen T, et al. Chemical composition and morphology of welding fume particles and grinding dusts. Am Ind Hyg Assoc J 1992; 53(5): 290–7
Fogh A, Frost J, Georg J. Report on a Danish investigation into the health and working environment of arc welders. Villepinte: International Institute of Welding; 1971. Doc. 8-440-71
Bellido-Milla D, Hernandez-Artiga MP, Hidalgo-Hidalgo de Cisneros JL, et al. Analytical study of hygiene hazards involved in naval industry welding processes. Appl Occup Environ Hyg 1995; 10(11): 921–6
Korczynski RE. Occupational health concerns in the welding industry. Appl Occup Environ Hyg 2000 Dec; 15(12): 936–45
Smargiassi A, Baldwin M, Savard S, et al. Assessment of exposure to manganese in welding operations during the assembly of heavy excavation machinery accessories. Appl Occup Environ Hyg 2000 Oct; 15(10): 746–50
Susi P, Goldberg M, Barnes P, et al. The use of a task-based exposure assessment model (T-BEAM) for assessment of metal fume exposures during welding and thermal cutting. Appl Occup Environ Hyg 2000 Jan; 15(1): 26–38
Ojima J, Shibata N, Iwasaki T. Laboratory evaluation of welder’s exposure and efficiency of air duct ventilation for welding work in a confined space. Ind Health 2000 Jan; 38(1): 24–9
Mattorano D, Harney J, Cook C, et al. Metal exposure during ship repair and shipbreaking procedures. Appl Occup Environ Hyg 2001 Mar; 16(3): 339–49
Spiegel-Ciobanu VE. Hazardous substances in welding and allied processes. Villepinte: International Institute of Welding Document; 1997. Doc. CVIII-1812-97
Lippold JG, Dickinson DW. Characterisation of arc welding fume. Presentation given to Commission VIII (Health and Safety) of the International Institute of Welding, 2005 Jul 13, Prague, Czech Republic
Farrants G, Schuler B, Karlsen J, et al. Characterisation of the morphological properties of welding particles by transmission electron microscopy and digital image analysis. Am Ind Hyg Assoc J 1989; 50(9): 473–9
Fasiska EJ, Wagenblast HW, Nasta M. Characterization of arc welding fume. Miami (FL): American Welding Society, 1983
Spiegel-Ciobanu VE. Some remarks on the question of ultrafine particles (UFP) in welding. Villepinte: International Institute of Welding; 2000. Doc. CVIII 1904-00
Chen BT. Effect of particle size on welding fume deposition based on a lung model. In: Handbook of presentations at Conference on Health Effects of Welding; 2005 Jul 23–24; Morgantown (WV)
Spiegel-Ciobanu VE. The formation of ultrafine particles during welding and allied processes. Annual Assembly of the International Institute of Welding; 2003 Jul 6–11; Bucharest
Donaldson K, Stone V, Clouter A, et al. Ultrafine particles. Occup Environ Med 2001; 58(3): 211–6
Health and Safety Executive. Nanoparticles: an occupational hygiene review [research report 274]. London: Health and Safety Executive, 2004: 59
Voitkevich VG. Investigation of heterogenicity of welding fume particle composition by the method of x-ray photoelectron spectroscopy. Welding World 1988; 26: 108–11
Minni E, Hofmann S, Sivonen SJ. An AES study of particles in the welding fumes of mild and stainless steel. Surface Interface Anal 1990; 16(1-12): 563–4
Rossander-Hultan L, Brune M, Sandstrom B, et al. Competitive inhibition of iron absorption by manganese and zinc in humans. Am J Clin Nutr 1991; 54(1): 152–6
Doherty MJ, Healy M, Richardson SG, et al. Total body iron overload in welder’s siderosis. Occup Environ Med 2004 Jan; 61(1): 82–5
Buckley BT. Report to Judge Kathleen O’Malley, United States District Court, Northern District of Ohio, Eastern Division. Case No 1: 03-CV-17000. Dated 11 Nov 2004.t
Byczkowski S, Cempel M, Gadomska J, et al. A trial for estimating the health condition of welders performing hand electric arc welding: part II. Villepinte: International Institute of Welding; 1968. Doc. 8-334-68
Bergert KD, Voigt H, Holler U. Detection of exposure in welders by determining manganese contents of biological materials. Z Gesamte Inn Med 1982; 37: 504–7
Knight GS, Williams HEM, Hinton D. Elevated plasma manganese levels in welders cutting manganese steel. N Z Med J 1985 Oct 9; 98(788): 870
Jarvisalo J, Olkinuora M, Kiilunen M, et al. Urinary and blood manganese in occupationally nonexposed populations and in manual metal arc welders of mild steel. Int Arch Occup Environ Health 1992; 63(7): 495–501
Luse I, Bake MA, Bergmanis G, et al. Risk assessment of manganese. Cent Eur J Public Health 2000 Jul; 8 Suppl.: 51
Longo WE, Rigler MW, Russell PE. Size distribution measurements and high resolution electron microscopy analysis of welding fume particles. In: Handbook of presentations at Conference on Health Effects of Welding; 2005 Jul 23–24; Morgantown (WV)
Tepper LB. Hazards to health: manganese. N Engl J Med 1961; 16(264): 347–8
Yu IJ, Park JD, Park ES, et al. Manganese distribution in brains of Sprague-Dawley rats after 60 days of stainless steel welding-fume exposure. Neurotoxicology 2003 Dec; 24(6): 777–85
Bowler RM, Gysens S, Diamond E, et al. Neuropsychological sequelae of exposure to welding fumes in a group of occupationally exposed men. Int J Hyg Environ Health 2003 Oct; 206(6): 517–29
Bowler RM, Roels H. Exposure to welding fumes and health effects after two years of confined space welding at the San Francisco/Oakland Bridge. In: Handbook of presentations at Conference on Health Effects of Welding; 2005 Jul 23–24; Morgantown (WV)
Wender M, Kabschowa B, Owsianowski M. Nervous system diseases in workers in a large metallurgic plant. Neurol Neurochir Pol 1976; 10(5): 613–20
Koller W, Vetere-Overfield B, Gray C, et al. Environmental risk factors in Parkinson’s disease. Neurology 1990; 40(8): 1218–21
Zayed J, Ducie G, Campanella G, et al. Environmental factors in the aetiology of Parkinson’s Disease. Can J Neurol Sci 1990; 17: 286–91
Wechsler LS, Checkoway H, Franklin GM, et al. A pilot study of occupational and environmental risk factors for Parkinson’s disease. Neurotoxicology 1991; 12(3): 387–92
Hertzman C, Wiens M, Bowering D, et al. Parkinson’s disease: a case control study of occupational and environmental risk factors. Am J Ind Med 1990; 17(3): 349–55
Granieri E, Carreras M, Casetta L, et al. Parkinson’s disease in Ferrara, Italy, 1967 through 1987. Arch Neurol 1991; 48(8): 854–7
Hubble JP, Cao T, Hassanein RE, et al. Risk factors for Parkinson’s disease. Neurology 1993; 43(9): 1693–7
Rybicki BA, Johnson CC, Uman J, et al. Parkinson’s disease mortality and the industrial use of heavy metals in Michigan. Mov Disord 1993; 8(1): 87–92
Semchuk KM, Love EJ, Lee RG. Parkinson’s disease: a test of the multifactorial etiologic hypothesis. Neurology 1993 Jun; 43(6): 1173–80
Wang W, Fang X, Cheng X. A case control study on the environmental risk factors of Parkinson’s disease in Tianjiu, China. Neuroepidemiology 1993; 12: 209–18
Hertzman C, Wiens M, Snow B, et al. A case-control study of Parkinson’s disease in a horticultural region of British Columbia. Mov Disord 1994 Jan; 9(1): 69–75
Rocca WA, Anderson DW, Meneghini F, et al. Occupation, education, and Parkinson’s disease: a case-control study in an Italian population. Mov Disord 1996; 11(2): 201–6
Seidler A, Hellenbrand W, Robra BP, et al. Possible environmental, occupational, and other etiologic factors for Parkinson’s disease: a case-control study in Germany. Neurology 1996 May; 46(5): 1275–84
Schulte PA, Burnett CA, Boeniger MF, et al. Neurodegenerative diseases: occupational occurrence and potential risk factors, 1982 through 1991. Am J Public Health 1996; 86(9): 1281–8
Gorell JM, Johnson CC, Rybicki BA, et al. Occupational exposures to metals as risk factors for Parkinson’s disease. Neurology 1997; 48(3): 650–8
Fall PA, Fredrikson M, Axelson O, et al. Nutritional and occupational factors influencing the risk of Parkinson’s disease: a case-control study in southeastern Sweden. Mov Disord 1999; 14: 28–37
Tsui JK, Calne DB, Wang Y, et al. Occupational risk factors in Parkinson’s disease. Can J Public Health 1999; 90(5): 334–7
Behari M, Srivastava AK, Das RR, et al. Risk factors of Parkinson’s disease in Indian patients. J Neurol Sci 2001; 190(1–2): 49–55
Kirkey KL, Johnson CC, Rybicki BA, et al. Occupational categories at risk for Parkinson’s disease. Am J Ind Med 2001; 39(6): 564–71
Zorzon M, Capus L, Pellegrino A, et al. Familial and environmental risk factors in Parkinson’s disease: a case-control study in north-east Italy. Acta Neurol Scand 2002; 105(2): 77–82
Hakansson N, Gustavsson P, Johansen C, et al. Neurodegenerative diseases in welders and other workers exposed to high levels of magnetic fields. Epidemiology 2003; 14(4): 420–6
McDonnell L, Maginnis C, Lewis S, et al. Occupational exposure to solvents and metals and Parkinson’s disease. Neurology 2003 Sep 9; 61(5): 716–7
Goldman SM, Quinlan PJ, Smith AR, et al. Manganese exposure and risk of Parkinson’s disease in twins. Mov Disord 2004; 19Suppl. 9: S162b
Gorell JM, Peterson EL, Rybicki BA, et al. Multiple risk factors for Parkinson’s disease. J Neurol Sci 2004 Feb 15; 217(2): 169–74
Park J, Yoo CI, Kim JW, et al. Occupations and Parkinson’s disease: a case-control study in South Korea. Ind Health 2004; 42(3): 352–8
Goldman SM, Tanner CM, Olanow CW, et al. Occupation and parkinsonism in three movement disorders clinics. Neurology 2005 Nov 8; 65(9): 1430–5
Park J, Yoo CI, Sim CS, et al. Occupations and Parkinson’s disease: a multi-center case-control study in South Korea. Neurotoxicology 2005; 26(1): 99–105
Racette BA, McGee-Minnich L, Moerlein SM, et al. Welding-related parkinsonism: clinical features, treatment, and pathophysiology. Neurology 2001 Jan 9; 56(1): 8–13
Racette BA, Tabbal SD, Jennings D, et al. Prevalence of parkinsonism and relationship to exposure in a large sample of Alabama welders. Neurology 2005; 64: 230–5
Bernheimer H, Birkmayer W, Hornykiewicz O, et al. Brain dopamine and the syndromes of Parkinson and Huntington: clinical, morphological and neurochemical correlations. J Neurol Sci 1973 Dec; 20(4): 415–55
Fearnley JM, Lozano AJ. Ageing and Parkinson’s disease: substantia nigra regional selectivity. Brain 1991; 114: 2283–301
Morrish PK, Sawle GV, Brooks DJ. Clinical and 18Fdopa PET findings in early Parkinson’s disease. J Neurol Neurosurg Psychiatry 1995; 59: 597–600
Witholt R, Gwiazda RH, Smith DR. The Neurobehavioural effects of subchronic manganese exposure in the presence and absence of pre-parkinsonism. Neurotoxicol Teratol 2000; 22: 851–6
Acknowledgements
The author is an accredited specialist in occupational medicine in independent private practice and an Honorary Senior Clinical Lecturer at the Institute of Occupational and Environmental Medicine in the University of Birmingham, England. Whereas, the author has received fees and sponsorship for work done for organisations and companies in and associated with the welding industry, his agreements with these clients and sponsors have included his guaranteed freedom to express and publish his views without prior consultation with them. In consequence, he has felt neither conflict of interests nor any threat to maintaining his independence and objectivity.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McMillan, G. Is Electric Arc Welding Linked to Manganism or Parkinson’s Disease?. Toxicol Rev 24, 237–257 (2005). https://doi.org/10.2165/00139709-200524040-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00139709-200524040-00004