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Upper Respiratory Complications of Sulfur Mustard (SM) Poisoning

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Basic and Clinical Toxicology of Mustard Compounds

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Abstract

Various chemical agents have been used as a war weapon. Sulfur mustard (SM) due to its low cost, easy access and easy manufacture and storage are the most wildly used warfare agents in the world. It was used widely during Iraq-Iran conflict against Iranian troops. SM is a potent alkylating blistering agent that causes low mortality, but it could incapacitate a large number of soldiers in the war. SM exposure may occur in occupational or war exposure. SM can be absorbed from skin, eye, mouth and respiratory and the gastrointestinal systems. Among these organs, respiratory tract and skin are the main susceptible organs for SM intoxication and injury. Upper and lower respiratory tract may be affected by SM, however the acute and chronic effects of SM in upper respiratory tract has been less studied and most of studies have focused on lung injuries induced by SM. This study reviewed early and late clinical features and complications of SM in upper respiratory tract as well as its molecular mechanism of action and treatment.

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Authors and Affiliations

  1. Otorhinolaryngology Department, Mashhad Branch, Islamic Azad University, Mashhad, Iran

    Ramin Zojaji MD

  2. Arya Teaching Medical Hospital ENT Department, Islamic Azad Medical University, Golestan 5, East GolestanStr, Jahanbany Street, Mashhad, Iran

    Ramin Zojaji MD

  3. Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran

    Morteza Mazloum Farsi Baf MD

Authors
  1. Ramin Zojaji MD
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  2. Morteza Mazloum Farsi Baf MD
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Correspondence to Ramin Zojaji MD .

Editor information

Editors and Affiliations

  1. Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Mahdi Balali-Mood

  2. Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Abdollahi

Glossary

Aphonia

The inability to produce voice. It is more severe than dysphonia

Bronchiectasis

A disease in which there is permanent enlargement of parts of the airways of the lung

Bronchospasm

Sudden constriction of the muscles in the walls of the bronchi

Carcinogenicity

The ability to produces cancer

Chronic bronchitis

A chronic inflammatory condition in the lungs that causes the respiratory passages to be swollen and irritated

CWA

Chemical warfare agents: a chemical substance whose toxic properties are used to kill, injure or incapacitate human beings

Cytotoxic

The quality of being toxic to cells

Dysphonia

An impairment in the ability to produce voice sounds using the vocal organs

Dyspnea

Shortness of breath or breathlessness is the feeling or feelings associated with impaired breathing

Exposure

The condition of being subjected to something, as to infectious agents, extremes of weather, radiation, or chemical agent which may have a harmful effect.

Hoarseness

A harsh, raspy, or strained voice caused by a variety of conditions

Hypopharynx

The area where the larynx and esophagus meet

Inhalation

The flow of air into an organism. In humans, it is the movement of air from the external environment, through the airways, and into the alveoli.

Inspiratory

Relating to the act of breathing in

Intoxication

An abnormal state that is essentially a poisoning

Laryngitis

An inflammation of the larynx

Laryngoscopy

An exam that gives doctors a close-up view of the larynx and the throat

Lipophilic

The ability of a chemical compound to dissolve in fats, oils, lipids, and non-polar solvents

Mutagenic

Capable of inducing mutation or increasing its rate

Nasopharynx

A part of the pharynx lies in the upper part of the throat behind the nose

Oropharynx

This space lies behind the oral cavity, extending from the uvula to the level of the hyoid bone

Pulmonary Alveol

An anatomical structure at the terminal ends of the respiratory tree in the lug parenchyma that has the form of a hollow cavity and is the site of gas exchange with the blood.

SM

Sulfur mustard: a class of related cytotoxic and vesicant chemical warfare agents with the ability to form large blisters on the exposed skin and in the lungs

Stroboscopy

Direct examination of the vocal cords and surrounding structures with the use of a stroboscope

Teratogenic

A drug or other substance capable of interfering with the development of a fetus, causing birth defects

Toxicity

The degree to which a substance can damage an organism

Tracheobronchial stenosis

Abnormal narrowing of the central air passage ways

Tracheobronchitis

A condition involving inflammation of the windpipe orbronchi

Tracheobronchomalacia

A condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse with condition extends further to the bronchi

Tracheotomy

A surgical procedure, which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea

Turbinate or conchae

A long, narrow and curled bone shelf that protrudes into the breathing passage of the nose

Video laryngoscopy

A form of indirect laryngoscopy in which the clinician does not directly view the larynx. Instead, visualization of the larynx is performed with a fiberoptic or digital laryngoscope inserted transnasally or transorally

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Zojaji, R., Mazloum Farsi Baf, M. (2015). Upper Respiratory Complications of Sulfur Mustard (SM) Poisoning. In: Balali-Mood, M., Abdollahi, M. (eds) Basic and Clinical Toxicology of Mustard Compounds. Springer, Cham. https://doi.org/10.1007/978-3-319-23874-6_6

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