The insecticide used in the mosquito fogging is synthetic pyrethroids. The aim of the mosquito fogging operations is to kill any adult dengue mosquitoes that may be carrying the dengue virus. Although their potential for systemic intoxication is quite low, the pyrethroids are known allergens with the skin or respiratory tract as target organs.
8 years old boy with underlying Trencher Collin's syndrome and global developmental delay was presented to emergency and trauma department for post fitting. A day before admission child was exposed to fogging. He developed rashes over face, vomiting and starting to make noisy breathing. Child’s saturation was able to maintain, however noted child was having wheezing and rhonchi. Child was treated as anaphylactic reaction due to fogging. Intramuscular (IM) Adrenaline, intravenous (IV) Hydrocortisone and Chlorpheniramine given stat, within less than 30mins symptom resolved.
Discussion and conclusion:
Synthetic pyrethroids are pesticides derived from naturally occurring pyrethrins, taken from pyrethrum of dried Chrysanthemum flowers. In general they are less acutely toxic. Pyrethroids cause mild irritation to the skin and eyes and some case facial skin sensitization. Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. It typically involves more than 2 systems. However there are very little data and case regarding, post exposure fogging anaphylactic reaction. In an extensive review of 573 cases of acute pyrethroids poisoning between 1983 and 1988 in China, while in America another extensive review of 200 000 cases recorded between 1993 to 2005, overall the 3 most frequent reported effect are gastrointestinal, dermal and ocular effects.
Fogging is thought to be relatively safe to human with minimal side effect post exposure. But it may cause lethal effect to some. In the case of mentioned, child might die if treatment was delay and symptoms were not picked up by medical personnel.