Amitraz poisoning in South Africa: a two year survey (2008-2009).

INTRODUCTION Analysis of the annual pesticide poisoning statistics of the Tygerberg Poison Information Centre (TPIC) for the period 2005-2007 showed an increase in the number of amitraz poisonings. This prompted a 2-year survey (2008-2009) to establish the extent of amitraz poisoning in South Africa. Amitraz is a pesticide used as a tick dip. It acts as an α(2)-adrenoceptor agonist and the principal clinical effects of amitraz poisoning are related to its stimulation of these receptors; METHODS Data from amitraz poisoning cases in humans were evaluated for 2 years and analyzed for: demographic data, type of exposure, type of formulation, and clinical details. Serious cases were followed up; RESULTS 4.6% of the pesticide poisoning cases were amitraz-related which comprised 0.8% of all TPIC poisoning consultations. Ingestion of amitraz formulations accounted for the majority of the cases (94%). Forty-one percent of cases were children (n = 28) and all were accidental exposures. Of the adult cases (59%), 88% were intentional ingestions. The majority of the cases were from the predominantly rural province of KwaZulu Natal (44.9%). CNS depression was the most common clinical sign (76.8%) followed by bradycardia 34.8%, respiratory depression 27.5%, miosis 27.5%, and hypotension 23.1%. Mechanical ventilation was required in 15.9% of cases. Other commonly reported clinical signs were hypothermia 15.9%, mydriasis 10.1%, and hyperglycaemia 7.2%. Supportive and symptomatic care was shown to be adequate treatment. Amitraz poisoning was misdiagnosed as cholinesterase inhibitor poisoning in 17.4% of cases; CONCLUSION This is the first report of amitraz poisoning in humans in Africa. The data suggest a different demographic pattern in South Africa to that currently reported in the literature. The study identified a very high incidence of intentional poisoning in adults. The misuse of amitraz for deliberate self-harm emphasizes the necessity for continued toxicovigilance.