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Incidence of Lung, Eye, and Skin Lesions as Late Complications in 34,000 Iranians With Wartime Exposure to Mustard Agent

Khateri, Shahriar MD; Ghanei, Mostafa MD; Keshavarz, Saeed MD; Soroush, Mohammad MD; Haines, David PhD

Journal of Occupational and Environmental Medicine: November 2003 - Volume 45 - Issue 11 - p 1136-1143
doi: 10.1097/01.jom.0000094993.20914.d1
ORIGINAL ARTICLES: CM: CME Article #1
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CME
Learning Objectives 
  • Recall the frequency and severity of chronic pulmonary, ocular, and cutaneous lesions in this study of 34,000 Iranians exposed in war to mustard agent and followed up after 13 to 20 years.
  • Relate the physical and chemical properties of mustard agents to their biological effects in exposed persons.
  • Describe the chronic clinical sequelae of mustard exposure as observed in the lungs, eyes, and skin.
  • Describe a categorizing method for determining the severity of lung, eye, and skin lesions based on clinical criteria.

Recall the frequency and severity of chronic pulmonary, ocular, and cutaneous lesions in this study of 34,000 Iranians exposed in war to mustard agent and followed up after 13 to 20 years.Relate the physical and chemical properties of mustard agents to their biological effects in exposed persons.Describe the chronic clinical sequelae of mustard exposure as observed in the lungs, eyes, and skin.Describe a categorizing method for determining the severity of lung, eye, and skin lesions based on clinical criteria. Approximately 34,000 Iranians known to have sustained mustard agent exposure during the Iran–Iraq war of 1980–1988 and survived over a decade afterwards were screened for distribution of the most commonly occurring medical problems. In order of greatest incidence, these include lesions of the lungs (42.5%), eyes (39.3%), and skin (24.5%). Within each subpopulation, patients were ranked according to severity of lesions. Twenty-three percent to 37% of patients exhibited at least mild coverage, with 1.5% to 4.5% classed as moderate, and a much smaller population (0.023–1.0%) of the 34,000 patients exhibiting extensive (severe) lesional coverage. These results provide a comprehensive overview of the medical problem most common among mustard victims and could serve as a predictor of the likely impact of these weapons on health status of populations exposed to them during ongoing military conflicts.

From the Chemical Warfare Victims Unit, Organization of Veterans Affairs (Janbazan Organization) Health and Treatment Department (Dr Khateri), Tehran, Iran; Baghiatollah University of Medical Sciences, Tehran, Iran (Dr Ghanei); Baghiatollah Hospital, Tehran, Iran (Dr Keshavarz); Medical and Engineering Research Center (MERC), Janbazan Foundation (Dr Soroush); and Department of Epidemiology and Biostatistics, The George Washington University Washington, DC (Dr Haines).

Address correspondence to: Shahriar Khateri, MD, Director, Chemical Warfare Victims Research Unit, Janbazan Medical and Engineering Research Center—JMERC, P.O. Box: 19615/616, Tehran, Iran; E-mail: s_khateri@hotmail.com.

This research was supported by an Iranian Health Ministry grant and by the Organization of Veterans Affairs (Janbazan).

David Haines has no commercial interests related to this article.

©2003The American College of Occupational and Environmental Medicine
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