Annals of Occupational and Environmental Medicine

Case Report

Dermal and neural toxicity caused by acrylamide exposure in two Korean grouting workers: a case report: Heeyun Kim, Sang Gil Lee, Jeongbae Rhie; Ann Occup Environ Med 2017;29:50. Published online October 9, 2017; DOI: https://doi.org/10.1186/s40557-017-0207-7

Background

Peripheral neuritis caused by acrylamide is well-known, and many Korean grouting workers are frequently exposed to acrylamide in grouting agents that are injected into cracked concrete. We recently encountered two cases of dermal and neural toxicity in Korean grouting workers with exposure to grouting agents that contained a high concentration of acrylamide.

Case presentation

The first case involved a 44-year-old man with 8 years of waterproofing experience. The patient developed peeling skin on both hands while grouting, which progressed to systemic neurological symptoms, such as reduced sensory function and strength. The patient was diagnosed with peripheral neuropathy caused by acrylamide exposure, and fully recovered after conservative treatment and withdrawal of exposure to the grouting agent. The second case involved a 34-year-old man with 10 years of grouting experience. The patient initially experienced weakness in both legs, which progressed to weakness in his arms and uncontrolled phonation. After being hospitalized, he was diagnosed with cerebellar ataxia and peripheral neuropathy caused by acrylamide exposure, and was discharged after conservative treatment. Our follow-up investigation revealed that both workers were recently exposed to grouting agents that contained higher concentrations of acrylamide, compared to the agents that they had previously been using.

Conclusions

Both workers had workplace acrylamide exposure through dermal contact plus inhalation of dust and vapor, which led to the neural toxicity and dermatitis. Therefore, government studies are needed to investigate the current status of workplace acrylamide use, and to protect workers from the hazardous effects of using acrylamide-containing grouting agents.

Citations

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The role of microRNAs in acrylamide toxicity
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Effects of acrylamide on indoor air based on the reactions with O3 and •OH: Mechanism, kinetics, and toxicity evaluation
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Original Article

Evaluation of Early Neurologic Abnormalities on the Workers Exposed to Acrylamide: Seong Soon Kim, Hae Kwan Cheong, Yong Wook Kwon; Korean Journal of Occupational and Environmental Medicine 2000;12(3):367-383. Published online September 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.3.367

Abstract PDF

OBJECTIVES
Acrylamide is a neurotoxin inducing central-peripheral distal axonopathy. The authors evaluated several neurologic tests to screen the early effect of occupational acrylamide exposure.
METHODS
Fifty-two males working either in the production of acrylamide monomer or in the handling of acrylamide in Ulsan, Korea, were selected and subcategorized into the high-exposure group (n=10, mean age of 30. 4 years) and the low-exposure group (n=42, mean age of 28.9 years). Twenty-three males (mean age 29.4 years) from medical professionals and students were chosen as a non-exposed reference group. Symptom questionnaire, neurologic examination, electrodiagnostic test, vibrotactile threshold test, and Lanthony desaturated 15 panel test (LD-15D) were done.
RESULTS
The high-exposure group showed more number of specific symptoms on questionnaire and more abnormal two point discrimination test. High-exposure group showed a significant difference in the median motor conduction velocity, peroneal nerve motor latency, sensory amplitude of median nerve action potential, and sensory latency of sural nerve. The vibrotactile threshold of the high-exposure group was significantly higher in both hands and feet than that of the low-exposure group and the reference group. Average color confusion index on the LD-15D was significantly higher in the high-exposure group (median 22.7, range 0-135.7) than in the reference group (median 2.4, range 0-33.2).
CONCLUSIONS
The symptom questionnaire, vibrotactile threshold test, and color discrimination test are sensitive in detection of the early acrylamide-induced neuropathy, and the combination of these tests would further facilitate the effectiveness of the screening.

Citations

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Usefulness of Color Vision Test for Early Detection of Neurological Damages by Neurotoxic Substances
Eun-Hee Lee, Kyungho Choi, Hong Jae Chae, Domyung Paek
Journal of Preventive Medicine and Public Health.2008; 41(6): 397. CrossRef

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Original Article

Polyneuropathy by Occupational Exposure to Acrylamide: Hae Kwan Cheong, Yong Wook Kwon, Kyung Yun Uh, Byung Joon Kim, Jeong Sun Yang, Cheol Jung, Youngwoo Jin, Mi Young Lee, Seong Kyu Kang; Korean Journal of Occupational and Environmental Medicine 1998;10(3):388-403. Published online August 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.3.388

Abstract PDF

Authors report a first Korean case of polyneuropathy in an acrylamide producing factory together with an environmental and epidemiologic survey for the ten workers of the same workplace and 46 workers in the production and manufacturing acrylamide in Ulsan, Korea. The case is 30 years old man who worked in the prcduction of the acrylamide for two years. In August, 1997, he had a weakness of the lower extremity with loss of body weight of 15 Kg which progressed to paresthesia of the limbs, the loss of vibration sense, difficulty in walking, speech disturbance, dysuria, constipation, difficulty in erection and swallowing difficulty. Neurologic examination showed a complete loss of vibration and position sense, and loss of deep tendon reflex in all the limbs. There was a contact dermatitis-like skin lesion on the feet. Electrodiagnostic test showed a generalized polyneuropathy of moderate degree involving motor and sensory component of peripheral and cranial nerves. After 8 months' cessation from exposure and supportive care, his symptoms were completely resolved, but abnormality in electrodiagnostic test and vibrotactile perception threshold still persisted, although much improved than before. There were 11 workers in the same workplace of the case, producing acrylamide by microorganism as a catalyst. Environmental monitoring of the workplace revealed air-borne concentration of the acrylamide to be from 0.05 to 0.23 mg/m(3) by personal sampling and from 7.65 to 11.65 mg/m(3) by area sampling during filter exchanging process, which far exceeds TLV-TWA of 0.03 mg/m(3). However acrylamide was not detected from the plasma of the workers. Symptom questionnaire showed a markedly higher complain of neurologic symptoms, compared to the workers of the other acrylamide producing companies. Electrodiagnostic test showed a several workers are in the lower normal range without definite abnormality. Vibrotactile perception threshold by Vibratron II showed a significantly increased threshold in the workers of the same workplace compared to the other acrylamide workers and significantly decreased test score of color vision compared to normal controls. After improvement of the production process and strict wearing of the protective device, most workers reported the improvement of clinical symptoms, but vibrotactile perception threshold was not improved. These result suggests the need for the effective environmental monitoring together with a periodic biological monitoring. Development of effective screening test is urgently needed to control and assess the skin absorption of acrylamide.

Citations

Citations to this article as recorded by

Dermal and neural toxicity caused by acrylamide exposure in two Korean grouting workers: a case report
Heeyun Kim, Sang Gil Lee, Jeongbae Rhie
Annals of Occupational and Environmental Medicine.2017;[Epub] CrossRef
Occupational Neurologic Disorders in Korea
Yangho Kim, Kyoung Sook Jeong, Yong-Hun Yun, Myoung-Soon Oh
Journal of Clinical Neurology.2010; 6(2): 64. CrossRef
Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef

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