Module 3: Toxicology - Section 5: An Approach To Managing Case Problems In Occupational Medicine
TOX 5.1: Overview

OBJECTIVES
By the end of this module
  • You should know when to suspect a work-related disease.
  • You should know the general approach to follow once you have diagnosed an occupational disease.

ACTIVITIES

We will do this as a group exercise in class.

EXERCISE:

  1. Question 1: A worker from a nearby smelter presents to your clinic complaining of an itchy skin rash affecting his forearms and darkening of his skin around the eyelids and neck during the past 3 months. He also complains of red, itchy eyes and nose bleeds. He suspects that his symptoms are due to his work. What are some of the pointers in his history that may suggest a work-related problem?
    (Answer).

  2. Question 2: What do you do next? (Answer).

  3. Question 3: Assuming that his problem is work-related, what are the possible chemicals that could be responsible? (Answer).

  4. Question 4: On further questioning he indicates that he works in the roasting plant where arsenic is collected and bagged. You send an end of work-week urine specimen of the worker to the laboratory. The results indicate that the urinary arsenic levels are 80 µg/g creatinine (normal = 50 µg/g creatinine). What are the main principles in your approach to managing this problem? (Answer).

    5. REFERENCES:

    1. Govender M, Ehrlich RI, Mohamed A. Notification of occupational diseases by general practitioners in the Western Cape. S Afr Med J 2000;90:1012-1014.
    2. Jeebhay MF. Health and safety legislation and worker’s compensation for allergic diseases of occupational aetiology. Current Allergy and Clinical Immunology 2000;13(3),4-8.

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer to Question 1:

WHEN TO SUSPECT A WORK RELATED DISEASE?

  1. The worker denies having symptoms prior to working at the current workplace.

  2. The worker complains of work-related symptoms that may or may not deteriorate over the working day or working week.

  3. The symptoms improve when the worker is away from current work on weekends and holidays.

  4. The worker develops the disease while doing high-risk work (current or previous jobs) and was sufficiently exposed to the hazardous agent as it appears in Schedule 3 of COIDA (in the first instance).

Note: Not all criteria need be present in each situation.

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Answer to Question 2:

Do a clinical examination. On clinical examination you observe the following positive findings (The rest of the examination is normal):

Examination of the face:
Examination of the neck:
Examination of forearms:
Examination of hands:
Examination of Nose:

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Answer to Question 3:

Check Schedule 3 of COIDA to make the link. Possible causes of skin ulcers and nasal perforations are arsenic, chrome, nickel.

COMPENSABLE OCCUPATIONAL DISEASES UNDER THE COMPENSATION FOR OCCUPATIONAL INJURIES AND DISEASES ACT (COIDA) SCHEDULE 3

1. Respiratory diseases:

Diseases

Work

Any work involving the handling of or exposure to any of the following:
Pneumoconiosis-fibrosis of the parenchyma of the lung (eg. asbestosis, silicosis) organic or inorganic fibrogenic dust
Pleural thickening causing significant impairment of function asbestos or asbestos dust
Mesothelioma of the pleura or other malignancy of the lung asbestos or asbestos dust
Bronchopulmonary disease metal carbides (hard metals)
Byssinosis flax, cotton or sisal
Occupational asthma the sensitising agents -

    (1) isocyanates
    (2) platinum, nickel, cobalt, vanadium or chromium salts
    (3) hardening agents, including epoxy resins
    (4) acrylic acids or derived acrylates
    (5) soldering or welding fumes
    (6) substances from animals or insects
    (7) fungi or spores
    (8) proteolytic enzymes
    (9) organic dust
    (10) vapours or fumes of formaldehyde, anhydrides, amines or diamines
Extrinsic allergic alveolitis moulds, fungal spores or any other allergenic proteinaceous material, 2,4 toluene-diisocyanates
Malignancy of the lung coal-tar, pitch, asphalt or bitumen or volatiles thereof
Malignancy of the lung nickel or its compounds
Malignancy of the lung hexavalant chromium compounds, or bis chloromenthyl ether
Tuberculosis of the lung (1) crystalline silica (alpha quartz)
(2) mycobacterium tuberculosis or MOTTS (mycobacterium other than tuberculosis) transmitted to an employee during the performance of health care work from a patient suffering from active open tuberculosis
2. Skin diseases:

Diseases

Work

Any work involving the handling of or exposure to any of the following:
Allergic or irritant contact dermatitis dust, liquids or other external agents or factors
Malignancy of the skin coal-tar, pitch, asphalt or bitumen or volatiles thereof
Melanoma of the skin polychlorinated biphenyls
3. ENT-Related Diseases:

Diseases

Work

Any work involving the handling of or exposure to any of the following:
Hearing impairment excessive noise
Erosion of the tissues of the oral cavity or nasal cavity irritants, alkalis, acids, or fumes thereof
Malignancy of the larynx or mouth cavity coal-tar, pitch, asphalt or bitumen or volatiles thereof
Malignancy of the mucous membrane of the nose or associated air sinuses nickel or its compounds
4. Musculoskeletal diseases:

Diseases

Work

Any work involving the handling of or exposure to any of the following:
Hand-arm vibration syndrome (Raynaud's phenomenon) vibrating equipment
Any disease due to overstraining of muscular tendonous insertions repetitive movements
5. Other diseases and pathological manifestations:

Diseases

Work

Any work involving the handling of or exposure to any of the following:
Any disease or pathological manifestations eg.
  • Acute toxicity: heavy metals
  • Peripheral neuropathy: solvents, heavy metals
  • Personality change, cognitive fall-off: paints, solvents, heavy metals
  • Renal failure: heavy metals
 Beryllium, cadmium, phosphorus, chromium, manganese, arsenic, mercury, lead, fluorine, carbon disulphide, cyanide, halogen derivatives of aliphatic or aromatic hydrocarbons, benzene or its homologues, nitro- and amino-derivatives of benzene or its homologues, nitroglycerine or other nitric acid esters, hydrocarbons, trinitrotoluol, alcohols, glycols or ketones, acrylamide, or any compounds of the aforementioned substances
Dysbarism, including decompression sickness, barotrauma or osteonecrosis abnormal atmospheric or water pressure
Any disease ionising radiation from any source
Angiosarcoma of the liver vinyl chloride monomer
Malignancy of the bladder 4-amino-diphenyl, benzidine, beta naphthylamine, 4-nitrodiphenyl
Mesothelioma of the peritoneum asbestos or asbestos dust
Leukaemia Benzene
Brucellosis brucella abortus, suis or mellitensis transmitted through contact with infected animals or their products
Anthrax bacillus anthracis transmitted through contact with infected animals or their products
Q-fever coxiella burneti emanating from infected animals or their products
Bovine tuberculosis mycobacterium bovis transmitted through contact with infected animals or their products
Rift Valley Fever virus transmitted by infected animals or their products

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Answer to Question 4:

FIVE STEPS TO FOLLOW ON DIAGNOSING AN OCCUPATIONAL DISEASE:

  1. Remove from exposure (Discussion);
  2. Institute appropriate treatment where possible (Discussion);
  3. Submit a claim for worker's compensation (Discussion);
  4. Notify the case to the Chief Inspector in the Department of Labour (Discussion);
  5. Investigate and treat the workplace (Discussion);

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    Postgraduate Diploma in Occupational Health (DOH) - Modules 3 – 5: Occupational Medicine & Toxicology by Prof Rodney Ehrlich & Prof Mohamed Jeebhay is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
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