Grand rounds: an outbreak of toxic hepatitis among industrial waste disposal workers.
BACKGROUND
Industrial waste (which is composed of various toxic chemicals), changes to the disposal process, and addition of chemicals should all be monitored and controlled carefully in the industrial waste industry to reduce the health hazard to workers.


METHODS
Five workers in an industrial waste plant developed acute toxic hepatitis, one of whom died after 3 months due to fulminant hepatitis. In the plant, we detected several chemicals with hepatotoxic potential, including pyridine, dimethylformamide, dimethylacetamide, and methylenedianiline. The workers had been working in the high-vapor-generating area of the plant, and the findings of pathologic examination showed typical features of acute toxic hepatitis.


CONCLUSIONS
Infectious hepatitis and drug-induced hepatitis were excluded by laboratory findings, as well as the clinical course of hepatitis. All cases of toxic hepatitis in this plant developed after the change of the disposal process to thermochemical reaction-type treatment using unslaked lime reacted with industrial wastes. During this chemical reaction, vapor containing several toxic materials was generated. Although we could not confirm the definitive causative chemical, we suspect that these cases of hepatitis were caused by one of the hepatotoxic agents or by a synergistic interaction among several of them.


CONCLUSIONS
In the industrial waste treatment process, the danger of developing toxic hepatitis should be kept in mind, because any subtle change of the treatment process can generate various toxic materials and threaten the workers' health. A mixture of hepatotoxic chemicals can induce clinical manifestations that are quite different from those predicted by the toxic property of a single agent.
Cheong
Hae-Kwan
HK
Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
Kim
Eun A
EA
Choi
Jung-Keun
JK
Choi
Sung-Bong
SB
Suh
Jeong-Ill
JI
Choi
Dae Seob
DS
Kim
Jung Ran
JR
D000328:Adult; D017610:Calcium Compounds; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007220:Industrial Waste / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016273:Occupational Exposure / Q000009:adverse effects*; D010087:Oxides; D012037:Refuse Disposal
D017610:Calcium Compounds; D007220:Industrial Waste; D010087:Oxides; C016538:lime