Iranian Journal of Medical Sciences (Sep 2009)
Sulphur Mustard Poisoning and Its Complications in Iranian Veterans
Abstract
Sulphur mustard is a chemical warfare agent, which was largelyused during the World War One and in Iraq-Iran conflict. It mayalso be used as a chemical terrorism agent. Therefore, medicalprofessions should have sufficient knowledge and be preparedfor medical intervention of any such chemical attack.Sulphur mustard exerts direct toxic effects on the eyes, skin,and respiratory tract, with subsequent systemic actions on thenervous, immunologic, hematologic, digestive, and reproductivesystems. It is an alkylating agent that affects DNA synthesis andthus, delayed complications have been considered since theWorld War One. Cases of malignancies in the target organs particularlyin hematopoietic, respiratory, and digestive systemswere reported. Common delayed respiratory complications includechronic bronchitis, bronchiectasis, frequent bronchopneumonia,and pulmonary fibrosis, all of which tend to deterioratewith time. Severe dry skin, delayed keratitis, and reduction ofnatural killer cells with subsequent increased risk of infectionsand malignancies are also among the most distressing long-termconsequences of sulphur mustard intoxication. However, despiteextensive research that has been conducted on Iranian veteransduring the past decades, major gaps continue to remain in thesulphur mustard literature. Immunological and neurological dysfunctionsand the relationship between exposure to sulphur mustardand mutagenicity, carcinogenicity, and teratogenicity areimportant fields that require further studies, particularly on Iranianveterans with chronic health problems caused by sulphurmustard poisoning. There is also a paucity of information on themedical management of acute and delayed toxic effects of sulphurmustard poisoning, a subject that greatly challenges themedical professions.
