What is the role of TCE in the etiology of toxic neuropathy?

Updated: Dec 06, 2017
  • Author: Jonathan S Rutchik, MD, MPH, FACOEM; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

TCE is used as degreaser in many industrial processes (refer to Table 3 above to review its other industrial uses). Bernad et al evaluated 22 persons in a cohort of Michigan residents exposed for 5-20 years to well water with a low level of TCE contamination; 8-14 ppm of TCE was measured in the well water. Questionnaire, examination, and computer current perception-threshold testing (CPT) was performed. Results revealed hyperesthesia in 21 of 22 persons by CPT. Fatigue, lack of energy, somnolence, numbness, and tingling were reported by all 10 adults.

Feldman et al evaluated 21 residents of a Massachusetts community with alleged long-term exposure to TCE through drinking water and laboratory controls. The wells in question had 256 and 111 parts per billion (ppb) mean concentrations of TCE (maximum contaminant level [MCL] recommended by the Environment Protection Agency [EPA] is 0.5 ppb) and 26 and 24 ppb mean concentrations of PERC; duration of exposures was less than 1 to 12 years. Blink reflexes revealed differences in conduction latency of the reflex for the exposed population versus the controls, suggesting a subclinical alteration in the function of the fifth cranial nerve. [47]

In 1994, Feldman et al published a study that compared this population to 2 other populations that had been exposed to environments contaminated with TCE and PERC and included more details of the population's neurologic examinations. The Massachusetts group was found to have sensory impairment and reflex abnormalities as evidence of peripheral neuropathy.

The second group was 12 residents from an Ohio community who had been exposed to well water contaminated by wastewater deposited in a nearby creek by a company that fabricated sheet metal and precision-formed metal tubes. Their exposure was 3.3-330 ppb of TCE for 5-17 years. PERC also was found in the contaminated water. Nerve conduction studies (including blink reflexes) were performed. Reflex abnormalities were the most prevalent examination finding. Abnormal ulnar sensory latencies were noted in 81% of the group.

The third group comprised 14 residents from a Minnesota community who had been exposed to well water contaminated by a nearby army ammunitions plant. Exposure to TCE was between 261 and 2440 ppb in wells. 1,1-dichloroethane (DCE), 1,2-DCE, and 1,2-trans -DCE were identified in some wells. Questionnaires, examinations, and nerve conduction studies (including blink reflexes) were performed. Reflex abnormalities were the most common finding on neurologic examination. Approximately 70.6% had abnormal ulnar sensory latency, while 21% had abnormal blink reflex studies. [47]

Table 3. Industrial Uses of Common Organic Solvents and Metals (Open Table in a new window)

Compound

Industrial Uses

Acrylamide

Mining and tunneling, adhesives, waste treatment, ore processing, paper, pulp industry, photography, dyes

Arsenic

Pesticides, pigments, antifouling paint, electroplating, seafood, smelters, semiconductors, logging

Carbon disulfide

Viscose rayon, explosives, paints, preservatives, textiles, rubber cement, varnishes, electroplating

Ethylene oxide

Instrument sterilization, chemical precursor

n -hexane

Glues and vegetable extraction, components of naphtha, lacquers, metal-cleaning compounds

Lead

Solder, lead shot, illicit whiskey, insecticides, auto body shops, storage batteries, foundries, smelters, lead-based paint, lead stained glass, lead pipes

Mercury

Scientific instruments, electrical equipment, amalgams, electroplating, photography, felt making, taxidermy, textiles, pigments, chloroalkali industry

Methyl n -butyl ketone

Paints, varnishes, quick-drying inks, lacquers, metal-cleaning compounds, paint removers

Organochlorine

Insecticides

Organophosphates

Insecticides

Perchloroethylene

Dry cleaning, degreaser, textile industry

Styrene

Fiberglass component, ship building, polyester resin

Thallium

Rodenticides, fungicides, mercury and silver alloys, lens manufacturing, photoelectric cells, infrared optical instruments

Toluene

Paint, fuel oil, cleaning agents, lacquers, paints and paint thinners

1,1,1

Trichloroethane (methyl chloroform)

Degreaser and propellant

Trichloroethylene

Cleaning agent, paint component, decaffeination, rubber solvents, varnish

Vinyl chloride

Intermediate for polyvinyl chloride (PVC) resins for plastics, floor coverings, upholstery, appliances, packaging

Xylene

Fixative for pathologic specimens, paint, lacquers, varnishes, inks, dyes, adhesives, cements


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