Accidental human poisoning with a neonicotinoid insecticide, imidacloprid: A rare case report from rural India with a brief review of literature

Acute pesticide poisoning is an important public health problem worldwide and accounts for a significant number of deaths occurring each year. Most of these fatalities are due to poisoning with organophosphorus insecticides which are an integral part of agriculture within this region of Asia. Due to their very high intrinsic toxicity, continuous efforts are being made to develop newer pesticides of low toxicity and high potency. Invariably such compounds are released into the market without appropriate data on direct human toxicity. Human toxicity is often extrapolated from toxicological studies in animals, the relevance of which remains poorly defined. Imidacloprid is a neonicotinoid insecticide belonging to the chloronicotinyl nitroguanidine chemical family. It acts on the nervous system through an acetylcholine receptor blockade and is considered nontoxic to humans based on the available literature. It is routinely used to kill fleas present on pet animals, termites and bees. This study reports a case that presented with severe gastrointestinal symptoms along with respiratory distress and neuropsychiatric features following accidental inhalational exposure to imidacloprid. The patient recovered from the effects of the poisoning with supportive and symptomatic treatment. As far as this research is concerned, this is the first report of acute inhalational intoxication with imidacloprid in India.