Objective: We aimed to assess the clinical characteristics and symptoms of chronic manganese intoxication in workers involved in grinding the manganese ore in the Zestafoni Ferroalloy plant in Georgia.

Background: Chronic manganese intoxication is a chronic condition that results from long-standing exposure to manganese. Intoxication typically results from inhalation of the metal. The disease manifestation predominantly involves the nervous system due to excessive accumulation of Mn in the specific regions of the CNS.

Method: We selected 20 individuals (all of them were male, mean age = 52.25, SD = 3.34. working experience mean = 21.25 years, SD = 5.26), from the Zestafoni Ferroalloy plant who had confirmed diagnosis of chronic manganese intoxication and assessed their clinical symptoms and course of the disease.

Results: In our patients, the main subjective complaints were: fatigue, weakness in extremities, headache, vertigo, tremor in upper limbs, abdominal discomfort, and memory impairment. Neurologic examination revealed oligo-bradykinesia, Facial hypomimia. In contrast to Parkinson’s disease, tremor was present at rest but was present during movement as well, interestingly, in the majority of cases tremor was prominent in the right upper limb. Other features of neurologic examination were similar to Parkinson’s disease. Romberg’s sign was positive in most patients, dysmetria was also present. Axial signs were another universally present symptom in examined individuals, especially  Palmo-mental. It is of uttermost importance that administration of levodopa did not alleviate upper mentioned symptoms. In contrast to Parkinson’s’ disease, psychiatric manifestations occurred much early than the specific motor and sensory alterations emerged. Laboratory studies have been conducted to detect the concentration of Mn in the blood and urine. Mean concentrations of Mn in the blood and urine in examined patients were 0.0326mg%, SD = 0.003 and 0.0086mg/L, SD = 0.003, Respectively.

Conclusion: While many symptoms of chronic manganese intoxication are similar to Parkinson’s disease, there are still pretty clear peculiarities that make this disease stand on its own. After assessment of clinical symptoms and course of the disease, it was clear that the disease was progressing in all of the patients, making it difficult for them to carry out day-to-day activities.

References: Not applicable

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-manifestations-of-mn-induced-parkinsonism-in-the-workers-of-manganese-ferroalloy-ore/