Haz-Map Category Details

Disease/Syndrome	Manganese, chronic toxic effect
Category	Metal Poisoning, Occupational
Acute/Chronic	Chronic
Synonyms	Manganism
Biomedical References	Search PubMed
Comments	Classic reports were given by Mena of Chilean miners in 1967 and by Rodier of Moroccan miners in 1955. Workers exposed to Mn have higher average urine and blood levels than unexposed workers, but these tests will not predict disease severity in a particular case. Similarly, abnormalities in the globus pallidus of the brain by MRI study reflect recent exposure to Mn, but are not diagnostic of disease. Neuropsychological testing can identify workers with advanced disease. Symptoms first appear after a chronic exposure of at least several months in duration: 1) Prodromal Phase: evidence of cognitive dysfunction and emotional disturbance begin to occur prior to severe motor and neurological dysfunction; symptoms may include fatigue, anorexia, muscle pain, nervousness, irritability, violent outbursts, insomnia, decreased libido, and labile affect; workers may also report headache, hypersomnia, spasms, weariness of the legs, and arthralgias; 2) Intermediate Phase: compulsive uncontrollable laughter or crying, clumsiness of movement, exaggeration of reflexes in lower limbs, speech disorders, visual hallucinations, excessive sweating, excessive salivation, and confusion; 3) Established Phase: muscular weakness, difficulty in walking, stiffness, impaired speech, mask-like face, increased muscular tone, slow and shuffling gait, micrographia, and resting tremors; the syndrome is indistinguishable from Parkinson's disease; [Sullivan, p. 930-7] Parkinsonism caused by manganese has the following that distinguish it from Parkinson's disease: psychiatric symptoms early in the disease; cock walk; tendency to fall backward; less frequent resting tremor; more frequent dystonia; lack of response to dopaminomimetics; abnormal MRI showing manganese in the pallidum and caudate nucleus; and normal fluorodopa positron emission tomography scan. [IRRST] Characteristic findings of manganese poisoning are poor steadiness of hands, difficulty doing rapid alternating movements, muscular rigidity, and postural instability. [PMID 17096374] "Manganism may be associated with some effect on dopamine pathways but does not respond to treatment with L-dopa, whereas PD [Parkinson Disease] shows severe impairment of dopamine metabolism and improves with administration of L-dopa." [ACGIH] Urine and plasma Mn levels are ineffective biomarkers. Blood Mn "may reflect average elevated daily air Mn levels when exposures are on-going and relatively consistent." [PMID 17924418]
Latency/Incubation	Weeks to years
Diagnostic	Clinical; Neurobehavioral testing; Urinary and blood manganese levels are not useful unless much higher than normal; MRI shows Mn in globus pallidus, striatum, and substantia nigra for up to 6 months after end of exposure; [IRSST]
ICD-9 Code	985.2
Reference Link	EPA - Air Toxics Website - Manganese Compounds
Related Information in Haz-Map
Symptoms/Findings	Symptoms/Findings associated with this disease: gait, abnormal hallucinations headache incoordination mood disturbance rigidity speech, impaired tremor weakness
Job Tasks	High risk job tasks associated with this disease: Heat or machine manganese alloys Mine or crush manganese ores Use ferromanganese in alloy production Use manganese-containing welding rods
Agents	Hazardous agents that cause the occupational disease: (R,R)-Jacobsen's catalyst Barium permanganate Bromopentacarbonylmanganese C.I. Pigment Black 26 Calcium permanganate Dimanganese decacarbonyl Disodium manganese EDTA Fatty acids, C6-19-branched, manganese salts Lithium manganese oxide Mancozeb Maneb Manganese Manganese 2-ethylhexanoate Manganese bromide Manganese citrate Manganese cyclopentadienyl tricarbonyl Manganese dioxide Manganese gluconate Manganese hydroxide Manganese naphthenate Manganese neodecanoate Manganese oxalate Manganese tallate Manganese tetroxide Manganese zirconium oxide Manganese(II) acetate Manganese(II) acetate tetrahydrate Manganese(II) acetylacetonate Manganese(II) carbonate Manganese(II) chloride Manganese(II) cyclohexanebutyrate Manganese(II) fluoride Manganese(II) molybdate Manganese(II) nitrate Manganese(II) oxide Manganese(II) perchlorate hexahydrate Manganese(II) sulfate Manganese(II) sulfide Manganese(III) fluoride Manganese(III) oxide Manganese, bis(eta5-cyclopentadienyl) Methylcyclopentadienyl manganese tricarbonyl Permanganic acid Potassium manganate(VI) Potassium permanganate Silver permanganate Sodium permanganate Zinc permanganate Zinc silicate, manganese

Disease/Syndrome
Manganese, chronic toxic effect
Category
Metal Poisoning, Occupational
Acute/Chronic
Chronic
Synonyms
Manganism
Biomedical References
Search PubMed
Comments
Classic reports were given by Mena of Chilean miners in 1967 and by Rodier of Moroccan miners in 1955. Workers exposed to Mn have higher average urine and blood levels than unexposed workers, but these tests will not predict disease severity in a particular case. Similarly, abnormalities in the globus pallidus of the brain by MRI study reflect recent exposure to Mn, but are not diagnostic of disease. Neuropsychological testing can identify workers with advanced disease. Symptoms first appear after a chronic exposure of at least several months in duration: 1) Prodromal Phase: evidence of cognitive dysfunction and emotional disturbance begin to occur prior to severe motor and neurological dysfunction; symptoms may include fatigue, anorexia, muscle pain, nervousness, irritability, violent outbursts, insomnia, decreased libido, and labile affect; workers may also report headache, hypersomnia, spasms, weariness of the legs, and arthralgias; 2) Intermediate Phase: compulsive uncontrollable laughter or crying, clumsiness of movement, exaggeration of reflexes in lower limbs, speech disorders, visual hallucinations, excessive sweating, excessive salivation, and confusion; 3) Established Phase: muscular weakness, difficulty in walking, stiffness, impaired speech, mask-like face, increased muscular tone, slow and shuffling gait, micrographia, and resting tremors; the syndrome is indistinguishable from Parkinson's disease; [Sullivan, p. 930-7] Parkinsonism caused by manganese has the following that distinguish it from Parkinson's disease: psychiatric symptoms early in the disease; cock walk; tendency to fall backward; less frequent resting tremor; more frequent dystonia; lack of response to dopaminomimetics; abnormal MRI showing manganese in the pallidum and caudate nucleus; and normal fluorodopa positron emission tomography scan. [IRRST] Characteristic findings of manganese poisoning are poor steadiness of hands, difficulty doing rapid alternating movements, muscular rigidity, and postural instability. [PMID 17096374] "Manganism may be associated with some effect on dopamine pathways but does not respond to treatment with L-dopa, whereas PD [Parkinson Disease] shows severe impairment of dopamine metabolism and improves with administration of L-dopa." [ACGIH] Urine and plasma Mn levels are ineffective biomarkers. Blood Mn "may reflect average elevated daily air Mn levels when exposures are on-going and relatively consistent." [PMID 17924418]
Latency/Incubation
Weeks to years
Diagnostic
Clinical; Neurobehavioral testing; Urinary and blood manganese levels are not useful unless much higher than normal; MRI shows Mn in globus pallidus, striatum, and substantia nigra for up to 6 months after end of exposure; [IRSST]
ICD-9 Code
985.2
Reference Link
EPA - Air Toxics Website - Manganese Compounds
Related Information in Haz-Map
Symptoms/Findings
Symptoms/Findings associated with this disease:
Job Tasks
High risk job tasks associated with this disease:
Agents
Hazardous agents that cause the occupational disease: