Epidemic of Kala Pathar(Paraphenylene Diamine) Poisoning: an Emerging Threat in Southern Punjab

Objective: To assess cases of the spectrum of Kala Patharpoisoning in all age groups.

Study Design: Cross-sectional study.

Place And Duration Of Study: Combined Military Hospital (CMH) Bahawalpur and Bahawal Victoria Hospital (BVH), Bahawalpur, from January 2016 to April 2017.

Methodology: All the cases of Kala Pathar(Paraphenylene diamine (PPD)) poisoning, admitted and treated at the study places during said period were included in the study. The assessed variable included gender, age, education status, socioeconomic status, reason of poisoning and mortality. Chi-square was applied for qualitative variables with p-value less than 0.05 was considered significant.

Results: A total of 1,258 cases of PPD poisoning were included in the study; 814 (64.7%) females and 444 (35.3%) males. Their age ranged from 5 - 63 years, with median age 21 (IQR 4). Sixty-six (5.2%) were children and the rest 1,192 (94.8%) were adults. In adults 1,125 (94.37%) cases of PPD poisoning were suicidal and 62 (5.20%) accidental cases; only 5 (0.42%)adults were intentionally poisoned. On the other hand, only one child took it with suicidal intent, 54 (81.81%) ingested it accidentally and 11 (16.66%) children were given poison deliberately with the intent to murder. The overall mortality was 24.08% - 22.81% in adults, and 46.96% in children.

Conclusion: Kala Pathar(PPD) is a lethal substance when ingested. PPD poisoning is not limited to adults; many cases of pediatric poisoning are also being reported in Southern Punjab. Mortality due to Kala Patharis high. Tracheostomy should be done immediately in all such cases; and high intensive multidisciplinary approach is required.