We all know tobacco is bad for those who smoke or chew it. But it can also sicken those who harvest it. As a UK HealthCare emergency physician, I have recently seen an increase in patients reporting to the emergency department with symptoms of green tobacco sickness.
GTS is seen in workers who have prolonged exposure to tobacco through harvesting and processing the crop. The illness is a form of nicotine overdose, believed to occur when morning dew or rain provides the moisture necessary for nicotine from tobacco leaves to leach into the body via the skin. Absorption can occur through bare skin, or even through clothing that is not moisture-resistant.
The illness has been described for decades in Southeastern states where tobacco is a common crop. However, before 1992, no cases of GTS had been reported to any public health agency in Kentucky. Since that time, GTS has been recognized as an ongoing problem in Kentucky.
It is estimated 60,000 people work in the tobacco harvest each year in Kentucky, resulting in hundreds of cases of GTS annually. Though many cases are not severe, 25 percent of patients require hospital admission. Deaths have also been associated with the illness.
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GTS is typically seen only occasionally during the late summer. However the illness struck early in Kentucky this year, as damp conditions set in during the first part of summer, followed by excessive heat. Because moisture is a key condition for GTS, the increased perspiration experienced by workers in summer heat is also a risk factor.
The key to prevention is protecting the skin of all farm workers from the nicotine-containing leaves of the tobacco plant. Water-resistant clothing and gloves are the first line of defense. Workers should also be educated to recognize the symptoms of GTS and know when to seek medical help.