Deaths from suspected mothball poisoning in children

Authors

  • M Dempster South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-7213-5399
  • L Erasmus South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  • S Johnstone South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0003-2033-270X
  • K Storath South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  • O Letlhake South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  • S van der Merwe South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  • S G Lala Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-9964-513X
  • S A Madhi South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-7629-0636
  • A M E Millen Wits Integrated Molecular Physiology Research Initiative, Department of Physiology, School of Biomedical Sciences, Faculty of Health Sciences, and Wits Health Consortium (PTY) Ltd, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-4831-7336
  • S Baijnath Wits Integrated Molecular Physiology Research Initiative, Department of Physiology, School of Biomedical Sciences, Faculty of Health Sciences, and Wits Health Consortium (PTY) Ltd, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-7860-1779
  • Z Dangor South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0003-4089-147X

DOI:

https://doi.org/10.7196/SAMJ.2025.v115i11.3192

Keywords:

Childhood poisoning, Accidental poisoning, Naphthalene, Mothballs, Toxicology, Organophosphate-like Poisoning, cholinergic toxidrome, Public health

Abstract

Childhood poisoning is a significant health concern in South Africa (SA), especially in densely populated informal housing settlements where children are frequently exposed to various household poisons. Poisoning accounts for 4 - 5% of paediatric hospital admissions in SA. The most common causes are fuels, pesticides and medicines, although many cases have unidentifiable causes. In this case series, three children, aged 3 - 5 years, were declared dead upon arrival at a public healthcare facility. Prior to death their symptoms included vomiting of a foam-like substance and distress (crying, shaking, fatigue). Postmortem fine-needle liver biopsies were obtained and underwent atmospheric pressure matrix-assisted laser desorption/ionisation mass spectrometry imaging (AP-MALDI-MSI) analysis. MSI analysis identified the presence of naphthalene-associated metabolites, the active component in household mothballs, suggesting death due to accidental ingestion. These cases highlight the urgent need for novel toxicology screening tools to accurately determine causes of death and guide targeted preventive strategies. Strategic efforts are needed to reduce childhood poisoning through robust toxicovigilance to monitor and regulate the sale of toxic substances and enhance access to toxicology testing.

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Published

2025-12-08

Issue

SAMJ Vol. 115 No. 11

Section

In Practice

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Copyright (c) 2025 M Dempster, L Erasmus, S Johnstone, K Storath, O Letlhake, S van der Merwe, S G Lala, S A Madhi, A M E Millen, S Baijnath, Z Dangor

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How to Cite

1.
Dempster M, Erasmus L, Johnstone S, Storath K, Letlhake O, van der Merwe S, et al. Deaths from suspected mothball poisoning in children. S Afr Med J [Internet]. 2025 Dec. 8 [cited 2026 Mar. 6];115(11):e3192. Available from: https://samajournals.co.za/index.php/samj/article/view/3192