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Suggested Citation: "Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.

D

Environmental Chemicals

Environmental chemicals reported to be associated with signs and symptoms similar to the chronic signs and symptoms observed in Havana patients (pesticides are in italics).

Symptoms	Chemicals Associated with Symptom
Ototoxicity, vestibulotoxicity, tinnitus, vertigo	Organic solvents (benzene-based and aliphatic hydrocarbons, 1,2-dinitrobenzene, toluene, trichloroethylene, xylene) Nitriles, carbon disulfide, asphyxiants (CO), metals Organophosphorus pesticides (OPs) and other phosphate-based chemicals (acute and chronic exposures) Acute pyrethroid exposure Quinine (chronic exposure)
Sensorimotor function	Bismuth Brevetoxins Pyrethroids Organophosphorus pesticides (OPs) Metals (Pb, Cd, thallium)
Vision	Acute OP exposures Chlordecone (kepone) Carbon tetrachloride, carbon disulfide, 2,5-hexanedione, methanol (formate) Quinine
Motor dysfunction (incoordination, muscle weakness)	Acute and chronic OP exposures B-N-methylamino-L-alanine (BMAA), domoic acid, tetanus toxin MPTP, ethanol, 3-nitropropionic acid Carbon monoxide, carbon disulfide, toluene Metals (Pb, Mn, Hg, As)
Concentration/memory deficits	Acute and chronic OP exposures Many pesticides that target neuronal signaling molecules Metals (Pb, Mn, Hg) Solvents
Headaches, fatigue, insomnia	OPs and pyrethroids

SOURCES: Alcaras et al., 2013; Anger et al., 2020; Ashok Murthy and Visweswara Reddy, 2014; Campo et al., 2007; Chen et al., 1991; Choochouy et al., 2019; Crawford et al., 2008; Dassanayake et al., 2007, 2008, 2009; Dundar et al., 2016; Edwards and Tchounwou, 2005; Fuente and McPherson, 2012; London et al., 1998; Mont’Alverne et al., 2016; Müller-Mohnssen,

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1999; Pham et al., 2016; Richter et al., 1992; Rohlman et al., 2011; Roldan-Tapia et al., 2006; Ross et al., 2013; Spencer et al., 2000; Teixeira et al., 2002; Zeigelboim et al., 2019.

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