| A Child with Chronic Manganese Exposure from Drinking Water Alan Woolf,1,2 Robert Wright,1,2,3 Chitra Amarasiriwardena,3 David Bellinger4,5 1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; 2Department of Medicine, Children's Hospital, Boston, Massachusetts, USA; 3Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA; 4Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA; 5Department of Neurology, Children's Hospital, Boston, Massachusetts, USA Abstract
    Harvard Medical School, Children's Hospital, and Brigham and Women's Hospital
The patient's family bought a home in a suburb, but the proximity of the house to wetlands and its distance from the town water main prohibited connecting the house to town water. The family had a well drilled and they drank the well water for 5 years, despite the fact that the water was turbid, had a metallic taste, and left an orange-brown residue on clothes, dishes, and appliances. When the water was tested after 5 years of residential use, the manganese concentration was elevated (1.21 ppm ; U.S. Environmental Protection Agency reference, < 0.05 ppm) . The family's 10-year-old son had elevated manganese concentrations in whole blood, urine, and hair. The blood manganese level of his brother was normal, but his hair manganese level was elevated. The patient, the 10-year-old, was in the fifth grade and had no history of learning problems ; however, teachers had noticed his inattentiveness and lack of focus in the classroom. Our results of cognitive testing were normal, but tests of memory revealed a markedly below-average performance: the patient's general memory index was at the 13th percentile, his verbal memory at the 19th percentile, his visual memory at the 14th percentile, and his learning index at the 19th percentile. The patient's free recall and cued recall tests were all 0.5-1.5 standard deviations (1 SD = 16th percentile) below normal. Psychometric testing scores showed normal IQ but unexpectedly poor verbal and visual memory. These findings are consistent with the known toxic effects of manganese, although a causal relationship cannot necessarily be inferred. Key words: ADHD, attention deficit hyperactivity disorder, manganese, manganese exposure, water, water pollution. Environ Health Perspect 110:613-616 (2002) . [Online 14 May 2002] http://ehpnet1.niehs.nih.gov/docs/2002/110p613-616woolf/ abstract.html Address correspondence to A. Woolf, Pediatric Environmental Health Center, Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115 USA. Telephone: (617) 355-5187. Fax: (617) 738-0032. E-mail: alan.woolf@tch.harvard.edu The work was supported in part by funds from the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) trust fund through a cooperative agreement with the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services. The Pediatric Environmental Health Center, Children's Hospital, is a member of the Association of Occupational and Environmental Clinics, 1010 Vermont Avenue NW, #513, Washington, DC 20005 USA. Telephone (202) 347-4976. Fax: (202) 347-4950. Homepage: http://www.aoec.org Received 26 December 2001 ; accepted 26 March 2002.
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