Clinical characteristics, management, and outcomes of diseases caused by mercury overexposure: a systematic review of case reports and case series

TL;DR

This study reviews global case reports of mercury poisoning to better understand its clinical features, causes, and treatments, aiming to improve clinical management and public awareness.

Contribution

The study provides a systematic analysis of mercury poisoning cases, offering insights into clinical patterns and treatment effectiveness.

Findings

Domestic/environmental exposure was the most common route of mercury poisoning.

Chelation therapy was used in 84.1% of cases, with DMSA and Dimercaprol being the most common agents.

Complete recovery occurred in 48.4% of cases, while 13.5% resulted in death.

Abstract

Mercury poisoning remains a serious public health issue due to its multiple exposure routes and diverse clinical presentations. However, existing clinical evidence is fragmented, especially regarding real-world case data. This study addresses the gap by systematically reviewing global case reports to analyze clinical features, diagnosis, and treatments, thereby offering more robust evidence for clinical practice.

Case reports of diseases caused by accidental mercury exposure, published from January 1950 to April 2025, were identified through a comprehensive search of three electronic databases: PubMed, Embase, and Web of Science. Following quality assessment using the Joanna Briggs Institute tool, data extraction was conducted on demographic characteristics, clinical manifestations, diagnostic methods, exposure sources, treatment modalities, and patient outcomes to facilitate further analysis.

This study analyzed 80 articles encompassing 126 cases of mercury poisoning, involving 61 males, 60 females, and 5 cases of unspecified sex. Patient ages ranged from 45-day-old neonates to 88-year-old adults. Clinical manifestations were diverse, primarily featuring systemic, respiratory, neurological, and gastrointestinal symptoms. Domestic/environmental exposure was the most common poisoning route (59.5%), followed by medical/iatrogenic exposure (16.7%) and occupational exposure (13.5%). Elemental and inorganic mercury were the predominant forms involved. Treatment primarily included chelation therapy, supportive care, and pharmacological interventions. Chelating agents were administered to 84.1% of patients, with DMSA, Dimercaprol (BAL), DMPS, and D-penicillamine being the most frequently used. Outcomes included complete recovery in 48.4% of cases, death in 13.5%, and long-term sequelae in some patients.

Mercury poisoning induces severe and multisystemic symptoms, notably neurological damage. Public awareness remains insufficient, and universally accepted diagnostic criteria are still lacking. This study highlights the urgent need to enhance public education, refine clinical guidance, and advance research toward standardized management protocols.

CRD420251133420.

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