Ricin

 

 

Purpose

 

To recommend procedures for handling potential biological threats of Ricin exposure.

 

Description of AgentlSyndrome

 

Ricin is a deadly protein toxin made from the bean of the castor plant (Ricinus communis). Ricin is fairly easy to make and the castor plant can be found in most parts of the world, thus making it a significant biological warfare agent. Ricin acts by inhibiting protein synthesis.

 

Transmission

 

The toxin can be delivered as an aerosol, given by injection, or ingested.

 

Incubation Period

 

Hours to days.

 

Signs and Symptoms

 

Clinical signs and symptoms and pathological manifestations of Ricin toxicity vary with dose and route of exposure.

 

1.    Inhalation

Weakness, fever, cough and pulmonary edema occur within 18-24 hours after exposure. Respiratory distress may be seen as early as 8 hours after exposure. Death from hypoxia occurs within 36 to 72 hours.

 

2.    Injection

Severe local necrosis of muscle and regional lymph nodes at injection site. Weakness may occur within 5 hours, with nausea, vomiting and elevation of temperature within 15-24 hours. Between 36 and 48 hours; hypotension and tachycardia may set in with an elevated WBC count. Cardiac dysrhythmias and gastric bleeding with vomiting may occur within 48 to 72 hours leading to death.

 

3.    Ingestion

Ingestion causes gastrointestinal hemorrhage with hepatic, splenic, and renal necrosis.

 

 

Diagnosis

 

Suspect possible ricin exposure when large numbers of normally healthy people present with one of the above signs and symptoms. Ricin induces pulmonary edema (1-3 days post­exposure). Ricin intoxication would be expected to progress despite treatment with antibiotics, as opposed to infection process.

 

Treatment

 

Treatment is mainly supportive and specific to care of symptoms including pulmonary edema. If ingestion of ricin is suspected, gastric decontamination should be done. If ingestion is suspected, gastric lavage and cathartics are indicated.

 

Prophylaxis

 

Currently there is no prophylaxis available.

 

Control Measures and Decontamination

 

Standard Precautions. Ricin is not volatile, so secondary aerosols are generally not a danger to health care providers. Soap and water should be used to decontaminate exposed skin surfaces.

 

Notification

 

Internal:    At hospital notify______________________________

 

External:  All suspected cases of suspected Ricin infection should be reported immediately to the Local Health Department who will then contact the State Health Department and/or

CDC.

 

Lab

 

Lab data not yet available through CDC Website.

 

Due to potential risks associated with handling toxic materials, laboratory testing should be the minimum necessary for diagnostic evaluation and patient care. Laboratory specimens should be placed in plastic bags (with a biohazard label) that are sealed, and then transported in clearly labeled, durable, leak-proof containers directly to the specimen handling area of the laboratory. Care should be taken not to contaminate the external surfaces of the container. Lab personnel should be notified of what they are handling. Bio-Safety Level 2 should be used for handling specimens.

 

References

 

Medical Management of Biological Casualties Handbook, U.S. Army Medical Research Institute of Infectious Diseases; Fort Detrick, Freserick, Maryland 2001, Feb.

 

Textbook of Military Medicine, Medical Aspects of Chemical and Biological Warfare, Office of The Surgeon General, Department of the Army, USA; 1997.

 

More information on Ricin can be found at http://www.bt.cdc.gov/agent/ricin/index.asp.

 

 

 

Note:    These are guidelines that have been developed with data available as of 1/21/02.

 

 

Initially Prepared by

The Akron Regional Hospital Association

Emergency Preparedness Subcommittee

August 20, 2002