Trichothecene (T2) Mycotoxins

Purpose

To recommend procedures for handling potential biological threats of T-2 Mycotoxin exposure.

Description of Agent/Syndrome

Trichothecene (T2) Mycotoxins are a diverse group of over 40 compounds produced by molds of the genus Fusarium These toxins inhibit protein and DNA synthesis, mitochondrial respiration, and alter cell membrane structure and function. Naturally occurring mycotoxicosis occurs in livestock following ingestion of grains contaminated with molds.

Transmission

1. Aerosol release or through contamination of food and water supplies.

2. Enter the body through the skin

Incubation Period

Immediate — from minutes to hours

Signs and Symptoms

T-2 and other mycotoxins may enter the body through the skin and digestive or respiratory epithelium. They are fast acting potent inhibitors of protein and nucleic acid synthesis. Their main effects are on rapidly proliferating tissues such as the bone marrow, skin, mucosal epithelia, and germ cells. In a successful BW attack with trichothecene toxin (T-2) can adhere to and penetrate the skin, be inhaled, or can be ingested. Clothing would be contaminated and serve as a reservoir for further toxin exposure. Early symptoms beginning within minutes of exposure include burning skin pain, redness, tenderness, blistering, and progression to skin necrosis with leathery blackening and sloughing of large areas of skin in lethal cases.

Diagnosis

Should be suspected if an aerosol attack occurs in the form of “yellow rain” with droplets of variously pigmented oily fluids contaminating clothes and the environment. Confirmation requires testing of blood, tissue and environmental samples.

Treatment

There is no specific antidote. Treatment is supportive. Soap and water washing, even 4-6 hours after exposure can significantly reduce dermal toxicity; washing within 1 hour may prevent toxicity entirely. Superactivated charcoal should be given orally is the toxin is swallowed.

Prophylaxis

The only defense is to prevent exposure by wearing a protective mask and clothing (or topical skin protectant) during an attack. No specific immunotherapy or chemotherapy is available.

Control Measures and Decontamination

Outer clothing should be removed and exposed skin decontaminated with soap and water. Eye exposure should be treated with copious saline irrigation. Secondary aerosols are not a hazard; however, contact with contaminated skin and clothing can produce secondary dermal exposures. Contact Precautions are warranted until decontamination is accomplished. Then, Standard Precautions are recommended for healthcare workers.

Notification

Internal: At hospital notify ________.

External: All suspected cases of suspected T-2 Mycotoxin exposure 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

http://www.vnh.org/MedAspChemBioWar/chapters/chapter_34.htm

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