Biological Weapons -- Clostridium Perfringens Toxins

Clostridium perfringens is a common anaerobic bacillus that produces at least 12 toxins. Spores survive cooking and then germinate and multiply at storage at ambient temperature, slow cooling, or inadequate rewarming. It lives in soil and the GI tract of healthy persons and animals. The primary threat is to the respiratory tract. This would result in pulmonary disease, vastly different from the naturally occurring diseases associated with C. perfringens. The toxin may also be combined with other toxins to produce a variety of symptoms. . Symptoms Incubation is 1 - 6 hours which produces respiratory distress syndrome and respiratory failure. Absorbed toxin can lead to intravascular hemolysis, thrombocytopenia, and liver damage. Early symptoms beginning within minutes of exposure include burning skin pain, redness, tenderness, blistering, and progression to skin death with leathery blackening and sloughing of large areas of skin. Upper respiratory exposure may result in nasal itching, pain, sneezing, epistaxis, and runny nose. Pulmonary/tracheobronchial toxicity produces difficulty in breathing, wheezing, and coughing. Mouth and throat exposure causes pain and blood tinged saliva and sputum. Loss of appetite, nausea, vomiting and watery or bloody diarrhea with crampy abdominal pain occurs with gastrointestinal toxicity. Eye pain, tearing, redness, foreign body sensation and blurred vision may follow ocular exposure. Skin symptoms occur in minutes to hours and eye symptoms in minutes. Systemic toxicity can occur via any route of exposure, and results in weakness, prostration, dizziness, ataxia, and loss of coordination. Irregular heartbeat, hypothermia, and hypotension follow in fatal cases. The most common symptoms are vomiting, diarrhea, skin involvement with burning pain, redness and pruritus, rash or blisters, bleeding, and difficulty in breathing. A late effect of systemic absorption is pancytopenia, predisposing to bleeding and sepsis. How does it spread? Gas gangrene results from wound contamination with soil containing spores of C. perfringens. Clostridial food poisoning follows eating foods contaminated with soil or feces and then stored under conditions that allow the organism to reproduce. This toxin is not communicable person to person. 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 are no specific antitoxins or antidotes available. Medical management consists of supportive care. Patients may require a tracheotomy or other means of assisted breathing. Vaccine None available. There is no pre-exposure or post-exposure prevention. Mortality Prognosis is poor. Death may occur in minutes, hours or days. Sources: USAMRIID's Medical Management of Biological Casualties Handbood; Fourth Edition February 2001; pages 9-10; http://usamriid.detrick.army.mil/education/bluebook/bluebook.pdf Federation of American Scientists; http://www.fas.org/nuke/intro/bw/agent.htm Virtual Naval Hospital: Treatment of Biological Warfare Agent Casualties; http://www.vnh.org/FM8284/index.html

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