Biological Weapons -- Trichothecene Mycotoxins (T2)

Because these toxins are easy to produce in large quantities and they can be dispersed via numerous methods - dusts, droplets, aerosols, smoke, rockets, artillery mines and portable sprays), mycotoxins have excellent potential as a biological weapon. Strong evidence suggests that trichothecenes ("yellow rain") have been used as a BW agent in Southwest Asia and Afghanistan. From 1974-1981, numerous attacks resulted in a minimum of 6310 deaths in Laos, 981 deaths in Cambodia, and 3042 deaths in Afghanistan. . Symptoms After exposure to the mycotoxins, early symptoms begin within about 5 - 60 minutes. They attack multiple systems at once providing full-body misery. Skin symptoms include burning, tender and reddened skin, swelling, and blistering progressing to tissue death dermal and sloughing of large skin areas in lethal cases. Respiratory exposure results in nasal itching, pain, sneezing, bloody and runny nose, difficulty breathing, wheezing, cough, and blood-tinged saliva and sputum. Gastrointestinal symptoms include loss of appetite, nausea and vomiting, abdominal cramping, and watery and/or bloody diarrhea. Following entry into the eyes, pain, tearing, redness, and blurred vision occurs. Systemic toxicity may occur bringing weakness, prostration, dizziness, lack of muscular coordination, irregular heartbeat, hyperthermia or hypothermia, diffuse bleeding, and hypotension. Death may occur within minutes to days depending on the dose and route of exposure. How does it spread? Mycotoxins are not transmitted person to person, but from e ating moldy grain. The T2 mycotoxins are the only potential BW agents that can harm and be absorbed through intact skin. Diagnosis Diagnosis generally depends on assessment of symptoms and identifying the toxin from biological and environmental samples. Many patients report seeing a yellow rain or smoke attack which supports the diagnosis. Initial laboratory studies are nonspecific. Serum and urine should be sent for antigen detection. The parent toxin and metabolites (50% - 75%) are eliminated in urine and feces within 24 hours; however, metabolites can be detected as late as 28 days after exposure. Treatment Treatment is supportive. If protective clothing and mask was worn during an attack, these should prevent illness. If unprotected, outer clothing should be removed within 4-6 hours and decontaminated with 5% sodium hydroxide for 6-10 hours. Skin should be washed with copious amounts of soap and uncontaminated water. Eyes, if exposed, should be irrigated with copious amounts of normal saline or sterile water. After appropriate skin decontamination, give victims of inhalation and oral exposures superactivated charcoal orally. Activated charcoal binds mycotoxins. US military personnel is currently equipped with a skin decontamination kit (M291) - effective against most chemical warfare agents, including mycotoxins. Two topical skin protectants as well as vaccines are in advanced development but have not been approved yet for use in humans. Ascorbic acid (400-1200 mg/kg, inter-peritoneal (ip)) works to decrease lethality in animal studies, but has not been tested in humans. These toxins require a 3-5% sodium hydroxide solution and heating at 900oF for 10 minutes or 500oF for 30 minutes for complete inactivation. Vaccine None available Mortality No specific statistics. 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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