eMedicine Specialties > Emergency Medicine > Warfare - Chemical, Biological, Radiological, Nuclear and Explosives

CBRNE - Staphylococcal Enterotoxin B: Treatment & Medication

Author: Bruce A Gleason, MD, Resident Physician, Department of Emergency Medicine, C R Darnall Army Medical Center, Ft Hood, Texas
Coauthor(s): Kermit D Huebner, MD, FACEP, Research Director, Carl R Darnall Army Medical Center
Contributor Information and Disclosures

Updated: Apr 29, 2009

Treatment

Prehospital Care

Treatment of staphylococcal enterotoxin B illness is supportive.

  • In the event of dehydration, vigorous administration of intravenous fluids is indicated.
  • For patients exposed via inhalation, supportive treatment with humidified oxygen may be all that is necessary, although significant exposure may dictate intubation and assisted ventilation with high oxygen concentrations.
  • The efficacy of steroids in SEB-induced pulmonary edema or ARDS has not been demonstrated.

Emergency Department Care

Treatment of staphylococcal enterotoxin B (SEB) illness is limited to supportive care, with special attention to elimination of hypotension and hypoxia and pain control as needed.1,11

  • Cough suppressants and acetaminophen for fever will make the patient more comfortable.
  • Antiemetics should be provided for nausea in food poisoning as necessary.
  • Mechanical ventilation may be required in severe cases.
  • Vasopressors and diuretics may be required in severe cases.
  • Antibiotics have not demonstrated efficacy in SEB intoxication, and steroids have not been shown to be effective in SEB-induced pulmonary edema.

Consultations

Consultations are dictated by the patient's physiologic condition.

  • If a terrorist attack using staphylococcal enterotoxin B (SEB) is suspected, expeditiously inform local law enforcement personnel, including the local Federal Bureau of Investigation.
  • In the event that a cluster of patients present with similar symptoms, either of pulmonary or GI origin, notify local public health officials to begin epidemiologic investigation.

More on CBRNE - Staphylococcal Enterotoxin B

Overview: CBRNE - Staphylococcal Enterotoxin B
Differential Diagnoses & Workup: CBRNE - Staphylococcal Enterotoxin B
Treatment & Medication: CBRNE - Staphylococcal Enterotoxin B
Follow-up: CBRNE - Staphylococcal Enterotoxin B
References
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References

  1. Woods JB, Darling RG, Dembek Z, et al. USAMRIID Medical Management of Biological Casualties Handbook. 6th ed. April 2005.

  2. CDC. Toxic-shock syndrome, United States, 1970-1982. MMWR Morb Mortal Wkly Rep. Apr 30 1982;31(16):201-4. [Medline].

  3. Ulrich RG, Sidell S, Taylor TJ. Staphylococcal enterotoxin B and related pyogenic toxins. In: Textbook of Military Medicine. Part I. Warfare, Weaponry and the Casualty. Vol 3. 1997:621-631.

  4. Ono HK, Omoe K, Imanishi K, Iwakabe Y, Hu DL, Kato H. Identification and characterization of two novel staphylococcal enterotoxins, types S and T. Infect Immun. Nov 2008;76(11):4999-5005. [Medline].

  5. Papageorgiou AC, Tranter HS, Acharya KR. Crystal structure of microbial superantigen staphylococcal enterotoxin B at 1.5 A resolution: implications for superantigen recognition by MHC class II molecules and T-cell receptors. J Mol Biol. Mar 20 1998;277(1):61-79. [Medline].

  6. Mattix ME, Hunt RE, Wilhelmsen CL, Johnson AJ, Baze WB. Aerosolized staphylococcal enterotoxin B-induced pulmonary lesions in rhesus monkeys (Macaca mulatta). Toxicol Pathol. May-Jun 1995;23(3):262-8. [Medline].

  7. Tierney LK, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment. 1998.

  8. Rajagopalan G, Sen MM, Singh M, Murali NS, Nath KA, Iijima K, et al. Intranasal exposure to staphylococcal enterotoxin B elicits an acute systemic inflammatory response. Shock. Jun 2006;25(6):647-56. [Medline].

  9. Rajagopalan G, Smart MK, Patel R, David CS. Acute systemic immune activation following conjunctival exposure to staphylococcal enterotoxin B. Infect Immun. Oct 2006;74(10):6016-9. [Medline].

  10. Khan AS, Cao CJ, Thompson RG, Valdes JJ. A simple and rapid fluorescence-based immunoassay for the detection of staphylococcal enterotoxin B. Mol Cell Probes. Apr-Jun 2003;17(2-3):125-6. [Medline].

  11. Virtual Naval Hospital, US Army Medical Research Institute of Infectious Diseases. Medical Management of Biological Casualties Handbook. 1998.

  12. Mantis NJ. Vaccines against the category B toxins: Staphylococcal enterotoxin B, epsilon toxin and ricin. Adv Drug Deliv Rev. Jun 17 2005;57(9):1424-39. [Medline].

  13. Yang M, Kostov Y, Bruck HA, Rasooly A. Carbon nanotubes with enhanced chemiluminescence immunoassay for CCD-based detection of Staphylococcal enterotoxin B in food. Anal Chem. Nov 15 2008;80(22):8532-7. [Medline].

  14. Soto CM, Martin BD, Sapsford KE, Blum AS, Ratna BR. Toward single molecule detection of staphylococcal enterotoxin B: mobile sandwich immunoassay on gliding microtubules. Anal Chem. Jul 15 2008;80(14):5433-40. [Medline].

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Further Reading

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Keywords

staphylococcal enterotoxin B, SEB, exotoxin, symptoms, treatment, Staphylococcus aureus, S aureus, enterotoxin, food poisoning, gastroenteritis, nonmenstrual toxic shock syndrome, TSS, biological warfare agent, biowarfare weapon, SEB toxicity, staphylococcal enterotoxin B toxicity, SEB exposure, staphylococcal enterotoxin B exposure, enterotoxin-induced gastroenteritis, SEB ingestion, SEB inhalation, staphylococcal enterotoxin B ingestion, staphylococcal enterotoxin B inhalation, terrorism

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Contributor Information and Disclosures

Author

Bruce A Gleason, MD, Resident Physician, Department of Emergency Medicine, C R Darnall Army Medical Center, Ft Hood, Texas
Bruce A Gleason, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Kermit D Huebner, MD, FACEP, Research Director, Carl R Darnall Army Medical Center
Kermit D Huebner, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Association of Military Surgeons of the US, Society for Academic Emergency Medicine, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Jerry L Mothershead, MD, Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences
Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP, Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine
Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

 
 
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