CBRNE - T-2 Mycotoxins Medication

  • Author: Chan W Park, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jul 9, 2010
 

Medication Summary

The use of activated charcoal is advocated to patients who have orally ingested the toxin. Some sources advocate the use of activated charcoal even after inhalational exposure with the rationale being that the toxin that is adherent to the oral mucosa may be bound.[24] While not clinically tested in human, theoretical use exists for administering colony-stimulating factors to patients presenting with bone marrow suppression.

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Antidotes, adsorbent

Class Summary

These agents are used to neutralize toxins.[22]

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Activated charcoal (Liqui-Char, Super-Char, Insta-Char, Actidose)

 

Believed to adsorb ingested toxin, thereby preventing absorption and removing toxin from the GI tract, preventing further cellular damage.

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Granulocyte-stimulating factors

Class Summary

These agents are used to correct severe neutropenia.

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Filgrastim (Neupogen)

 

Granulocyte colony-stimulating factor that activates and stimulates production, maturation, migration, and cytotoxicity of neutrophils. Although not demonstrated or indicated for use in T-2 mycotoxin exposure, may be theoretical use for granulocyte-stimulating factors for patients presenting with severe neutropenia; in this setting, conduct use with hematology consultation.

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Contributor Information and Disclosures
Author

Chan W Park, MD  Attending Physician, Research Coordinator, Naval Medical Center Portsmouth

Chan W Park, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin Scott Koehler, MD  Resident Physician, Department of Emergency Medicine, Naval Medical Center, Portsmouth

Disclosure: Nothing to disclose.

Michael R Melia, MD  Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia

Michael R Melia, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Lanny F Littlejohn, MD  Staff Emergency Physician and Medical Director for Tactical Combat Casualty Care, Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia

Lanny F Littlejohn, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Special Operations Medical Association, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Thomas M Stein, MD, FACEP  Assistant Professor, Department of Emergency Medicine, Medical College of Pennsylvania-Hahnemann University; Medical Director, Emergency Medical Support Services and LifeFlight, Department of Emergency Medicine, Allegheny General Hospital

Thomas M Stein, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Rick Kulkarni, MD  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

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  Adjunct 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, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

  1. Joffee A. Fusarium Species: Their Biology and Toxicology. NY: John Wiley & Sons; 1986:225-292.

  2. Darling, Woods, et al. USAMRIID's Medical Management of Biological Casualties Handbook. 5th. Fort Detrick, Frederick, MD: USAMRIID; 2004. [Full Text].

  3. McGovern TW, Christopher GW. Biological warfare and its cutaneous manifestations. The Electronic Textbook of Dermatology [serial online]. 1995-2001;Available from: The Internet Dermatology Society, Inc. Accessed 2010. Available at http://www.telemedicine.org/biowar/biologic.htm.

  4. Ueno Y. Trichothecene mycotoxins: Mycology, chemistry, and toxicology. Advances in food and nutrition research. 1989;3:301-353.

  5. Franz DR, Jahrling PB, Friedlander AM, McClain DJ, Hoover DL, Bryne WR, et al. Clinical recognition and management of patients exposed to biological warfare agents. JAMA. Aug 6 1997;278(5):399-411. [Medline].

  6. Marrs TC, Edginton JA, Price PN, Upshall DG. Acute toxicity of T2 mycotoxin to the guinea-pig by inhalation and subcutaneous routes. Br J Exp Pathol. Apr 1986;67(2):259-68. [Medline].

  7. Wannemacher RW Jr, Wiener SL. Trichothecene mycotoxins. In: Sidell FR, Takafuji ET, Franz DR. Medical Aspects of Chemical and Biological Warfare. Falls Church, Va: Office of the Surgeon General, US Dept of the Army; 1997:655-676.

  8. Blazes DL, Lawler JV, Lazarus AA. When biotoxins are tools of terror. Early recognition of intentional poisoning can attenuate effects. Postgrad Med. Aug 2002;112(2):89-92, 95-6, 98. [Medline].

  9. Zilinskas RA. Iraq's biological weapons. The past as future?. JAMA. Aug 6 1997;278(5):418-24. [Medline].

  10. Holstege CP, Bechtel LK, Reilly TH, Wispelwey BP, Dobmeier SG. Unusual but potential agents of terrorists. Emerg Med Clin North Am. May 2007;25(2):549-66; abstract xi. [Medline].

  11. Haig AM. Chemical Warfare in Southeast Asia and Afghanistan: Report to the Congress From Secretary of State Alexander M. Haig. Special Report No. 98. Washington, DC: US Department of State; March 22, 1982.

  12. Schieffer HB. Facts, not Rhetoric, on Yellow Rain. Nature. July 1983;304:10.

  13. Henghold WB 2nd. Other biologic toxin bioweapons: ricin, staphylococcal enterotoxin B, and trichothecene mycotoxins. Dermatol Clin. Jul 2004;22(3):257-62, v. [Medline].

  14. Johnsen H, Odden E, Johnsen BA, Bøyum A, Amundsen E. Cytotoxicity and effects of T2-toxin on plasma proteins involved in coagulation, fibrinolysis and kallikrein-kinin system. Arch Toxicol. Jan 1988;61(3):237-40. [Medline].

  15. Dearborn DG, Smith PG, Brooks LJ, Carroll-Pankhurst C, Kosick R, Dahms BB. Update: pulmonary hemorrhage/hemosiderosis among infants-Cleveland, Ohio 1993-1996. MMWR Morbidity Mortality Weekly Report. 1997;46:33-35.

  16. Richards CA. Stachybotrys atra suspected in three infant deaths: 18 others sickened. Journal of Pediatric Infectious Disease. 1997;10:1-8.

  17. Pestka JJ, Yike I, Dearborn DG, Ward MD, Harkema JR. Stachybotrys chartarum, trichothecene mycotoxins, and damp building-related illness: new insights into a public health enigma. Toxicol Sci. Jul 2008;104(1):4-26. [Medline].

  18. Schoenthal. Mycotoxins in food and the plague of Athens. Journal of Nutritional Medicine. 1994;4:83-85.

  19. Dohnal V, Jezkova A, Jun D, Kuca K. Metabolic pathways of T-2 toxin. Curr Drug Metab. Jan 2008;9(1):77-82. [Medline].

  20. Zapor M, Fishbain JT. Aerosolized biologic toxins as agents of warfare and terrorism. Respir Care Clin N Am. Mar 2004;10(1):111-22. [Medline].

  21. Wannemacher RW. Dermal toxicity of T-2 toxin in guinea pigs, rats and cynomolgus monkeys. Tricothecenes and Other Mycotoxins. 1985;423-432.

  22. Fricke RF, Jorge J. Assessment of efficacy of activated charcoal for treatment of acute T-2 toxin poisoning. J Toxicol Clin Toxicol. 1990;28(4):421-31. [Medline].

  23. Shohami E, Wisotsky B, Kempski O, Feuerstein G. Therapeutic effect of dexamethasone in T-2 toxicosis. Pharm Res. Dec 1987;4(6):527-30. [Medline].

  24. Poppenga RH, Lundeen GR, Beasley VR, Buck WB. Assessment of a general therapeutic protocol for the treatment of acute T-2 toxicosis in swine. Vet Hum Toxicol. Jun 1987;29(3):237-9. [Medline].

  25. Tucker JB. Mycotoxins and Gulf War Illness: A Possible Link [The National Gulf War Resource Center Web site]. The National Gulf War Resource Center. Available at http://www.ngwrc.org/. Accessed 2001.

 
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