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CBRNE - T-2 Mycotoxins Workup

  • Author: Chan W Park, MD, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
Updated: Mar 09, 2016

Laboratory Studies

With growing health concerns related to mold exposures and its related morbidity and mortality, devices have been developed to detect environmental mycotoxin exposure. To date, no data exist to differentiate the expected background levels of these substances from potential toxic and/or intentional contamination.

T-2 toxin is rapidly metabolized to HT-2, T2-triol, and T-2 tetraol within hours after exposure.[21] While these toxin metabolites may be detected in body fluids, tissue, and stomach contents for up to 28 days following exposure, these results are unlikely to be available to help the medical provider manage the patient. Newer urine assays detect T-2 metabolite for up to one week after exposure.[9] Definitive diagnosis must be made in a reference laboratory using thin-layer or gas-liquid chromatography, mass or nuclear magnetic resonance spectrometry, radioimmunoassay, and enzyme-linked immunosorbent assay (ELISA) techniques.[22]

  • Perform immediate postexposure laboratory studies to assess for other disease conditions in the differential diagnosis.
  • When considering T-2 mycotoxin exposure as the cause of the illness, collect nasal, throat, or respiratory secretions and send for mass spectrometric evaluation.
  • Collect serum, urine, and/or tissue samples for toxin detection from patients who are in the postexposure phase. ELISA screening tests and antibody assays that screen for mycotoxin exposure are available.
  • Observing the absolute lymphocyte count over time may differentiate those individuals destined to develop bone marrow suppression.
  • Coagulation panel may help identify patients who are at risk for developing severe coagulopathy.

Imaging Studies

No specific imaging tests help diagnose T-2 toxin exposure.



Warning: This is a potent dermally active toxin that is transmissible if not properly decontaminated. Do not approach the patient without observing universal precaution.

Decontamination procedure is as follows:

  • Remove all of the patient's clothing, and clean and scrub the entire skin surface with soap and water. Washing the contaminated area of the skin within 6 hours postexposure can remove 80-98% of the toxin and has been demonstrated to prevent skin lesions and death in experimental animals.[23]
  • Contain clothing to avoid contamination of the health care environment.
Contributor Information and Disclosures

Chan W Park, MD, FAAEM Adjunct Assistant Professor, Division of Emergency Medicine, Duke University Medical Center; Director of Simulation Medicine, Durham Veterans Affairs Medical Center

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

Disclosure: Nothing to disclose.


Thomas M Stein, MD 

Thomas M Stein, MD 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, Society for Academic Emergency Medicine

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.

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

Disclosure: Nothing to disclose.

Chris Luttig, MD, MPH Resident Physician, Departments of Emergency Medicine and Internal Medicine, Virginia Commonwealth University Health System

Chris Luttig, MD, MPH is a member of the following medical societies: American College of Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

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, National Association of EMS Physicians

Disclosure: Nothing to disclose.


Michael P Allswede, DO Program Director, Disaster and Emergency Medicine Residency, Conemaugh Memorial Hospital; Director, Strategic Medical Intelligence, Inc

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.

Donald A Locasto, MD Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Disclosure: Nothing to disclose.

  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. USAMRIID. 2004. Available at

  3. McGovern TW, Christopher GW. Biological warfare and its cutaneous manifestations. The Electronic Textbook of Dermatology. 1995-2001. [Full Text].

  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. 1997 Aug 6. 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. 1986 Apr. 67(2):259-68. [Medline].

  7. Wannemacher RW Jr, Wiener SL. Trichothecene mycotoxins. 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. 2002 Aug. 112(2):89-92, 95-6, 98. [Medline].

  9. Zilinskas RA. Iraq's biological weapons. The past as future?. JAMA. 1997 Aug 6. 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. 2007 May. 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. US Department of State. March 22, 1982.

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

  13. Wu J, Jing L, Yuan H, Peng SQ. T-2 toxin induces apoptosis in ovarian granulosa cells of rats through reactive oxygen species-mediated mitochondrial pathway. Toxicol Lett. 2011 May 10. 202(3):168-77. [Medline].

  14. Bouaziz C, Sharaf El Dein O, El Golli E, Abid-Essefi S, Brenner C, Lemaire C, et al. Different apoptotic pathways induced by zearalenone, T-2 toxin and ochratoxin A in human hepatoma cells. Toxicology. 2008 Dec 5. 254(1-2):19-28. [Medline].

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

  16. 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. 1988 Jan. 61(3):237-40. [Medline].

  17. 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.

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

  19. 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. 2008 Jul. 104(1):4-26. [Medline].

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

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

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

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

  24. Schwartz MD, Hurst CG, Kirk MA, Reedy SD, Braue EH Jr. Reactive Skin Decontamination Lotion (Rsdl) For the Decontamination of Chemical Warfare Agent (Cwa) Dermal Exposure. Curr Pharm Biotechnol. 2012 Feb 20. [Medline].

  25. 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].

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

  27. 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. 1987 Jun. 29(3):237-9. [Medline].

  28. 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 Accessed: 2001.

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