CBRNE - T-2 Mycotoxins Workup

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

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.[19] 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.[20]

  • 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.
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Imaging Studies

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

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Procedures

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.[21]
  • Contain clothing to avoid contamination of the health care environment.
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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

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  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].

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

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  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.

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  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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