CBRNE - T-2 Mycotoxins Workup
- Author: Chan W Park, MD, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD more...
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. 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. 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.
- 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.
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.
- Contain clothing to avoid contamination of the health care environment.
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