CBRNE - Staphylococcal Enterotoxin B Follow-up

Updated: Dec 31, 2015
  • Author: Bruce A Gleason, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
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Follow-up

Further Inpatient Care

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  • Disposition is dictated by the patient's condition after appropriate observation in the ED. In general, patients who are asymptomatic at rest with no shortness of breath, tolerable chest discomfort, and no progression of symptoms may be discharged home with appropriate follow-up instructions, including a caution to avoid any exertion for at least 24 hours.

  • Patients with continued vomiting who are unable to maintain their own hydration or those with significant dehydration require admission to at least an observation unit.

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Deterrence/Prevention

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  • Food-borne staphylococcal enterotoxin B (SEB) can be prevented by proper storage of dairy products and proper storage and preparation of meat products.

  • Any contaminated food should be destroyed.

  • SEB is not dermally active and can be removed from surfaces/skin with standard soap and water (ie, good handwashing).

  • Secondary aerosol exposure of SEB from infected patients is unlikely to be a hazard.

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Prognosis

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  • Prognosis with appropriate treatment is excellent in both food-borne and inhalation staphylococcal enterotoxin B (SEB).

  • Some respiratory symptoms, including nonproductive cough, may persist for up to 4 weeks.

  • Severe inhalational cases risk death from pulmonary edema and respiratory failure.

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Patient Education

Dairy products must be stored properly, and meat products must be stored and prepared properly.

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Biological Warfare and Personal Protective Equipment.

Special considerations

No human vaccine against staphylococcal enterotoxin B (SEB) is currently available. Use protective masks if the use of SEB in biological warfare is threatened.

SEB toxoid is a poor mucosal immunogen and efforts at traditional formalin-inactivated toxoid-based vaccines have been abandoned in favor of recombinant, site-directed attenuated mutants. Several of these new vaccine candidates are in development. [16]

Experimental use of passive immunotherapy can reduce mortality in animals but only if administered within 4-8 hours of inhalational exposure. Correlation of treatment in humans has not been proven.

Since SEB causes symptoms when inhaled at low doses, it can render up to 80% or more of exposed personnel clinically ill and unable to perform their duties for up to 1-2 weeks.

The US military once referred to SEB by the code name PG, and the toxin was part of the US stockpile prior to its destruction in 1972.

With more advanced technology available, research is showing promise in the development of newer, faster bioassays to detect the presence of SEB, even on the battlefield. [17, 18]

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