CBRNE - T-2 Mycotoxins Clinical Presentation

Updated: Aug 08, 2023
  • Author: Chan W Park, MD, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MS, MPH, LHD  more...
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Patients with cutaneous symptoms may report exposure to clouds of a yellow-colored smoke or aerosol, but blue and green aerosols have also been reported. [11] Patients may report having seen yellow droplets on clothing. Immediate skin pain and burning on exposed surfaces is described. Eye pain and burning also should be reported. [3]

Suspicion of the toxin being placed in an ingested food source may exist. Ingested toxin probably has no taste, since no documentation supports a foul odor or taste in previous epidemics of toxin ingestion. This is further supported by the historical experience that many individuals become ill when exposed to contaminated food without any suspicion of having ingested tainted food. [21]

The most common symptoms occurring with most exposures include the following [2] :

  • Skin (or oral) pain (burning)
  • Skin redness or rash
  • Vomiting
  • Diarrhea
  • Dyspnea
  • Bleeding

Physical Examination

The early signs and symptoms of T-2 toxin poisoning do reflect the route of exposure. However, irrespective to the route of entry, the systemic toxicity follows a protracted course of illness that is well characterized. Early symptoms can manifest within seconds of exposure depending on the dose of exposure. Symptoms become prominent after minutes to hours upon exposure. They are described by the respective organ system.

No specific neurologic signs or symptoms are related to the toxin except for mild ataxia, which reflects systemic toxicity.

Head, eyes, ears, nose, throat (HEENT) manifestations are as follows:

  • Ocular exposure causes tearing, pain, conjunctivitis, and blurred vision.
  • Nasal mucosa results in sinus irritation, pain, rhinorrhea, sneezing, and potentially epistaxis.
  • Oral and oropharyngeal exposure results in pain and blood-tinged saliva and sputum.

Respiratory manifestations are as follows:

  • Cough, dyspnea and wheezing
  • Delayed signs can include hemoptysis

Cardiovascular manifestations are as follows:

  • Tachycardia
  • Vascular collapse in severe toxin exposure

Gastrointestinal manifestations are as follows:

  • Nausea and vomiting
  • Anorexia
  • Watery diarrhea with abdominal cramping

Dermal manifestations are as follows:

  • Painful erythema and tenderness
  • Blistering and bullous lesions, leading to desquamation
  • Necrosis and sloughing of dermal layer

Systemic manifestations are as follows:

  • Severe toxin exposure can result in early systemic toxicity.
  • Severe dizziness, ataxia, and prostration
  • Tachycardia
  • Hypothermia
  • Vascular collapse

Alimentary toxic aleukia

Alimentary toxic aleukia (ATA) is a clinical syndrome that results from chronic exposure to T-2 toxin. [2]  ATA has four stages, which mirror the stages of radiation sickness.

Stage 1

This stage may be seen in the emergency department. This stage results from the acute injury to the exposed cells and tissue. The symptoms reflect the route of toxin exposure.

Stage 2

This stage occurs weeks after the exposure. Insult to the bone marrow initially produces a transient lymphocytosis. This is soon followed by bone marrow suppression due to the antimitotic effects of T-2 toxin. The result is significant leukopenia, granulocytopenia, and thrombocytopenia.

Stage 3

This stage also occurs weeks after the exposure and is considered the hemorrhagic stage. The patient exhibits petechial hemorrhages, especially of the mucosal areas of the nasopharynx and oropharynx. These lesions develop to form ulcerated and necrotic lesions, which can result in significant bleeding from the esophagus and the gastrointestinal tract. Moreover, the edema that accompanies the mucosal injury may threaten the airway. Also, severe coagulopathy may occur. During this stage, the patient is at a higher risk for sepsis because the immune system is significantly compromised.

Stage 4

During the recovery phase, the necrotic lesions heal and the bone marrow recovers.