Prehospital Care
Warning: Mycotoxin is a potent dermally active toxin that is transmissible in the health care setting. Do not approach the patient without observing universal precaution. Use hazardous materials teams in patient rescue and decontamination.
Decontamination is of paramount importance to avoid cross-contamination. 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. [24] Contain clothing to avoid contamination of the health care environment.
Available only to the US Department of Defense and many NATO military forces is the Reactive Skin Decontamination Lotion (RSDL). The proposed mechanism of action is neutralization of traditional chemical warfare agents by a combination of physical removal and nucleophilic breakdown, which renders the original toxic substance nontoxic. [2, 25]
For patients in extremis, attention to airway, breathing, and circulation per Advanced Trauma Life Support (ATLS) protocol needs to occur immediately as decontamination is being performed. While one team member is caring for issues involving the airway, breathing, and circulation, another member should be concerned primarily with patient decontamination.
Provide supportive measures addressing cardiovascular status as necessary. If the patient complains of eye pain or tearing, irrigate the eyes with copious amounts of water. No specific antidote exists for this toxin. General supportive measures are indicated.
Emergency Department Care
Warning: Mycotoxin is a potent dermally active toxin that is transmissible in the health care setting. Do not approach the patient without observing universal precautions. Never assume that a patient has been decontaminated in the prehospital setting. Reassess the patient's decontamination status. If the degree of prehospital decontamination is uncertain, rewash the patient to ensure the safety of staff and facility.
For patients in extremis, attention to airway, breathing, and circulation per ATLS protocol needs to occur immediately as decontamination is being performed. While one team member is caring for issues involving the airway, breathing, and circulation, another member should be concerned primarily with patient decontamination.
Remove all clothing, and clean and scrub the patient's 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. [24] Contain clothing to avoid contamination of the health care environment.
While no human studies have been conducted, survival benefits have been shown in animal models with the following treatment after T-2 toxin exposure.
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Use of activated charcoal to absorb T-2 toxin from the gut regardless of the portal of entry within 1 hour of exposure. [26]
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Dexamethasone administration (1 mg/kg at 12, 24, and 48 h) increased the survival rate in mice from zero to greater than 50%. [27]
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Although not proven clinically, a theoretical use exists for administering colony-stimulating factors to patients presenting with bone marrow suppression.
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Liver toxicity was successfully treated in rats with curcumin and taurine. Liver enzyme levels decreased following treatment with either antioxidative agent, however, curcumin proved to be more effective in ameliorating toxic effects. [28]
No specific antidote is available for T-2 mycotoxin exposure. Provide supportive measures, addressing respiratory and cardiovascular status as necessary. If the patient complains of eye pain or tearing, irrigate the eyes with copious amounts of water.
In all suspected cases involving T-2 mycotoxin exposure, admission to the hospital is warranted. Supportive care should be instituted, with particular attention to the prevention of superinfection. Depending on the time of exposure and the presenting symptoms, serial lymphocyte counts may help identify patients who are immunocompromised.
Consultations
Required consultants are dictated by the disease course. Pulmonary consultation may be required for severe dyspnea of hemoptysis. A hematologist may be consulted for patients presenting with severe pancytopenia. Contact the local poison control center for additional clinical guidance. Some larger cities' poison control centers may have specific guidelines to follow concerning weapons of mass destruction.
Consult the Federal Bureau of Investigations and Department of Homeland Security in any situation when nuclear, biological, or chemical weapon exposure is suspected.
Prevention
Physical barrier protection of the skin, mucous membranes, and airway provided by use of HAZMAT suits or chemical protective mask and clothing, such as MOPP (Mission Oriented Protective Posture) gear, are the only effective methods of protection. The Skin Exposure Reduction Paste Against Chemical Warfare Agents (SERPACWA) has been shown to block dermal irritation in animal studies and can be applied at closure points of protective garments as well as to any exposed skin. SERPACWA is approved by the US Food and Drug Administration (FDA) for use in conjunction with MOPP gear to reduce or delay the absorption of chemical warfare agents through the skin when is applied prior to exposure. [2]
Because T-2 toxin is readily found in grains, spices, and herbs and cannot be inactivated with normal sterilizing methods such as ultraviolet, autoclaving, and heat, food supplies must be screened to prevent large outbreaks. [29, 30] Rapid screening assays to detect and measure T-2 toxin include microplate enzyme-linked immunosorbent assays (ELISAs) and immunochromatographic devices, and lateral flow immunoassays. [31]
Vaccines, monoclonal antibodies, and chemo-protective pre-treatments are being studied in animal models, but are not yet available. [2]
