Pediatric emergency medicine trisk 4556 4556
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epidemiologic purposes, although positive nasal swabs do not prove penetration
of toxin to the lungs, and negative swabs do not exclude exposure in any given
patient. In addition, assays for the presence of toxin, as well as measurement of
an antibody response, can be performed on serum. Management is primarily
supportive, although the U.S. military has found that postexposure prophylaxis
with an investigational toxoid is efficacious in animal trials.
OTHER AGENTS
Numerous other agents may present bioterrorist threats of varying degrees. In
addition to previously discussed incidents, terrorists and belligerents have
attempted to use Salmonella, Shigella, glanders, cholera, typhus, and probably
many other organisms or toxins to induce disease. Many of these agents are
discussed adequately elsewhere in this and other texts; a few warrant additional
comment here.
Venezuelan equine encephalitis makes an attractive weapon because of its high
infection-to-disease ratio; virtually all those who are not immune become
symptomatic. In infants and young children the disease can be severe, with as
many as 4% developing overt encephalitis, often leading to permanent sequelae
or death.
Staphylococcal enterotoxin B (SEB) is a bacterial toxin that has been
weaponized in the past. Although familiar to many clinicians as a common cause
of food poisoning, SEB would also be a potent incapacitating toxin if delivered
by aerosol. Symptoms produced in this manner would begin 3 to 12 hours after
exposure and consist of fever, headache, chills, myalgias, and nonproductive
cough. Dyspnea and chest pain accompany the inhalation of high dosages of
inhaled toxin. Nausea, vomiting, and diarrhea may occur as a result of
inadvertently swallowed toxin. Treatment is supportive; meticulous attention
should be paid to fluid management. Patients may be ill for as long as 2 weeks
with aerosol exposure.
Various fungal toxins, such as the trichothecene mycotoxins, have been
mentioned in a biowarfare or bioterrorism context. After the Vietnam War, the
U.S. government accused the Soviets of using a trichothecene toxin, T-2
mycotoxin (otherwise known as “yellow rain”), against Hmong tribesmen. The
Iraqis are known to have weaponized another fungal toxin, aflatoxin, which in
addition to acute clinical effects, is a potent hepatic carcinogen. Symptoms
produced by various mycotoxins are variable and depend on the route of
exposure. The trichothecene mycotoxins are different from virtually all other
bioterrorist agents in that they are dermally active. Treatment is supportive.
