Characteristics.
The trichothecene mycotoxins are a
diverse group of more than 40 compounds
produced by fungi. The tricothecene (T-2)
mycotoxins are the only toxin threats
that penetrate skin or that are active on
skin surfaces. They are potent inhibitors
of protein synthesis, impair DNA
synthesis, alter cell membrane structure
and function, and inhibit mitochondrial
respiration. Secondary metabolites of
fungi, such as T-2 toxin and others,
produce toxic reactions called
mycotoxicoses upon inhalation or
consumption of contaminated food products
by humans or animals. Naturally occurring
trichothecenes have been identified in
agricultural products and have been
implicated in a disease of animals known
as moldy corn toxicosis (moldy corn
poisoning). There are no well-documented
cases of clinical exposure of humans to
trichothecenes. However, circumstantial
evidence has associated these toxins with
alimentary toxic aleukia (ATA), the fatal
epidemic seen in Russia during World War
II, and with alleged biological warfare
incidents ("yellow rain") in
Cambodia, Laos, and Afghanistan.
Clinical
Features. Consumption of these
mycotoxins results in weight loss,
vomiting, skin inflammation, bloody
diarrhea, diffuse hemorrhage, and
possibly death. The onset of illness
following acute exposure to T-2 (IV or
inhalation) occurs in hours, resulting
in the rapid onset of circulatory shock
characterized by reduced cardiac output,
arterial hypotension, lactic acidosis and
death within 12 hours. Clinical signs and
symptoms of ATA include hemorrhage,
leukopenia, ulcerative pharyngitis, and
depletion of bone marrow. The purported
use of T-2 as a biological warfare agent
resulted in an acute exposure via
inhalation and/or dermal routes, as well
as oral exposure upon consumption of
contaminated food products and water.
Alleged victims reported painful skin
lesions, lightheadedness, dyspnea, and a
rapid onset of hemorrhage,
incapacitation, and death. Ascorbic acid
(400-1200 mg/kg, intra-peritoneal) may
decrease lethality.
Vaccine.
There are no approved human vaccines for
immunization against mycotoxins.
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Medical
Management of Biological Agent Patients