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T-2 Mycotoxins “Yellow Rain”

T-2 Mycotoxins “Yellow Rain”

Diagnosis

1.
Skin pain, pruritus, redness, vesicles, necrosis (esp lips, fingers, nose), sloughing of epidermis

2.
Nose and throat pain, salivation, nasal discharge, itching and sneezing, cough, dyspnea, wheezing, chest pain, hemoptysis

3.
Weakness, ataxia, collapse, systemic hemorrhage, petechiae, shock, and death

4.
Extremely debilitating due to skin and pulmonary involvement

5.
Suspect if aerosol attack in form of “yellow rain” with droplets of yellow fluid affecting clothes and environ

6.
Gas liquid chromatography-mass spectrometry: blood, tissue, environ samples
History

1.
Used in aerosol form (“yellow rain”) to produce lethal and nonlethal casualties in Laos (1975-81), Kampuchea (1979-81), and Afghanistan (1979-81)

2.
> 6,300 deaths in Laos, 1,000 in Kampuchea, and 3,042 in Afghanistan
Pathophysiology

1.
Trichothecene mycotoxins produced by fungi (molds) of genera Fusarium, Myrotecium, Trichoderma, Stachybotrys

2.
Heat to 1500 deg F for 30 mins required for inactivation

3.
Brief exposure to NaOCl destroys toxic activity

4.
Stable in acidic conditions

5.
Inhaled or ingested

6.
Infective dose: moderate

7.
Incubation: 2-4 hrs

8.
Duration: may persist for 1 mth

9.
Lethality: moderate

10.
Stable for yrs at room temp
Prevention

1.
Wear protective mask and clothing during an attack

2.
No vaccine available
Isolation/Decontamination

1.
Standard precautions for healthcare workers

2.
Decontamination of outer clothing and exposed skin with soap and water

3.
Eye exposure treated with copious saline irrigation

4.
2.5% hypochlorite and 0.25% NAOH with 30 min contact time; can irritate skin
Treatment

1.
No specific antidote

2.
Activated charcoal 2 g/kg PO for oral ingestions

3.
M291 kit to remove skin adherent T-2

4.
Eyes irrigated with normal saline

5.
Supportive therapy

6.
Unproven treatments: metoclopramide, magnesium sulfate, magnesium sulfate, sodium bicarbonate and dexamethasone sodium phosphate
Disposition

1.
Admit; standard precautions

2.
Notify CDC & local health dept

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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