CDC Chemical Emergencies March 17, 2005

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CDC Chemical Emergencies March 17, 2005

http://www.bt.cdc.gov/agent/trichothecene/pdf/trichothecenecasedef.pd

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CASE DEFINITION

Trichothecene Mycotoxins

Clinical description

Trichothecene mycotoxins might be weaponized and dispersed through

the air or mixed in food or beverages. Initially, route-specific

effects are typically prominent. Dermal exposure leads to burning

pain, redness, and blisters, and oral exposure leads to vomiting and

diarrhea. Ocular exposure might result in blurred vision, and

inhalational exposure might cause nasal irritation and cough.

Systemic symptoms can develop with all routes of exposure and might

include weakness, ataxia, hypotension, coagulopathy, and death (1).

Laboratory criteria for diagnosis

• Biologic: Selected commercial laboratories are offering

immunoassays to identify trichothecenes or trichothecene-specific

antibodies in human blood or urine (2, 3). However, these procedures

have not been analytically validated and are not recommended.

• Environmental: Detection of trichothecene mycotoxins in

environmental samples, as determined by FDA.

As a result of indoor air-quality investigations involving mold and

potentially mold-related health effects, mycotoxin analyses of bulk

environmental samples are now commercially available through

environmental microbiology laboratories in the United States (4).

Studies have not been done to determine the background level of

trichothecenes in non-moldy homes and office buildings or

nonagricultural outdoor environments. Therefore, the simple

detection of trichothecenes in environmental samples does not

invariably indicate an intentional contamination.

Case classification

• Suspected: A case in which a potentially exposed person is being

evaluated by health-care workers or public health officials for

poisoning by a particular chemical agent, but no specific credible

threat exists.

• Probable: A clinically compatible case in which a high index of

suspicion (credible threat or patient history regarding location and

time) exists for trichothecene mycotoxins exposure, or an

epidemiologic link exists between this case and a laboratory-

confirmed case.

• Confirmed: A clinically compatible case in which laboratory tests

of environmental samples have confirmed exposure.

The case can be confirmed if laboratory testing was not performed

because either a predominant amount of clinical and nonspecific

laboratory evidence of a particular chemical was present or a 100%

certainty of the etiology of the agent is known.

Trichothecene Mycotoxins

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March 17, 2005 Page 2 of 2

Additional resources

1. Wannemacher RW Jr, Wiener SL. Trichothecene mycotoxins. In:

Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical

aspects of chemical and biologic warfare. Washington, DC: Office of

the Surgeon General at TMM Publications, Borden Institute, Walter

Army Medical Center; 1997:655-77.

2. Croft WA, Jastromski BM, Croft AL, s HA. Clinical

confirmation of trichothecene mycotoxicosis in patient urine. J

Environ Biol 2002;23:301-20.

3. Vojdani A, Thrasher HD, Madison RA, Gray MR, Heuser G,

AW. Antibodies to molds and satratoxin in individuals exposed in

water-damaged buildings. Arch Environ Health. 2003;58:421-32.

4. Tuomi T, Reijula K, sson T, et al. Mycotoxins in crude

building materials from water-damaged buildings. Appl Environ

Microbiol 2000;66:1899-904.