CBRNE - T-2 Mycotoxins: Differential Diagnoses & Workup

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Workup

Laboratory Studies

Updated: Aug 19, 2008

http://emedicine.medscape.com/article/830892-diagnosis

With growing health concerns related to mold exposures and its related morbidity

and mortality, devices have been developed to detect environmental mycotoxin

exposure. To date, no data exist to differentiate the expected background levels

of these substances from potential toxic and/or intentional contamination.

T-2 toxin is rapidly metabolized to HT-2, T2-triol, and T-2 tetraol within hours

after exposure. While these toxin metabolites may be detected in body fluids,

tissue, and stomach contents for up to 28 days following exposure, these results

are unlikely to be available to help the medical provider manage the patient.

Newer urine assays detect T-2 metabolite for up to one week after exposure.

Definitive diagnosis must be made in a reference laboratory using thin-layer or

gas-liquid chromatography, mass or nuclear magnetic resonance spectrometry,

radioimmunoassay, and enzyme-linked immunosorbent assay (ELISA) techniques.

•Perform immediate postexposure laboratory studies to assess for other disease

conditions in the differential diagnosis.

•When considering T-2 mycotoxin exposure as the cause of the illness, collect

nasal, throat, or respiratory secretions and send for mass spectrometric

evaluation.

•Collect serum, urine, and/or tissue samples for toxin detection from patients

who are in the postexposure phase. ELISA screening tests and antibody assays

that screen for mycotoxin exposure are available.

•Observing the absolute lymphocyte count over time may differentiate those

individuals destined to develop bone marrow suppression.

•Coagulation panel may help identify patients who are at risk for developing

severe coagulopathy.

Imaging Studies

•No specific imaging tests help diagnose T-2 toxin exposure.

Procedures

•Warning: This is a potent dermally active toxin that is transmissible if not

properly decontaminated. Do not approach the patient without observing universal

precaution.

•Decontamination procedure is as follows:

& #9702;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.

& #9702;Contain clothing to avoid contamination of the health care environment.