CDC Acknowledges Inhaled Mycotoxins Can Cause Death

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CDC Chemical Emergencies

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.

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.