Biological Agents -- Toxins
Biological toxins are poisonous (toxic) substances that are produced by a variety of living organisms such as fungi, flowering plants, bacteria and animals. They differ from chemicals agents, as they are not man-made. Biological toxins are some of the most poisonous substances known. They tend to be more toxic per weight than many chemical agents.

Some of the toxins adapted for potential bioterrorist use are:

• Botulinum toxin
  
• Mycotoxinsl
  
• Ricin
  
• Staphylococcal enterotoxin B
  

Botulism
Description
Q: What is botulism?
A: Botulism is a muscle-paralyzing disease caused by bacteria-produced nerve toxins. It can cause death through paralysis of respiratory muscles. The toxins that cause botulism are the most potent toxins known to man.

Q: How prevalent is the toxin that causes botulism?
A: In the U.S., an estimated 110 cases of botulism are reported each year. Of these cases, approximately 25 percent are food-borne botulism, 72 percent are infant botulism and the rest are wound botulism.

Q: Where is botulism found?
A: The bacteria that cause botulism are commonly found in soil. These rod-shaped organisms grow best in low oxygen conditions. The bacteria survive as spores in a dormant state until exposed to conditions that support their growth. Under the right conditions, these bacteria produce toxins.

Q: Can I die from botulism?
A: Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients who die from botulism has fallen from about 50 percent to 8 percent due to advances in respiratory support available in most hospitals. About 2 percent of the infant botulism patients die.

Q: How would a deliberate aerosol or food-borne release of botulinum toxin be
different than a normal outbreak of the disease?
A: It would differ in the following ways:

• A large number of acute cases would appear all at once.
  
• Cases might involve an uncommon botulinum toxin type.
  
• Patients might have a common geographic factor but not a common dietary factor.
  
• There would be multiple simultaneous outbreaks without a common source.
  

Transmission
Q: How can I get botulism?
A: Botulism is transmitted as follows:

• Food-borne botulism occurs when foods that contain the botulinum toxin are consumed. Illness occurs within a few hours to days. The most frequent source of food-borne botulism is home-canned foods with low acid content, prepared in an unsafe manner.
  
• Airborne (inhalational) botulism occurs when a person breathes in toxins. This leads to a rapid onset of the illness within 12 to 36 hours. Inhalational botulism would be the result of an intentional release of the toxin.
  
• Infant botulism occurs in a small number of susceptible infants each year who ingest botulinum spores that then grow and produce toxins. Honey has been identified as a potential source of the spores.
  
• Wound botulism occurs when wounds or breaks in the skin are infected with the organism.
  

Q: Is botulism spread from one person to another?
A: No, there is no person-to-person transmission.

Q: Can botulism toxin be released in the air?
A: Yes, this method of delivery has been developed by several nations. This is not the natural mode of transmission.

Q: Can I get botulism from drinking water?
A: No cases of water-borne botulism have been reported. The toxin is easily inactivated by common water disinfection (chlorine).

Symptoms
Q: What are the symptoms of botulism?
A: Patients may initially show gastrointestinal distress, nausea and vomiting preceding neurological symptoms. Symptoms are similar for all toxin types.

• The classic neurological symptoms of botulism include double vision or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth and muscle weakness. These are all symptoms of the muscle paralysis caused by the bacterial toxin.
  
• If untreated, symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. Muscle weakness always descends symmetrically through the body – first, shoulders are affected, then upper arms, lower arms, thighs and calves.
  
• Paralysis of breathing muscles can cause a person to stop breathing and die, unless assistance with breathing (mechanical ventilation) is provided.
  
• Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.
  

Q: How soon after I eat something contaminated by the toxin, will symptoms show up?
A: In food-borne botulism, symptoms generally begin 12 to 36 hours after eating contaminated food. It is not known how long it takes symptoms to appear in infant botulism.

Q: If I have a severe case of botulism poisoning and don't die, how else could it affect me?
A: A patient with severe botulism may require a breathing machine as well as intensive medical and nursing care for several months.

Recovery from paralysis can take weeks or months and up to a year.

Patients who survive an episode of botulism may have fatigue and shortness of breath for years. Long-term therapy may be needed to aid recovery.

Treatment
Q: Is there any treatment for botulism?
A: Yes, an antitoxin can prevent the progression of the illness or shorten symptoms in severe botulism cases. If diagnosed early, inhalation, food borne and wound botulism can be treated with the antitoxin, which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery may still take many weeks.

Q: Can my baby take the antitoxin?
A: There is a human antiserum available from the California Department of Health Services for infant botulism.

Q: Is there any other treatment for botulism?
A: Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds are usually treated to remove the source of the toxin-producing bacteria.

Q: Is there a vaccine for botulism?
A: Not for the public. There is an investigational vaccine used for occupationally at-risk workers.

Q: If I become paralyzed what can be done to help me?
A: Supportive care for patients with botulism may include mechanical ventilation in an intensive care unit and treatment of secondary infections.

Q: If I think I have botulism, what should I do?
A: See your health care provider. Optimal therapy requires early diagnosis of the disease and prompt administration of antitoxin in conjunction with supportive care.

Q: Is there any other disease that could be mistaken for botulism?
A: Other diseases such as Guillain-Barré syndrome, stroke and myasthenia gravis can appear similar to botulism. Your doctor can conduct special tests that can exclude other conditions.

Decontamintation
Q: If I suspect my home was exposed to the botulinum toxin, how can I get rid of any bacteria that may be left?
A: Take these steps:

• Clothing and skin should be washed with soap and water.
  
• Contaminated objects or surfaces should be cleaned with a bleach solution if they can't be avoided for the hours or days needed for natural degradation.
  
• Sunlight inactivates the toxin in one to three hours. Exposure to air inactivates the toxin in 12 hours.
  

Bioterrorist Threat
Q: Why does botulism pose a major bio-weapons threat?
A: It has bioweaponry potential because of its extreme potency and lethality; its relative ease of production, transport and delivery; and the need for prolonged intensive care in affected persons.

Q: Is botulism being developed for use as a weapon?
A: A number of countries and terrorist groups are believed to have developed or are developing the toxin as a biological weapon.

Mycotoxins
Description
Q: What are mycotoxins?
A: They are naturally occurring poisonous compounds produced by various fungi.

Q: Where are mycotoxins found?
A: Mycotoxins are compounds produced by fungi, or molds, which co-exist with various plants. For example, a group of approximately 40 mycotoxin compounds are produced by mold that grows on grain (genus Fusarium).

Q: Can I die from exposure to mycotoxins?
A: Yes. The fatality rate is considered moderate.

Transmission
Q: How is one exposed to mycotoxins?
A: Mycotoxins can enter the body through the skin, eyes or respiratory and digestive tracts.

Q: Can the toxins be spread from one person to another?
A: No, there is no person-to-person transmission.

Q: Can mycotoxins be released in the air?
A: Yes.

Symptoms
Q: What are the symptoms of mycotoxin poisoning?
A: Early symptoms, beginning within moments of exposure, include burning skin pain, redness, tenderness, blistering, and progression to skin necrosis (death of cells) with leathery blackening and sloughing of large areas of skin in lethal cases.

• When inhaled, symptoms include nose and throat pain, nasal discharge, itching and sneezing, cough, wheezing, difficult breathing, chest pain and bloody sputum.
  
• Following ingestion, symptoms include nausea, vomiting, and watery or bloody diarrhea with abdominal pain.
  
• Symptoms of eye contact with mycotoxins include tearing, pain, redness, foreign body sensation and blurred vision.
  
• Severe poisoning results in weakness, loss of muscle coordination, collapse, shock and death. Death may occur in minutes, hours or days.
  

Q: How soon following exposure to mycotoxins will symptoms show up?
A: Skin symptoms appear in minutes to hours. Eye symptoms appear minutes following exposure. Death can occur in minutes, hours or days.

Treatment
Q: Is there any treatment for mycotoxin poisoning?
A: There is no specific antidote for mycotoxins.

• Super activated charcoal can be given orally if the toxin is ingested.
  
• Eyes can be irrigated with saline solution or water to remove toxin.
  
• The skin should be thoroughly washed with soap and uncontaminated water.
  
• The only other treatment is supportive.
  

Q: Is there a vaccine for mycotoxins?
A: No.

Decontamination
Q: If I suspect my home was exposed to mycotoxins how can I decontaminate it?
A: Take the following steps:

• Contaminated objects or surfaces should be cleaned with a bleach solution if they can't be avoided for the hours or days needed for natural degradation.
  
• Mycotoxins are extremely stable in heat and ultraviolet light (sunlight).
  

Bioterrorist Threat
Q: Have mycotoxins been developed for use as a weapon?
A: Mycotoxins were allegedly used in aerosol form to produce lethal and non-lethal casualties in Laos in 1975-81, Kampuchea in 1979-81 and Afghanistan in 1979-81. It is estimated there were more than 6,300 deaths in Laos, 1,000 in Kampuchea and 3,042 in Afghanistan. These releases were known as "yellow rain" and because of the remote locations were never accurately documented.

Q: Are mycotoxins a major bio-weapons threat?
A: Although they have been used as bio-weapons, they are not considered to have major bio-weaponry potential because of the large quantity of toxin required for lethal potency. However, they are very easy to produce.

Q: How could a deliberate aerosol release of mycotoxins be identified?
A: A deliberate release could be identified as follows:

• A rapid onset of symptoms within minutes to hours would result from a deliberate mycotoxin aerosol release.
  
• A release would be suspected if droplets of yellow fluid (yellow rain) contaminate clothing or the environment.
  
• Mycotoxins are one of the few bio-weapons to affect the skin in a manner similar to mustard (a chemical agent). However, a mycotoxin release would differ from a release of mustard because there would be no odor, and eye and skin symptoms would appear quickly.
  

Ricin
Description
Q: What is ricin?
A: It is a potent protein toxin derived from the beans of the castor plant.

Q: Where is ricin found?
A: Castor beans are grown worldwide. It is estimated that one million tons of castor beans are processed each year in the production of castor oil. The waste mash from this process is 5 percent ricin by weight.

Q: Can I die from exposure to ricin?
A: Yes, ricin is very toxic to cells and mortality rates are high.

Transmission
Q: How can I be exposed to ricin?
A: Ricin normally enters the body through the digestive tract after castor beans are eaten. Just one seed can kill a child. Ricin poisoning can also be deliberate. It can be inhaled following a deliberate aerosol release and it has been injected in several assassination attempts.

Q: Can the toxin be spread from one person to another?
A: No, there is no person-to-person transmission. As a toxin, ricin acts directly on the person who ingests or inhales it and is not an "infection" that is reproduced inside the body. Isolation of affected individuals is not necessary.

Q: Can ricin be released in the air?
A: Yes.

Symptoms
Q: What are the symptoms of ricin exposure?
A: The immediate symptoms of ricin ingestion occur within a few hours of ingestion and include severe abdominal pain, vomiting and diarrhea, which can be bloody. Other symptoms are fever, thirst, headache, sore throat and dilation of the pupils. Additional symptoms appear within several days including severe dehydration, and a decrease in urine and blood pressure. If death does not occur in three to five days the victim usually recovers. Death is usually due to vascular collapse.

Following inhalation of ricin weakness, fever, cough, nausea, chest tightness and pulmonary edema occur in eight to 24 hours. These symptoms are followed by severe respiratory distress and death from respiratory failure and cardiovascular collapse in 36 to 72 hours.

Q: How soon following exposure to ricin do symptoms appear?
A: Symptoms appear eight to 24 hours following inhalation or within a few hours of ingestion.

Treatment
Q: Is there any treatment for ricin poisoning?
A: There is no specific treatment available.

Treatment is supportive for respiratory failure and dehydration.

Q: Is there a vaccine for ricin?
A: No vaccine or antitoxin for humans is available for ricin.

Decontamination
Q: If I suspect my home was exposed to ricin how can I decontaminate it?
A: Contaminated objects or surfaces should be cleaned with a bleach solution (1 part bleach to 9 parts water). They can also be washed with a soap and water solution.

Bioterrorist Threat
Q: Has ricin been developed for use as a bioweapon?
A: Yes.

Q: Can ricin really be used as a bioweapon?
A: Ricin is considered a potential Bioterrorist Threat because:

• Large quantities can be produced relatively easily and inexpensively.
  
• It is extremely toxic and can be fatal when ingested or inhaled.
  
• The toxin is widely available and is quite stable.
  
• It can be prepared in liquid, crystalline or dry powder form.
  
• No antidote or vaccine exists.
  

Q: How would a deliberate aerosol release of ricin be identified?
A: A deliberate release could be identified as follows:

• Acute lung injuries affecting a large number of people would appear in a geographical cluster.
  
• Ricin intoxication would progress despite treatment with antibiotics, as opposed to an infectious agent.
  
• The rapid progression to severe symptoms and death that would occur with ricin would be unusual for infectious agents.

Staphylococcal enterotoxin B
Description
Q: What is staphylococcal enterotoxin B?
A: It is one of several toxins produced by the Staphylococcus aureus bacteria. The toxin causes illness when ingested and inhaled. It interacts with the immune system to produce a variety of effects. The toxin is normally acquired through ingestion of improperly handled food and is a common source of unintentional outbreaks of food poisoning.

Q: Where is staphylococcal enterotoxin B found?
A: The bacteria that produces staphylococcal enterotoxin B thrives in unrefrigerated meats, dairy and bakery products.

Q: Can I die from staphylococcal enterotoxin B?
A: Yes. However, the toxin, while potentially debilitating for short durations, is rarely fatal with adequate hydration.

Q: Is staphylococcal enterotoxin B a bioweapons threat?
A: It has been studied as a potential biological agent of war because:

• It can be easily aerosolized and is very stable.
  
• Can cause multi-organ system failure and even shock and death when inhaled at very high dosages.
  
• Staphylococcal enterotoxin B is classified as an "incapacitating agent" because in most cases aerosol exposure results not in death, but in a temporary though profoundly incapacitating illness lasting as long as 2 weeks.
  

Transmission
Q: How is one exposed to staphylococcal enterotoxin B?
A: Staphylococcal enterotoxin B normally enters the body through the digestive tract. A deliberate aerosol release would enter the body by inhalation.

Q: Can staphylococcal enterotoxin B be spread from one person to another?
A: No, there is no person-to-person transmission. As a toxin, staphylococcal enterotoxin B acts directly on the person who ingests or inhales it and is not an "infection" that is reproduced inside the body. Isolation of affected individuals is not necessary.

Q: Can staphylococcal enterotoxin B be released in the air?
A: Yes, this method of delivery has been developed

Symptoms
Q: What are the symptoms of staphylococcal enterotoxin B exposure?
A: The symptoms of ingested staphylococcal enterotoxin B usually start within two to four hours of ingestion of contaminated foods. They include:

• Significant nausea, vomiting and intestinal cramping, followed by profuse watery non-bloody diarrhea. Symptoms normally go away within 12-24 hours.
  
• The symptoms of inhalation of aerosolized staphylococcal enterotoxin B appear three to 12 hours after exposure and consist of a sudden onset of a high fever of 103 to 106 degrees F, chills, headache, muscle aches and a dry cough. In addition, there may be inflammation of the lining of the eyelids, difficulty breathing, chest pain and fluid in the lungs. The fever lasts two to five days. The cough may persist up to four weeks.
  

Q: How soon following exposure to staphylococcal enterotoxin B will symptoms show up?
A: Symptoms will appear within one to 12 hours, depending on the route of exposure.

Treatment
Q: Is there any treatment for staphylococcal enterotoxin B poisoning?
A: There is no specific treatment available. Drug therapies are under investigation.

For inhalational, pain relievers and cough suppressants may be used after symptoms appear. Severe cases may require supportive treatment such as mechanical breathing aids or replacement of fluid.

Q: Is there a vaccine for staphylococcal enterotoxin B?
A: No vaccine or antitoxin is available to treat staphylococcal enterotoxin B before or after exposure.

Decontamination
Q: If I suspect my home was exposed to staphylococcal enterotoxin B how can I decontaminate it?
A: Contaminated objects or surfaces should be cleaned with a bleach solution (1 part bleach to 9 parts water). They can also be washed with a soap and water solution. Destroy any food that may have been contaminated.

Bioterrorist Threat
Q: Has staphylococcal enterotoxin B been developed for use as a weapon?
A: Yes, it can be delivered in aerosol form. Staphylococcal enterotoxin B could also be used to sabotage food and water.

Q: How would a deliberate aerosol release of staphylococcal enterotoxin B be identified?
A: A deliberate release could be identified as follows:

• Following inhalation of aerosolized staphylococcal enterotoxin B, numerous patients of all ages would become ill within a short period, at a common location, and symptoms would appear quickly -- within three to 12 hours.
  
• Early symptoms might be similar to those of inhalation anthrax, tularemia, plague, or Q fever, but the rapid progress of symptoms to a stable state distinguishes staphylococcal enterotoxin B exposure from the other agents.
  
• Symptoms of inhaled staphylococcal enterotoxin B differ from those of ingestion of staphylococcal enterotoxin B – the natural route of entry. Even when inhaled at low doses, it is suspected that staphylococcal enterotoxin B would render up to 80 percent of exposed personnel clinically ill and unable to perform their duties for one to two weeks.

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