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Staphylococcal Enterotoxin B as a Biological Weapon: Recognition, Management, and Surveillance of Staphylococcal Enterotoxin

One of the most important toxin threats in warfare or bioterrorism is Staphylococcal enterotoxin B (SEB), an incapacitating toxin. SEB had been considered and produced as an offensive biologic warfare agent. Staphylococcal enterotoxin B is a toxin associated with incidences of massive food poisoning. The bacteria that produce this toxin (SEB) are universally associated with man and other warm blooded mammals and their spheres of environmental influence include sewage and plumes. Staphylococcus aureus can readily be isolated from nose, armpits or anal swabs and about 50% of clinical isolates produce this toxin. Staphylococcal enterotoxin B is one of the superantigens capable of massive nonspecific activation of the immune system including a massive release of cytokines, such as interferon-gamma, interleukin-6 and tumor necrosis factor-alpha. Staphylococcal enterotoxin B is a potential agent of bioterrorism because of the ease of its production and dispersion, a delayed onset of symptoms, an ability to cause high morbidity and the difficulty in discerning between intentional intoxication and natural intoxication when a viable organism is the etiologic agent. This article presents a brief discussion on the recognition, management and surveillance of SEB, as well as the pathogenesis, clinical manifestation, diagnosis, and treatment of patients exposed to this toxin.