injuries poisoning
Toxins as Mass Casualty Weapons
Staphylococcal Enterotoxin B (SEB)
. SEB is responsible for Staphylococcal food poisoning when ingested. Mass casualties could result from food adulteration but also from inhalation of aerosolized toxin; SEB was developed for use as an aerosol to cause incapacitation in military personnel. The latent period is typically 1 to 12 hours after ingestion and 2 to 12 hours (with a range of 1.5 to 24 hours) after inhalation. After initial influenza-like symptoms of fever, chills, headache, and myalgias, subsequent symptoms and signs depend on the route of exposure. Ingestion causes nausea, vomiting, and diarrhea for 1 to 2 days. Inhalation causes nonproductive cough, retrosternal chest pain, and often nasal irritation and congestion. Conjunctivitis can result from contact of aerosol with the eyes. Although SEB was intended to be an incapacitating agent, inhalation can cause death due to pulmonary edema and circulatory collapse. In survivors, fever may persist up to 5 days and cough for 4 weeks. Specialized toxin assays may help confirm the diagnosis. Treatment is supportive. The views expressed in this chapter are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, or the US Government. 