T-2 Mycotoxin

The only mycotoxin known to have been used as a biological weapon.

In the event of aerosol exposure, first responders should wear personal protective equipment and evacuate the adjacent area. Decontamination and use of protective clothing are vital, as human-to-human transmission may occur via skin contact.

Diagnosis is clinical, based on signs and symptoms (which may include skin pain and blistering, vomiting and diarrhoea, respiratory symptoms, and bleeding) and a history of exposure to contaminated grains and/or droplets. Systemic symptoms may develop.

Mainstay of management is supportive care with aggressive fluid and electrolyte replacement. Mortality rates associated with untreated exposure vary from 10% to 16%.

T-2 mycotoxin is a group A trichothecene mycotoxin, mostly produced by Fusariumspecies of fungi. It is the only mycotoxin known to have been used as a biological weapon, although there is potential for others (such as diacetoxyscirpenol) to be used. Both of these mycotoxins are listed as CDC Federal Select Agents.[1]Centers for Disease Control and Prevention Federal Select Agent Program. Select agents and toxins list. 2017 [internet publication]. https://www.selectagents.gov/SelectAgentsandToxinsList.html The term ‘modified mycotoxins’ includes all possible derivatives of the ‘parent’ mycotoxin compound; these often occur in contaminated food and may also be toxicologically relevant.[2]Rychlik M, Humpf HU, Marko D, et al. Proposal of a comprehensive definition of modified and other forms of mycotoxins including "masked" mycotoxins. Mycotoxin Res. 2014 Nov;30(4):197-205. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202116 http://www.ncbi.nlm.nih.gov/pubmed/24962446?tool=bestpractice.com [3]Lorenz N, Dänicke S, Edler L, et al. A critical evaluation of health risk assessment of modified mycotoxins with a special focus on zearalenone. Mycotoxin Res. 2019 Feb;35(1):27-46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331505 http://www.ncbi.nlm.nih.gov/pubmed/30209771?tool=bestpractice.com

Transmission is most commonly foodborne via ingestion of mouldy grain in situations where this has not been stored properly, causing mainly gastrointestinal symptoms which may be followed by a protracted illness with leukopenia and bone marrow depletion.

In chemical warfare dispersal may be by droplets or aerosols, causing toxicity in seconds. The effects may be through inhalation (causing an acute syndrome of sore throat, bloody nasal discharge, dyspnoea, cough, and fever) and/or skin contact (causing blistering and systemic toxicity).