T-2 Mycotoxin

With any suspected mycotoxin event (other than chronic food exposures), clinicians must contact local and national authorities. Reporting to regional poison information centres is also strongly encouraged for toxicovigilance purposes.

Urgent considerations

In the event of aerosol exposure, first responders should wear personal protective equipment (protective clothing and mask) and evacuate the adjacent area.[20]NATO. Project on minimum standards and non-binding guidelines for first responders regarding planning, training, procedure and equipment for chemical, biological, radiological and nuclear (CBRN) incidents: guidelines for first responders to a CBRN incident. Aug 2014 [internet publication]. https://www.nato.int/docu/cep/cep-cbrn-response-e.pdf [21]National Health Service England. Hazardous Materials (HAZMAT) and Chemical, Biological, Radiological and Nuclear (CBRN). Feb 2022 [internet publication]. https://www.england.nhs.uk/ourwork/eprr/hm [22]Public Health England. Chemical, biological, radiological and nuclear incidents: clinical management and health protection. May 2018 [internet publication]. https://www.gov.uk/government/publications/chemical-biological-radiological-and-nuclear-incidents-recognise-and-respond The contaminated area covered with aerosolised mycotoxins is likely to be small. A filtering mask that blocks the penetration of aerosol particles 3 to 4 micrometres or larger will provide respiratory protection against mycotoxins. Patients with dermal exposure should be decontaminated with soap and water. 

Observation and supportive care

Early signs of T-2 poisoning will reflect the route of exposure. However, as any route of exposure may lead to systemic symptoms, all patients require monitoring for progression of toxicity over 24 to 48 hours. Data are limited therefore much of the advice is empirically based.

Supportive care is the mainstay of management. Suspected or confirmed cases of T-2 mycotoxin poisoning should be assessed and monitored for adequacy of airway-protective reflexes (gag and cough), adequacy of oxygenation, and adequacy of ventilation. Airway control and mechanical ventilation should be considered for any patient with upper airway compromise or a decline in ventilation. In patients with profuse or intractable vomiting and diarrhoea, aggressive fluid and electrolyte replacement is indicated.

Gastrointestinal decontamination with activated charcoal may reduce the absorption of toxins from the stomach and could reduce the severity of poisoning if used soon after ingestion.

There are currently no available effective antidotes.