(Editor’s note: The full report is available at www.cacsh.org/eptpp.html.)

Rusnak JM, Kortepeter M, Ulrich R, et al. Laboratory exposures to staphylococcal enterotoxin B. Emerg Infect Dis 2004. Web site: www.cdc.gov/ncidod/EID/vol10no9/04-0250.htm.

Outside the context of food poisoning, few physicians would have experience evaluating people with staphylococcal enterotoxin B (SEB) intoxication. However, an increase in lab exposures and intoxications with staphylococcal enterotoxins can be expected as more institutions work with them due to increased funding for biodefense research, the authors said. "Health care workers evaluating persons who work with SEB need to be aware of the full spectrum of toxicity symptoms associated with SEB to avoid misdiagnosis resulting in unnecessary treatment, to identify breaches in laboratory technique, and to educate persons at risk of the importance of personal protective measures in preventing SEB exposure and intoxication. These cases emphasize that personal protective measures such as biosafety cabinets, gloves, and eye protection are paramount when working with SEB."

They reported three cases of purulent conjunctivitis with localized facial swelling that occurred after ocular exposure to SEB in the lab. Two of the patients also complained of gastrointestinal symptoms. The symptoms in the three mucocutaneous-acquired cases, and summary of symptoms from 16 lab-acquired inhalational intoxications with SEB, may help define the clinical spectrum that might be expected after exposures. The full spectrum of clinical signs and symptoms of intoxication with SEB is important to health care workers evaluating people with potential exposures to these agents, including bioterrorism. This discussion is relevant to military practitioners, since SEB previously has been developed as an incapacitating biowarfare agent.

Three events that occurred during the now disbanded U.S. offensive biologic warfare program resulted in inhalational exposures to SEB and subsequent intoxication. During that program, a contractor report on the efficacy of biosafety cabinets noted toxic reactions in those performing SEB purification studies on open lab benches. Symptoms seen in six people: conjunctivitis, nondescript chemical irritation of one eye, general skin reaction, severe facial skin reaction, dermatitis, and cold symptoms. Conjunctivitis and acute pharyngitis, plus vomiting and diarrhea in two cases, were observed in 23 people wearing surgical masks or face shields while working with SEB. Those working within a biosafety cabinet had no symptoms.