Ricin

Signs and Symptoms

Acute onset of fever, chest tightness, cough, shortness of breath, nausea, and joint pain occurs 4 to 8 hours after inhalational exposure. Airway necrosis and pulmonary capillary leak resulting in pulmonary edema would likely occur within 18-24 hours, followed by severe respiratory distress and death from lack of oxygen in 36-72 hours.

Diagnosis

Acute lung injury in large numbers of geographically clustered causalities suggests exposure to aerosolized ricin. The rapid onset for severe symptoms and death would be unusual for infectious agents. Serum and respiratory secretions should be submitted for laboratory testing. Acute and convalescent sera provide retrospective diagnosis. Nonspecific laboratory and radiographic findings include an abnormally large increase in the number of white blood cells in the blood and bilateral interstitial infiltrates.

Treatment

Seek medical attention immediately. Treatment options are limited; they include flushing and pumping the stomach with sterile or salt water solution, and bowel purging.

Preventative

There is currently no vaccine or preventative antitoxin. Use of the protective mask is currently the best protection against inhalation.

Isolation and Decontamination

Standard Precautions for healthcare workers. Ricin is non-volatile, and secondary aerosols are not expected to be a danger to health care providers. Decontaminate with soap and water. Hypochlorite (household bleach) solutions (0.1% sodium hypochlorite, or 9 parts water to one part Clorox) can inactivate ricin.