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Arch Hellen Med, 23(3), May-June 2006, 233-239


Ricin as a weapon for bioterrorism:
Clinical characteristics of ricin poisoning and management in healthcare facilities

1Bureau for Nosocomial Infections, Hellenic Center for Control of Infectious Diseases, Athens,
2Section of Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Patras, Greece

Ricin is a potent toxin derived from the beans of the castor plant, which can grow in essentially every part of the world. International authorities have placed ricin in category B of critical biological agents, based on its potential to cause morbidity and mortality. It can be produced easily at low cost, it can exist in a relatively stable aerosol form and there is no specific treatment or vaccine available. It has been used repeatedly in the past in terrorist attacks of small scale. The toxin is a protein synthesis inhibitor, resulting in cell death. Exposure to the toxin can involve only the skin and superficial mucosal membranes, it can involve the pulmonary and digestive tract and also there can be parenteral exposure. Aerosol exposure can lead, within a few hours, to the development of acute respiratory distress syndrome, while gastrointestinal exposure can lead to severe hemorrhagic gastroenteritis. Parenteral exposure can lead to severe systemic toxicity and subsequent multi-organ failure. Apart from isolated exposure of the skin and superficial mucosa, exposure through the other routes not infrequently leads to death, usually within 36-72 hours of exposure. Diagnosing ricin poisoning can be extremely difficult in case of an isolated attack, while in a scenario of massive exposure, usually through the pulmonary or gastrointestinal tract, the presentation of a large number of patients with a similar clinical picture within a small period of time in a particular area should raise the suspicion of deliberate release of ricin. Decontamination of the exposed person(s) is necessary using soap and water followed by sodium hypochlorite solution. The risk of secondary transmission is minimal. No specific therapy is available, while investigations are under way with candidate vaccines. Management is supportive and may include intensive care and, if needed, mechanical ventilation. The only effective prevention is avoidance of exposure to the toxin.

Key words: Bioterrorism, Chemical agent, Decontamination, Ricin, Toxin.

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