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inferred from animal studies. Use requires pretesting for
sensitivity to animal serum (and desensitization for those
allergic), and disadvantages include rapid clearance by immune
elimination, as well as theoretical risk of serum sickness.

STAPHYLOCOCCAL ENTEROTOXIN B

CLINICAL SYNDROME

Staphylococcal enterotoxin B (SEB) is one of the several
exotoxins produced by Staphylococcus aureus, causing food
poisoning when ingested.

A biological warfare attack with aerosol delivery of SEB to
the respiratory tract produces a distih-ct syndrome causing
significant morbidity and potential mortality.

Clinical Features. The disease begins 1-6 hours after
exposure with the sudden onset of fever, chills, headache,
myalgia, and non-productive cough. In more severe cases,
dyspnea and retrosternal chest pain may also be present.
Fever, which may reach 103-106 degrees F, has lasted 2-5 days,
cough may persist 1-4 weeks. In many patients, nausea, which
may be severe, vomiting, and diarrhea will also occur.
Physical findings are often more unremarkable. Conjunctival
injection may be present, and in the most severe cases, signs
of pulmonary edema would be expected. The chest x-ray is
generally normal, but in severe cases, there will be increased
interstitial markings, atelectasis, and possible overt
pulmonary edema. In moderately severe laboratory exposures,
lost duty time has been greater than 2 weeks, but, based upon
animal data, it is anticipated that severe exposures will
result in fatalities.

 DIAGNOSIS

Routine Laboratory Findings. Laboratory findings are
non-contributory except for a neutrophilic leukocytosis and
elevated erythrocyte sedimentation rate.

Differential Diagnosis. In foodborne SEB intoxication,
fever and respiratory involvement are not seen, and
gastrointestinal symptoms are prominent.

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