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File: 970207_aadcn_012.txtinferred 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. 10
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