Clinical Signs and Symptoms

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There is a 1-4-hour incubation period after oral ingestion.139,140 Usual symptoms include nausea, vomiting, abdominal cramping, and diarrhea. Symptoms typically last up to 20 hours. With severe intoxication, there can be profound dehydration due to loss of fluids, shock, respiratory failure, and cardiovascular collapse. Approximately 15% of patients require hospitalization, with a 5% fatality rate, usually in the very young or the very old. Inhalational SEB exposure would present with different symptoms than seen with oral ingestion (food poisoning). Cytokine activation in the lungs would lead to low-pressure pulmonary edema and acute respiratory failure. The key to diagnosis, as with other biothreat agents, is a high index of suspicion and recognition of a cluster of clinically related cases. Intentional oral release of SEB would have to be distinguished from a naturally occurring outbreak of food poisoning. Routine laboratory tests will show only nonspecific findings. A specific serum ELISA has been described which could be performed on food or environmental specimens or serum, and acute and convalescent sera can be collected for detection of SEB-specific antibodies. Therapy is supportive, but only infrequently requires hospitalization. No specific approved antitoxin or vaccine exists; however, experimental vaccines are under development.141,142

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