Ricin

Aka: Ricin

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II. Historical

  1. Used in assassination of Bulgarian exile Georgi Markov
    1. Gun disguised as Umbrella London 1978
    2. Implanted ricin pellet in his body

III. Pathophysiology

  1. Mechanism
    1. Ricin is a Protein toxin used as Biological Weapon
    2. Derived from castor plant (Ricinus communis)
    3. Small particle aerosol
  2. Transmission
    1. No secondary aerosol risk to healthcare workers

IV. Symptoms

  1. Weakness
  2. Fever
  3. Cough
  4. Dyspnea
  5. Chest tightness
  6. Arthralgia
  7. Gastrointestinal symptoms if ingested

V. Signs

  1. Pulmonary Edema
  2. Hypotension
  3. Vascular collapse
  4. Shock
  5. Disseminated Intravascular Coagulation (DIC)
  6. Multiple organ failure

VI. Radiology: Chest XRay

  1. Bilateral infiltrates on Chest Radiographs
  2. Pulmonary Edema

VII. Labs

  1. Complete Blood Count
    1. Neutrophilic Leukocytosis

VIII. Differential Diagnosis

  1. Staphylococcal Enterotoxin B (SEB)
  2. Q Fever
  3. Tularemia
  4. Plague
  5. Phosgene (Chemical Toxin)

IX. Course

  1. Pathologic changes seen as early as 8 hours
  2. Symptom onset 18-24 hours after inhalation
  3. Severe respiratory distress and failure in 36-72 hours

X. Management

  1. Supportive for Pulmonary Edema
  2. Gastric Decontamination for ingestion

XI. Prevention

  1. No Vaccine or antitoxin available

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