RICIN

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: Inhalation of ricin toxin results in symptoms such as fever, cough, dyspnea, weakness, nausea and chest tightness. Dust containing ricin can also cause irritation of the eyes and eyelids, nasal congestion, sore throat and lung irritation. Ingestion of ricin toxin results in diarrhea, vomiting, abdominal cramps and rapid pulse. Castor beans are the source of ricin and the degree of poisoning increases as the beans are chewed. Within days of ingestion dehydration and decreased blood pressure can occur.

B. REPORTING CRITERIA: Laboratory confirmation of ricin or a diagnosis without laboratory confirmation if the clinical and epidemiological evidence is overwhelming.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Detection of ricin toxin in environmental samples (i.e., suspect food, water or dust).

 D. WISCONSIN CASE DEFINITION: A clinically compatible illness that is laboratory confirmed or that occurs among persons who ingested laboratory confirmed ricin-containing food/water or were exposed to airborne ricin articles.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY I: Report IMMEDIATELY BY TELEPHONE to the patient's local health officer upon identification of a case or suspected case. Complete and mail the Acute and Communicable Disease Case Report (DPH 4151) to the local health officer within 24 hours. Public health intervention expected.

B. EPIDEMIOLOGY REPORTS REQUESTED: Acute and Communicable Diseases Case Report (DPH 4151).

C. PUBLIC HEALTH INTERVENTIONS:

• Immediate treatment required for case patients.
• Contact local law enforcement and the FBI.
• Isolate the area(s) where the exposure was reported to have occurred.
• Determine if others consumed suspect food/water items or were exposed to suspect dust or airborne particles.
• Source investigation by the FBI.

D . BIOTERRORISM MEASURES: Ricin toxin can be easily used by terrorists. Although the greatest threat may be via aerosol use, the more common threat may be via its use in food or drink. The occurrence of even a single case of ricin inhalation, ingestion or ingestion should raise the possibility of deliberate use of ricin toxin. All such cases should be reported immediately so that appropriate investigations can be initiated without delay.

 

III. CONTACTS FOR CONSULTATION

A. Immediately contact local law enforcement and the FBI.

B. Contact the DHFS 24-hour on-call service and request that the environmental/chemical on-call staff be alerted.

C. For non-emergency information contact a Bureau of Environmental and Occupational Health toxicologist at (608) 266-9337.

 

 IV. RELATED REFERENCES

 1. “Ricin Poisoning” . DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets

2. Gosselin RE, et al. In: Clinical Toxicology of Commercial Products. 4 th Edition. Williams and Wilkins, Baltimore, 1976:11-176.

3. Kopferschmitt J, et al. Acute Voluntary Intoxication by Ricin. Human Toxicology. 1983;2:239.

V. DISEASE TRENDS

There have been no confirmed cases of ricin poisoning in Wisconsin .