09-FEB-2005 - - Money that has been contaminated with a biological toxin; it's a whole new possible direction for bioterrorism. It is a case that the FBI terrorism unit has taken over from state police that involves several cities, including Philadelphia. As CBS 3's Tamsen Fadal reports, the unit is trying to determine whether or not a toxin was
actually placed over money to protect the interest of the Russian mob.

In an exclusive investigation, CBS 3 has obtained documents detailing a bizarre criminal plot involving a toxin, suspected drug money, and the Russian mob in Northeast Philadelphia.

Earlier in January 2005, Pennsylvania State Troopers intercepted USD 250 000 during a routine traffic stop. The alleged drug money, which had been sealed in plastic, was being driven from Columbus, Ohio to Northeast Philadelphia. According to law enforcement sources, after counting the seized cash, troopers began feeling ill, and one trooper was even hospitalized with flu-like symptoms.

Sources tell CBS 3 that tests on the cash counter revealed the presence of a toxin derived from the bacterium _Staphylococcus_.

Dr. Joseph Smith, a local terrorism expert, says it may be a new application of terrorism, although this time, it was used as a deterrent among thieves: "I am not that surprised; this is the nature of terrorism. By its nature, you have to say we must always be mindful and careful of new applications."

However, Fadal says that when CBS inquired about the case, FBI spokesperson Jerri Williams said "This is under investigation, and we have no information to provide to the public at this time."

While law enforcement says there are no known instances in which the toxin has been used with malicious intent, Dr. Smith says he would not be surprised if criminals are now employing some of the same tools as terrorists: "This is one of the unique natures of terrorism. It's different than your conventional type of warfare."

Fadal has learned that a warning has been issued, at both the state and federal level, recommending that officers should take extra precaution, and wear protective masks when handling suspected drug
money, now more than ever.

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George A. Robertson PhD
Bethesda, MD

[Not enough information is available regarding the incubation period of illness in the state troopers, and the manifestations of this illness, to assess the biological plausibility of this report. In addition, the type and amount of toxin is not mentioned. ProMED would
like more information in these regards.

Influenza-like illnesses can occur after aerosol exposure to staphylococcal enterotoxin B (SEB), as reported by the USA Army Medical Research Institute of Infectious Diseases at Fort Detrick in Maryland.

In one episode, which occurred in 1964 (1), at least 9 laboratory workers were exposed to aerosolized staphylococcal enterotoxin B, following what was described as an accident in a lab. The ensuing illness was heralded by rigors and fever with readings as high as 106
F. The onset of the fever averaged 12 hours after the exposure (range 8-20 hours), and the febrile period lasted from 12-76 hours (mean duration 50 hours). The fever was associated with muscle aches and headache. Respiratory symptoms began about the same time as the fever and muscle pain as a nonproductive cough. Of the 9, 5 had an abnormal
lung exam associated with shortness of breath, and 3 had shortness of breath at rest. One of these had "profound" shortness of breath for the 1st 12 hours of symptoms and exertional shortness of breath for 10 days. Chest x-rays obtained during this sublethal exposure were abnormal. Chest pain, described as moderately intense, also occurred
with the respiratory symptoms, lasting an average of one day (range 4 hours to 4 days). Vomiting and loss of appetite developed in most, with a mean onset of 17 hours (8-24 hour range), with the anorexia lasting several days and the vomiting limited to a mean of 9 hours (4-20 hour range).

In a 2nd, more recently reported laboratory event (in which the timing of the events involved are not noted) (2), ocular exposure with purified toxin occurred, resulting in conjunctivitis with periorbital swelling 1-9 hours after exposure; subsequent gastrointestinal symptoms followed. This report also summarized 16 cases of aerosolized SEB occurring in 1963 and 1964 which included reference 1.

Exposure to the usual inoculum of staphylococcal enterotoxin (there are at least 15 antigenically distinct toxins) by the usual route (enteric) produces a short incubation, self-limited (usually 24 hours or less) primarily afebrile illness with vomiting. Most of the
laboratory exposures initially presented with respiratory symptoms and high fever, the latter being quite uncommon with natural enterotoxin exposures. If SEB was contaminating the money and a respiratory influenza-like illness followed, it would have to be concluded that aerosolization of toxin occurred by some mechanism.
The flu-like illness reported in the posting could represent "stomach "flu," which is not influenza at all, and could be due to inadvertent ingestion of a significant amount of toxin.

1. Ulrich RG, Sidell S, Taylor TJ, et al: Staphylococcal enterotoxin B and related pyrogenic toxins. In, Medical Aspects of Chemical and Biological Warfare. Chapter 31, Falls Church, VA, Office of Surgeon General, Dept of the Army, 1997, pp 621-630.

2. Rusnak JM, Kortepeter M, Ulrich R, et al: Laboratory exposures to staphylococcal enterotoxin B. Emerg Infect Dis 2004: 10:1544-49.
 

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