Case Definition: Ricin Inhalation
Inhalation of ricin typically leads to cough and respiratory distress followed by pulmonary edema, respiratory failure, and multi-system organ dysfunction. Weakness and influenza-like symptoms of fever, myalgia, and arthralgia might also be reported (1-5).
Laboratory criteria for diagnosis
- Biologic: CDC can assess selected specimens on a provisional basis for urinary ricinine, an alkaloid in the castor bean plant. Only urinary ricinine testing is available at CDC or the Laboratory Response Network
- Environmental: Detection of ricin in environmental samples, as determined by CDC. Ricin can be detected qualitatively by TRF in environmental specimens (e.g., filters, swabs, or wipes).
- Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
- Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for ricin exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
- Confirmed: A clinically compatible case in which laboratory tests have confirmed exposure.
The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.
Note: A case should not be considered ricin poisoning if another confirmed diagnosis exists to explain the signs and symptoms.
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