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Biomarkers of Chemical Warfare Agents
Published in Anthony P. DeCaprio, Toxicologic Biomarkers, 2006
Exposure to vesicating agents comprises either mustard (“mustard gas,” sulfur mustard) or Lewisite (an arsenical). A third vesicant, phosgene oxime (CX), is listed among the chemical threat agents, but information concerning it is sparse other than its ability to generate early, severe pain. Phosgene oxime will not be further discussed. Mustard and Lewisite generate similar final-stage pathologies, but the clinical sequelae immediately following exposure are different between the two agents.
Medical Management of Chemical Warfare Agents
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Unfortunately, vesicant exposure creates a huge problem, since microscopic cellular damage occurs within a very few minutes of exposure, but at a minimum, outward physical signs of that damage do not normally occur for at least 2 or 3 hours after exposure, usually longer. While phosgene oxime produces immediate pain on skin contact, and lewisite produces pain usually within 1 minute after skin contact, sulfur mustard produces absolutely no pain on contact with the skin. As much as people do not like pain, pain is an extremely important protective mechanism for the body. If one places one’s hand on a hot stove, the pain generated causes the individual to withdraw their hand before serious cellular injury can occur. However, without pain, there is no impetus to withdraw the hand from danger or know that such danger exists. Such is the case with sulfur mustard. If contact with sulfur mustard continues for more than 2 minutes, irreversible structural damage within the body’s cells will take place. Indeed, an old U.S. Army Chemical School rite of passage was to place dilute sulfur mustard on both forearms near the hand. This diluted drop was placed on the skin over either the ulnar or the radial artery. One forearm was decontaminated within 2 minutes, and no residual cellular damage became evident, either immediately or later. On the opposite forearm, decontamination was delayed for 15 minutes, and although there was no initial hint of cellular damage present, within a day, the cellular damage became evident in the form of vesicles and bullae. So with only 15 minutes of exposure to the significantly diluted agent, tissue damage was 90% as great as if no decontamination of the forearm had been accomplished (Hurst, 2001). After a latency period of a few hours, in which no change in the skin occurred, erythema (redness) of the skin became evident. This was followed by the appearance of multiple small vesicles (tiny fluid-filled elevations of the skin), which later joined to form bullae (large fluid-filled elevations of the skin). Frequently, these bullae would rupture and if improperly treated, would become infected.
Phosgene oxime: a highly toxic urticant and emerging chemical threat
Published in Toxicology Mechanisms and Methods, 2021
Satyendra K. Singh, Joshua A. Klein, Holly N. Wright, Neera Tewari-Singh
The use of nerve agents and vesicating agent SM in civilian attacks in Syria and Iraq has been recently reported, which emphasizes that terrorist attacks using extremely toxic chemicals are a high possibility (SAMSFoundation 2015; Kohnavard 2016; Chulov 2017; Nebehay 2017; Tewari-Singh 2020). In addition, toxic chemicals (TICs and TIMs) are widely used in the manufacturing process of various pesticides and in pharmaceutical industries. An accidental or deliberate release of these TICs/TIMs from industrial plants, stockpiles, or their transport, can lead to chemical emergencies (Ganesan et al. 2010). The readily available TICs/TIMs, and other chemicals that can be easily synthesized, pose a serious future threat to the human population as chemical terrorism weapons in the present world scenario. Manufactured chemical phosgene oxime [CX; dichloroformoxime; N-(dichloromethylidene)hydroxylamine; Cl2CNOH] is easy to synthesize, and due to its highly toxic nature, unknown mechanism of action, and no available antidote, is considered to be a hazardous chemical with both military and terrorist potentials (Goswami et al. 2018; Tewari-Singh 2020).
Special issue: emerging chemical terrorism threats
Published in Toxicology Mechanisms and Methods, 2021
Robert P. Casillas, Neera Tewari-Singh, Joshua P. Gray
This special issue provides readers with insights into the toxicity, molecular biology and development of MCMs for the next generation of chemical threats. A brief discussion of the CounterACT and BARDA programs authored by CounterACT Director Dr. David Jett of NINDS and Dr. Judith Wolfe Laney, Chief, Chemical Medical Countermeasures, Division of CBRN Countermeasures of BARDA is included in this special issue and highlights the role of these programs in supporting the development of MCMs for chemical threats. Subsequent in-depth reviews cover chlorine, halogens, phosgene oxime, and phosgene. Finally, this Special Issue includes an in-depth review of the Strategic National Stockpile and the future acquisition of MCMs to protect the homeland from chemical agents.