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The purpose of this document is to enable health care workers and public health officials to recognize when a chemical event has poisoned people by exposing them to vesicants/blister agents. Vesicants include distilled mustard (HD), mustard gas (H), lewisite, mustard/lewisite, mustard/T, nitrogen mustard, phosgene oxime, sesqui mustard, and sulfur mustard. SummaryVesicants, also referred to as “blister agents,” were the most commonly used chemical warfare agents during World War I. The most likely routes of exposure are inhalation, dermal contact, and ocular contact. Vesicants are highly reactive chemicals that combine with proteins, DNA, and other cellular components to result in cellular changes immediately after exposure. Depending on the vesicant, clinical effects may occur immediately (as with phosgene oxime or lewisite) or may be delayed for 2 to 24 hours (as with mustards). Following exposure, the most commonly encountered clinical effects include dermal (skin erythema and blistering), respiratory (pharyngitis, cough, dyspnea), ocular (conjunctivitis and burns), and gastrointestinal (nausea and vomiting). The amount and route of exposure to the vesicant, the type of vesicant, and the premorbid condition of the person exposed will contribute to the time of onset and the severity of illness. For example, ingestion of a vesicant leads to gastrointestinal symptoms more prominent than those that would result from inhalation exposure to the same dose and type of vesicant. Signs and symptomsThe following is a more comprehensive list of signs and symptoms that may be encountered in a person exposed to a vesicant. Signs and symptoms are not listed in order of presentation or specificity. Also, partial presentations (an absence of some of the following signs/symptoms) do not necessarily imply less severe disease. Respiratory signs and symptoms
Dermal signs and symptoms
Ocular signs and symptoms
Cardiovascular signs
Gastrointestinal signs and symptoms (prominent if ingestion is a route of exposure)
Central nervous system signs and symptoms (with exposure to high doses)
Laboratory findings suggestive of vesicant exposureAlthough it is a nonspecific finding, leukopenia can indicate vesicant exposure. It usually begins 3 to 5 days after exposure. With a white blood cell count < 500, the prognosis is poor. Differential diagnosis
Note: The actual clinical manifestations of a vesicant exposure may be more variable than the syndrome described above. This toxic syndrome description is based on CDC's best current information. |
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