One of the most important toxin threats in warfare or bioterrorism is Staphylococcal
enterotoxin B (SEB), an incapacitating toxin. SEB had been considered and produced as an
offensive biologic warfare agent. Staphylococcal enterotoxin B is a toxin associated with
incidences of massive food poisoning. The bacteria that produce this toxin (SEB) are
universally associated with man and other warm blooded mammals and their spheres of
environmental influence include sewage and plumes. Staphylococcus aureus can readily be
isolated from nose, armpits or anal swabs and about 50% of clinical isolates produce this
toxin. Staphylococcal enterotoxin B is one of the superantigens capable of massive
nonspecific activation of the immune system including a massive release of cytokines, such
as interferon-gamma, interleukin-6 and tumor necrosis factor-alpha. Staphylococcal
enterotoxin B is a potential agent of bioterrorism because of the ease of its production
and dispersion, a delayed onset of symptoms, an ability to cause high morbidity and the
difficulty in discerning between intentional intoxication and natural intoxication when a
viable organism is the etiologic agent. This article presents a brief discussion on the
recognition, management and surveillance of SEB, as well as the pathogenesis, clinical
manifestation, diagnosis, and treatment of patients exposed to this toxin.
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