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BOTULISM   Botulinum toxin is the single most poisonous substance known. This toxin poses a major bioweapons threat because of its potency and lethality, its ease of production and transport and the possible need for long term hospital care. Use of this toxin as a weapon would be suspected if there were a LARGE number of cases presenting all at once, especially if there was not a common dietary exposure.

Botulism is a rare but serious illness caused by a toxin (poison) produced by the bacteria called Clostridium botulinum. This germ can enter the body through cuts or wounds in the skin. The spore form of this bacterium can live in improperly preserved or canned food, where they produce toxin. When eaten, even minute amounts of this toxin can lead to severe poisoning. Botulism is NOT transmitted from person to person.

Approximately 20 cases of food-borne botulism in adults and 250 cases in infants are reported per year. This toxin affects the nerve endings and causes muscle weakness throughout the body. Respiratory failure caused by weakness in the muscles that control breathing could cause death in up to 10% of food-borne illness and 2% of infant disease. The death rate would be much greater in untreated people. Tiny amounts of a purified form of this toxin (Botox) are used in cosmetic surgery to decrease face wrinkles. In high doses, Botox is poisonous, but in small doses, like those used in treatment, it only affects the muscles being treated.

The usual incubation period for food borne botulism is 12 to 36 hours (range, 6 hours to 8 days). In infant botulism, the incubation period is 3 to 30 days. For wound botulism, it is 4 to 14 days between the time of injury and the onset of symptoms.

Foods most commonly contaminated are home-canned vegetables, cured pork and ham, and smoked or raw fish. Botulism may also occur if the organism enters open wounds and produces toxin there. Infant botulism is a special type of botulism in which living bacteria or its spores are ingested and grow within the infant's gastrointestinal tract and produce a toxin responsible for the infant's symptoms. Infants should not be given honey for this reason.

Symptoms of this disease include:

  • Progressive muscle weakness leading to difficulty in swallowing and speaking.
  • Nausea and vomiting.
  • Abdominal cramps.
  • Dry mouth.
  • Double vision, drooping eyelids.
  • Breathing difficulty that may lead to respiratory failure.
  • In infants:

  • Constipation.
  • Weakness, loss of muscle tone.
  • Weak cry.
  • Poor feeding and weak sucking.
  • Respiratory distress.
  • Appears alert but weak.
  • Tests include:

  • Blood test to identify toxin.
  • Laboratory analysis of suspected food.
  • Stool cultures.
  • Treatment includes:

  • Provide aid with breathing.
  • Provide aid with breathing.
  • Clear airway.
  • Give botulinum antitoxin.
  • Hospitalization to monitor respiratory difficulty.
  • If necessary, intubation and mechanical ventilation (a tube inserted through the nose or mouth into the trachea to provide an airway for oxygen).
  • Intravenous fluids and naso-gastric (feeding through a tube inserted in the nose) feeding should be initiated if symptoms get worse.

    Occurrences of the disease are reported to state health authorities or the CDC (Centers for Disease Control and Prevention) by health care providers so that contaminated food can be removed from stores. Antibiotics have not been shown to be beneficial in the infant form of botulism. You can prevent this disease. Sterilize home canned foods by pressure-cooking at 250 degrees Fahrenheit for 30 minutes. Discard bulging cans or foul smelling preserved foods. DO NOT TASTE TEST! Call your doctor, go to the emergency room or call the local emergency number (such as 911) if botulism food poisoning is suspected.

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