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Deliberate Exposure to Botulinum Toxin

Botulinum a Toxin


Presentation

  • An aerosolized or food-borne botulinum toxin weapon would cause acute symptoms that would typically present 12 to 72 hours after exposure.[upi.com]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • Presents a new full-color design -- complete with more than 1,500 full-color illustrations -- for enhanced visual guidance.[books.google.com]
  • Typical presentation is afebrile, descending symmetrical flaccid paralysis, which spares sensory nerves (2). Wounds may not be obviously infected.[icmcasesummaries.com]
  • We report a case of wound botulism and discuss the presenting features that should alert the emergency physician to the diagnosis of wound botulism.[emj.bmj.com]
Weakness
  • Signs and Symptoms The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.[viceprovost.tufts.edu]
  • Symptoms and signs(3) Cranial nerves: Diplopia, blurred vision, photophobia, ptosis, dilated pupils, nystagmus, facial weakness, dysphagia, dysarthria, dysphonia Peripheries: Weakness in the neck and arms followed by respiratory muscles and lower body[icmcasesummaries.com]
  • Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.[michigan.gov]
  • C. botulinum in infants include constipation, loss of appetite, weakness, an altered cry and a striking loss of head control.[who.int]
Surgical Procedure
  • These cases are comparable to infant botulism and may occur when the normal gut flora has been altered as a result of surgical procedures or antibiotic therapy.[who.int]
Dysphagia
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
  • Symptoms and signs(3) Cranial nerves: Diplopia, blurred vision, photophobia, ptosis, dilated pupils, nystagmus, facial weakness, dysphagia, dysarthria, dysphonia Peripheries: Weakness in the neck and arms followed by respiratory muscles and lower body[icmcasesummaries.com]
Constipation
  • C. botulinum in infants include constipation, loss of appetite, weakness, an altered cry and a striking loss of head control.[who.int]
  • Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.[michigan.gov]
Muscle Weakness
  • Signs and Symptoms The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.[viceprovost.tufts.edu]
  • Symptoms include double and/or blurred vision, drooping eyelids, slurred and/or disturbed speech, difficulty swallowing solid food, dry mouth, and muscle weakness.[michigan.gov]
Flushing
  • Mucous membranes (eye, nose, mouth): If contaminated material is splashed or sprayed into the face contaminating the eyes, nose or mouth: flush the eyes for 10-15 minutes, rinse mouth out with clean water and be sure not to swallow, and wash down face[viceprovost.tufts.edu]
Blurred Vision
  • Signs and Symptoms The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.[viceprovost.tufts.edu]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
  • Symptoms include double and/or blurred vision, drooping eyelids, slurred and/or disturbed speech, difficulty swallowing solid food, dry mouth, and muscle weakness.[michigan.gov]
  • Symptoms and signs(3) Cranial nerves: Diplopia, blurred vision, photophobia, ptosis, dilated pupils, nystagmus, facial weakness, dysphagia, dysarthria, dysphonia Peripheries: Weakness in the neck and arms followed by respiratory muscles and lower body[icmcasesummaries.com]
  • Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhoea, constipation and abdominal swelling may also occur.[who.int]
Blurred Vision
  • Signs and Symptoms The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.[viceprovost.tufts.edu]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
  • Symptoms include double and/or blurred vision, drooping eyelids, slurred and/or disturbed speech, difficulty swallowing solid food, dry mouth, and muscle weakness.[michigan.gov]
  • Symptoms and signs(3) Cranial nerves: Diplopia, blurred vision, photophobia, ptosis, dilated pupils, nystagmus, facial weakness, dysphagia, dysarthria, dysphonia Peripheries: Weakness in the neck and arms followed by respiratory muscles and lower body[icmcasesummaries.com]
  • Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhoea, constipation and abdominal swelling may also occur.[who.int]
Diplopia
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • A young female IV drug abuser presented with dysarthria, diplopia and weakness with loss of her gag reflex. She had recently had an abscess wound on her arm debrided. She was intubated for airway protection, and underwent early tracheostomy.[icmcasesummaries.com]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
Diplopia
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • A young female IV drug abuser presented with dysarthria, diplopia and weakness with loss of her gag reflex. She had recently had an abscess wound on her arm debrided. She was intubated for airway protection, and underwent early tracheostomy.[icmcasesummaries.com]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
Suggestibility
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Working group members reviewed subsequent drafts and suggested additional revisions.[experts.umn.edu]
  • If any individual working with or around Botulinum toxin develops signs or symptoms suggestive of exposure to Botulinum toxin, they must inform their Principal Investigator and Biosafety Officer immediately.[viceprovost.tufts.edu]
  • Incremental responses to tetanic stimulation suggests increases in acetylcholine release due to a pre-synaptic transmission defect (3).[icmcasesummaries.com]
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Flaccid Paralysis
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • It presents with an afebrile, descending, symmetrical, flaccid paralysis of motor and autonomic but not sensory nerves. Respiratory failure can occur rapidly with little prior ventilatory deterioration.[emj.bmj.com]
  • The end result is what’s known as flaccid paralysis, where the muscle is unable to contract. Most deaths from botulism poisoning are a result of the toxin reaching the respiratory system, causing respiratory failure and eventual fatality.[chemistryworld.com]
  • Typical presentation is afebrile, descending symmetrical flaccid paralysis, which spares sensory nerves (2). Wounds may not be obviously infected.[icmcasesummaries.com]
Flaccid Paralysis
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • It presents with an afebrile, descending, symmetrical, flaccid paralysis of motor and autonomic but not sensory nerves. Respiratory failure can occur rapidly with little prior ventilatory deterioration.[emj.bmj.com]
  • The end result is what’s known as flaccid paralysis, where the muscle is unable to contract. Most deaths from botulism poisoning are a result of the toxin reaching the respiratory system, causing respiratory failure and eventual fatality.[chemistryworld.com]
  • Typical presentation is afebrile, descending symmetrical flaccid paralysis, which spares sensory nerves (2). Wounds may not be obviously infected.[icmcasesummaries.com]
Dysarthria
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • A young female IV drug abuser presented with dysarthria, diplopia and weakness with loss of her gag reflex. She had recently had an abscess wound on her arm debrided. She was intubated for airway protection, and underwent early tracheostomy.[icmcasesummaries.com]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
Dysarthria
  • Situations suggesting release of botulinum toxin as a biological weapon: (1) Outbreak of acute flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, dysphagia) in patients who are afebrile and with a clear sensorium. (2) Outbreak[meducator3.net]
  • Conclusions: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours[experts.umn.edu]
  • A young female IV drug abuser presented with dysarthria, diplopia and weakness with loss of her gag reflex. She had recently had an abscess wound on her arm debrided. She was intubated for airway protection, and underwent early tracheostomy.[icmcasesummaries.com]
  • Prominent neurologic findings in all forms of botulism include ptsosis, diplopia, blurred vision, dysarthria and dysphagia. Patients typically are afebrile and do not have an altered level of consciousness.[jhsph.edu]
Slurred Speech
  • Signs and Symptoms The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.[viceprovost.tufts.edu]

Treatment

  • "Treatment with anti-toxin should not be delayed for microbiological testing." The findings were published in the Journal of the American Medical Association.[upi.com]
  • Treatment with antitoxin should not be delayed for microbiological testing.[experts.umn.edu]
  • After an Exposure Incident Occurs: Medical Evaluation and Follow-up Post-Exposure Treatment An equine antitoxin product is available for treatment of patients with symptoms consistent with botulism.[viceprovost.tufts.edu]
  • Botox treatments employ the purified and heavily diluted botulinum neurotoxin type A.[who.int]
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Epidemiology

  • Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting and epidemiological investigation.[upi.com]
  • Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation.[experts.umn.edu]
  • Offers an overview of botulism, including pathogenesis, microbiology, and epidemiology, and provides current news items, images, and resources related to bioterrorism.[osha.gov]
  • National Surveillance Team – Enteric Diseases Epidemiology Branch. Centers for Disease Control and Prevention. Updated May 12, 2017. Accessed January 25, 2018.[rarediseases.org]
Sex distribution
Age distribution

Prevention

  • Arnon of the Infant Botulism Treatment and Prevention Program and colleagues at the California Department of Health Services, Center for Civilian Biodefense Studies, Johns Hopkins University Schools of Medicine and Public Health, U.S.[upi.com]
  • Prevention Prevention of foodborne botulism is based on good practice in food preparation particularly during heating/sterilization and hygiene.[who.int]
  • Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 50(41);893-7, (October 19, 2001).[osha.gov]
  • […] that uses a combination of antibodies to treat or, possibly, prevent botulism.[dana.org]
  • Visit the Centers for Disease Control and Prevention (CDC) Botulism webpage at www.cdc.gov/botulism.[michigan.gov]

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