Presented in an easy-to-use double-page spread format, highly bulleted and concise, the Oxford Desk Reference: Toxicology is ideal for quick referral when an acute problem arises. [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]

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]

• 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]

  Neurological symptoms include: double vision droopy eyelids facial weakness dry mouth difficulties swallowing ( dysphagia ) slurred speech As the toxin spreads, you will have weakness and paralysis in your upper limbs. [your.md]

  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]

• Fever

  After initial flu-like symptoms of fever, chills, headache, and muscle aches, subsequent symptoms depend on the route of exposure. Ingestion causes nausea, vomiting, and diarrhea for 1 to 2 days. [merckmanuals.com]

  Precautions The Australian Immunisation Handbook (10th edition)[ 11 ] states that hypersensitivity, presenting as fever, serum sickness or anaphylaxis, may follow its use. [health.qld.gov.au]

  There are also no symptoms of fever, such as a high temperature, during a botulism infection. Infant botulism The symptoms of infant botulism usually begin with constipation. [your.md]

  Botulism poisoning does not cause fever. Patients typically are fully alert and aware of their situation. Although the patient's muscles may be paralyzed, they can still feel pain, temperature, and touch. [centerforhealthsecurity.org]

  There are also no symptoms of fever, such as a high temperature, during a botulism infection. Infant botulism The symptoms of infant botulism usually begin with constipation (difficulty passing faeces). [hse.ie]

• Dyspnea

  Airway irritation Eye and skin irritation Dyspnea, cough Sore throat Chest tightness Wheezing Bronchospasm Immediate to 3 hours Non-persistent and an inhalation hazard. [en.wikipedia.org]

• Vomiting

  Ingestion causes nausea, vomiting, and diarrhea for 1 to 2 days. Inhalation causes cough, chest pain, and often nasal irritation and congestion. Eye inflammation (conjunctivitis) can result from contact of the aerosol with the eyes. [merckmanuals.com]

  Patients may initially present with gastrointestinal distress, nausea and vomiting preceding neurological symptoms. [jhsph.edu]

  Autonomic system: Bladder distension, urinary incontinence/retention, paralytic ileus, dry mouth, postural hypotension, Gastrointestinal: Nausea, vomiting, diarrhoea, abdominal pain The clinical course varies from a mild illness to respiratory failure [icmcasesummaries.com]

  Food-borne botulism In some cases of food-borne botulism, medicines may be used to induce vomiting (being sick) in order to remove all particles of infected food from your body. [hse.ie]

• 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]

  Neurological symptoms include: double vision droopy eyelids facial weakness dry mouth difficulties swallowing ( dysphagia ) slurred speech As the toxin spreads, you will have weakness and paralysis in your upper limbs. [your.md]

• Constipation

  Infant botulism The symptoms of infant botulism usually begin with constipation. [your.md]

  C. botulinum in infants include constipation, loss of appetite, weakness, an altered cry and a striking loss of head control. [who.int]

  An almost universal symptom of progressing botulism is constipation. Deep tendon reflexes will diminish along with the corresponding paralysis levels. [physio-pedia.com]

  Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. [michigan.gov]

  Infant botulism The symptoms of infant botulism usually begin with constipation (difficulty passing faeces). [hse.ie]

• Diarrhea

  Ingestion causes nausea, vomiting, and diarrhea for 1 to 2 days. Inhalation causes cough, chest pain, and often nasal irritation and congestion. Eye inflammation (conjunctivitis) can result from contact of the aerosol with the eyes. [merckmanuals.com]

  Inactivates enzyme acetylcholinesterase, preventing the breakdown of the neurotransmitter acetylcholine in the victim's synapses and causing both muscarinic and nicotinic effects Miosis (pinpoint pupils) Blurred/dim vision Headache Nausea, vomiting, diarrhea [en.wikipedia.org]

  […] classic symptoms of such exposure, including longer term debilitation as found among chemical victims from World War I. 16 The most common long-term symptoms reported by veterans are fatigue, rashes, headaches, muscle aches, joint pain, abdominal pain, diarrhea [cia.gov]

• Abdominal Pain

  Autonomic system: Bladder distension, urinary incontinence/retention, paralytic ileus, dry mouth, postural hypotension, Gastrointestinal: Nausea, vomiting, diarrhoea, abdominal pain The clinical course varies from a mild illness to respiratory failure [icmcasesummaries.com]

  abdominal pain, diarrhea, hair loss, memory loss, difficulty sleeping, depression, and concentration problems. 17 Iraq tested or fielded CS-dispersing canisters, grenades, mortars (120-mm and 82-mm), rockert-propelled grenades (RPG-7s), smoke rockets [cia.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]

  They attack the nervous system (nerves, brain and spinal cord) and cause paralysis (muscle weakness). Left untreated, the paralysis will spread to the lungs, causing breathing failure followed by death. [your.md]

  Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. [michigan.gov]

  A release of aerosolized botulinum toxin would likely result in an outbreak of acute flaccid paralysis (sudden, profound muscle weakness) among persons in the same geographic area who have had no obvious common dietary exposure. [centerforhealthsecurity.org]

  weakness, paralysis, death, or constipation poor feeding, difficulty swallowing, an altered cry, loss of head control and hypotonia in infant botulism). [health.qld.gov.au]

• 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]

  In tactical operations, they can be used to penetrate fortified positions and flush out the enemy. Also, these agents are useful for disrupting unprotected “human wave” assaults by breaking up formations and destroying the momentum of the attack. [cia.gov]

• 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]

  Sagging eyelids, double vision, and blurred vision are common. Botulism is frequently misdiagnosed as Guillain-Barré syndrome, stroke, or other diseases of the central nervous system. [centerforhealthsecurity.org]

• 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]

  […] reported to the Public Health Unit if there is clinical evidence regardless of whether there is laboratory definitive evidence for botulism or if identified as a case of acute flaccid paralysis Clinical evidence A clinically compatible illness (eg. diplopia [health.qld.gov.au]

• 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]

  Animal models suggest that inhaling 0.7-0.9 µg of aerosolized botulinum toxin would be enough to kill a standard weight person (70 kg or 154 lbs). [centerforhealthsecurity.org]

• 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]

  A release of aerosolized botulinum toxin would likely result in an outbreak of acute flaccid paralysis (sudden, profound muscle weakness) among persons in the same geographic area who have had no obvious common dietary exposure. [centerforhealthsecurity.org]

  Flaccid paralysis continues, symmetrical and descending. There is no fever and no loss of consciousness. Paralysis of respiratory muscles can cause respiratory arrest and death without mechanical ventilation. [health.qld.gov.au]

• 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]

  Other early symptoms: dysarthria, a lack of sweating, severe dry mouth and throat, and finally postural hypotension. Food-borne botulism may initially present with nausea and vomiting. [physio-pedia.com]

• 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]

  Neurological symptoms include: double vision droopy eyelids facial weakness dry mouth difficulties swallowing ( dysphagia ) slurred speech As the toxin spreads, you will have weakness and paralysis in your upper limbs. [your.md]

  The neurological symptoms include: double vision droopy eyelids facial weakness dry mouth difficulties swallowing (dysphagia) slurred speech As the toxin spreads, you will have weakness and paralysis in your upper limbs. [hse.ie]

• Seizure

  Constipation 65% Lethargy 60% Weak Cry 18% Irritability 18% Respiratory Difficulties 11% Seizures 2%. [4] Associated Co-morbidities Botulism has no associated diseases and affects no one specific group more than another. [physio-pedia.com]

  Possible cherry-red skin Possible cyanosis Confusion Nausea Patients may gasp for air Seizures prior to death Metabolic acidosis Immediate onset Non-persistent and an inhalation hazard. [en.wikipedia.org]

• Staphylococcus Aureus

  Staphylococcal enterotoxin B is one of 7 enterotoxins (toxins acting in the intestine) produced by the bacteria called Staphylococcus aureus. Staphylococcal enterotoxin B is responsible for staphylococcal food poisoning when ingested. [merckmanuals.com]

• Clostridium Perfringens

  Centers for Disease Control and Prevention (CDC): Botulinum toxin Epsilon toxin from Clostridium perfringens Ricin toxin Staphylococcal enterotoxin B Of these, only botulinum toxin is classified among the highest priority agents. [merckmanuals.com]

"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]

In 2003, the FDA approved human botulinum immune globulin (BabyBIG) for the treatment of infant botulism. There is no antitoxin, to date, for type H botulism. [centerforhealthsecurity.org]

Botox treatments employ the purified and heavily diluted botulinum neurotoxin type A. [who.int]

Treatment Foodborne, inhalation, intestinal and wound botulism: supportive treatment with access to intensive care management, and antitoxin In addition for wound botulism surgical treatment of contaminated wound, and appropriate antibiotics to prevent [health.qld.gov.au]

The prognosis is excellent for infants who received the human derived antitoxin. [physio-pedia.com]

Etiology/Causes Clostridium botulinum [1] A gram-positive bacteria that produces spores anaerobically. This bacteria is found globally in soil and aquatic sediments. [8] Produces 7 immunologically distinct toxins designated by letters A-G. [physio-pedia.com]

Offers an overview of botulism, including pathogenesis, microbiology, and epidemiology, and provides current news items, images, and resources related to bioterrorism. [osha.gov]

Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation. [experts.umn.edu]

Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting and epidemiological investigation. [upi.com]

National Surveillance Team – Enteric Diseases Epidemiology Branch. Centers for Disease Control and Prevention. http://www.cdc.gov/nationalsurveillance/botulism-surveillance.html Updated May 12, 2017. Accessed January 25, 2018. [rarediseases.org]

March 8, 2006. ↑ 3.0 3.1 Shapiro R, Hatheway C, Swerdlow D: Botulism in the United States: A clinical study and epidemiologic review. Annals of Internal Medicine. August 1998; 129: 221-228 ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Cox N, Hinkle R. [physio-pedia.com]

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]