Botulinum

Signs and Symptoms

Look for cranial nerve paralysis, including drooping eyelids, blurred vision, double vision, dry mouth and throat, difficulty in swallowing, and difficulty in speaking.

This is followed by paralysis, in which muscle tone is lacking in the affected muscles, and in which tendon reflexes are decreased or absent, with generalized weakness and progression to respiratory failure.

Symptoms begin as early as 12-36 hours after inhalation but may take several days after exposure to low doses of toxin.

Diagnosis

Diagnosis is primarily a clinical one. A bioterrorism attack should be suspected if multiple casualties simultaneously present with progressive descending flaccid paralysis.

Treatment

Early administration of antitoxin or heptavalent antitoxin (IND product) may prevent or decrease progression to respiratory failure and hasten recovery. A tracheotomy, intubation and ventilation assistance may be required to prevent respiratory failure.

Preventative Measures Pentavalent toxoid vaccine (types A, B, C, D, and E) is available for those at high risk of exposure.