Botulism signs/symptoms

The natural occurrence of human foodbome and infant botulism translates into a wealth of information on the clinical signs and symptoms of disease. This information can be compared to the array of physiological and pathological findings in various species of experimental animals after oral administration of BoNTs. The ability for inhaled BoNTs to produce illness has also been documented in... 

Since inhalation bomlism does not occur in nature, aU outbreaks must be considered as suspicious. Prudence would dictate that each should be treated as a criminal or terrorist attack, unless other causes are found (Arnon et al., 2001). From the limited human and animal data currently available, inhalation bomlism does not have a unique presentation rather, the signs and symptoms resemble those of other forms of botulism. The latent period is comparable with that of foodborne bomlism without the early G1 signs (Adler, 2006). 

This function is quite unlike the action of the nerve agents, where there is too much acetylcholine due to the inhibition of acetylcholinesterase. What occurs with botulism is a lack of the neurotransmitter in the synapse. Therefore, using atropine as an antidote would not be helpful and could even provoke symptoms. When contaminated food is ingested by adults, the toxin is absorbed from the intestines and attaches to the nerves, causing the signs and symptoms of botulism poisoning. 

SIGNS AND SYMPTOMS OF INHALATIONAL BOTULISM, IN ORDER OF ONSET... 

A. For suspected or established clinical botulism, give one 10-mL vial diluted 1 10 in 0.9% saline (normal saline) and administer by slow IV infusion. A second vial may be administered in 2 to 4 hours if signs or symptoms worsen, but is usually not necessary as the neutralizing antibodies far exceed the levels of circulating toxin. 

Other clinical forms of the disease share many of these signs and symptoms. The presentation and dma-tion of the disease are coupled to the relative persistence of the toxin in blocking the release of ACh at peripheral nerve synapses. Although untreated botulism is potentially deadly, the availability of antisemm has dramatically reduced the mortality rates for the common clinical manifestations of the disease. Severe cases of foodbome botulism may still require ventilatory support for over a month, and neurological symptoms can sometimes persist for more than a year (Mackle et al., 2001). 

Varma, J.K., Katsitadze, G., Moiscrafishvili, M., et al., 2004. Signs and symptoms predictive of death in patients with foodborne botulism—Republic of Georgia, 1980-2002. Clin. Infect. Dis. 39, 357-362. 

The signs and symptoms of botulinum toxin exposure can be divided into early and late, and are summarised in Table 4.26. All serotypes and modes of exposure would result in the same symptoms. Sensory nerve impairment is typically absent. The presence of a fever should suggest a cause other than botulism. 

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