Inhalation botulism outbreak

The onset of symptoms in botulism depends upon the amount of toxin ingested or inhaled and the related kinetics of absorption. Time to onset can range from as early as 2 h to as long as 8 days, although symptoms typically appear between 12 and 72 h after consumption of toxin-contaminated food (Lecour et ah, 1988 Amon et ah, 2001). In a review of 13 foodbome botulism outbreaks involving 50 patients from 1970 to 1984, the incubation period ranged from 10 h to 6 days (Lecour et al, 1988). 

Worldwide, sporadic cases and hmited outbreaks of botulism can occur when food and food products are prepared or preserved by improper methods that do not destroy the spores of Clostridium botulinum and permit the formation of botulinum toxin. In industrially developed countries, the case fatality rate of food-borne botulism is 5-10%. Person-to-person transmission of botulism is not known. Botulinum toxin is the most poisonous substance known and poses a major bioweapon threat. In addition to the clinical forms of natural botulism (food-borne, wound, and intestinal), there is a fourth, man-made form of inhalational botulism that results from aerosolized botulinum toxin. 

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). 

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