Botulism inhalational

Botulism. Clinical features include symmetric cranial neuropathies (i.e., drooping eyelids, weakened jaw clench, and difficulty swallowing or speaking), blurred vision or diplopia, symmetric descending weakness in a proximal to distal pattern, and respiratory dysfunction from respiratory muscle paralysis or upper airway obstruction without sensory deficits. Inhalational botulism would have a similar clinical presentation as food-borne botulism however, the gastrointestinal symptoms that accompany foodborne botulism may be absent. 

Inhalational botulism cannot be clinically differentiated from the 3 naturally occurring forms... 

Cases of botulism that appear in temporal or geographic groups should prompt rapid investigation into foodborne sources of illness as well as raise the possibility of bioterrorism in the form of inhalational botulism. Any suspected or confirmed case of botulism should prompt immediate contact with local and state health departments. 

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. 

Franz, D.R., Pitt, L.M., Clayton, M.A., Hanes, M.A., and Rose, K.J. 1993. Efficacy of prophylactic and therapeutic administration of antitoxin for inhalation botulism. In Botulinum and Tetanus Neuroloxoins and Biomedical Aspects, ed. B. Das Gupta, 473 76. New York, NY Plenum Press. 

Symptoms of inhalation botulism may begin as early as 24-36 hours, or as late as several days, following exposure. Initial symptoms include ptosis, generalized weakness, lassitude, and dizziness. Diminished salivation with extreme dryness of the mouth and throat may cause complaints of a sore throat. Urinary retention or ileus may also occur. Motor symptoms usually are present early in the... 

Inhalational botulism, the syndrome most likely to be seen on the battlefield, is rare. One incident involving accidental exposure of humans to botulinum toxin occurred in a laboratory in Germany and was reported in 1962.31 After conducting a post-... 

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

Antibiotics are not indicated for ingested or inhaled botulism aminoglycosides can make muscle weakness worse (see p 136). Treat with bot-ulinum antitoxin (p 420). 

Death is generally due to respiratory failure secondary to paralysis of the respiratory muscles. The case-fatality rate for botulinum poisoning is between 7.5% and 15%. Mortality from inhalational botulism is thought to be higher than for food-bome exposure. Functional recovery may take several months to a year and some patients continue to experience chronic fatigue and dyspnoea for many years after. 

No person-to-person transmission Anthrax (Inhalational), Botulism NO SPECIAL PRECAUTIONS Always use proper infeclion control procedures according lo local pctky... 

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