Presentation and Diagnosis

The clinical presentation of human botulism depends on the route of exposure and the rate and amount of toxin absorption. Food-borne botulism has an incubation period ranging from as early as 2h or as long as 8 days after toxin ingestion (36), [Pg.71]

Neurologic symptoms develop acutely, with a symmetric, descending, flaccid paralysis beginning with the bulbar musculature (36). The presentation always includes multiple cranial nerve palsies. Severity of the disease may vary from patient to patient, with some mildly affected while others suffer from such severe paralysis that they appear comatose and require ventilatory support for months (36). The greater the amount of toxin absorbed, the more rapid the onset and severity of the paralysis. Recovery can take weeks or months, because new motor axons must reinnervate paralyzed muscle fibers (36). [Pg.72]

Patients with botulism classically present with difficulty seeing, speaking, and swallowing (36). Clinical features of botuhsm include [Pg.72]

As the paralysis extends, patients lose head control, become hypotonic and develop generalized weakness. Dysphagia and loss of the gag reflect may necessitate intubation and usually mechanical ventilation. Deep tendon reflexes, present initially. [Pg.72]

Early recognition of an intentional airborne release of botulinum toxin requires heightened clinical suspicion. Certain features are particularly suggestive (36) [Pg.73]

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