Violence... The story so far

June 2002; Dec 2003; Aug 2004 Botulinum Symptoms and other information is available here.

Symptoms of illness usually arise in 12- 36 hours with a range of 6 hours to 8 days after food is ingested. Initial symptoms include dry mouth, sore throat, weakness, vomiting, and diarrhea. These are followed by acute cranial nerve impairment and a descending weakness or paralysis of muscles in the extremities of the trunk, and difficult breathing. There is no fever; mental and sensory functions remain normal.

Botulinum is the most deadly of all toxins, and gives rise to botulism, a severe form of food poisoning. Botulinum toxin is produced by an anaerobic (lives out of contact with air) bacteria Clostridium Botulinumit is gram positive. It attacks the nervous system and causes death by paralysis. Anaerobic bacteria survive and multiply in environments where air is excluded.

Routes of infection

Ingestion is the most common route. Historically, botulism has been most often contracted by eating food that was not properly sterilized or eating inadequately cooked food, especially those with low acid content. Rarely, it is the result of a wound infection.

Progression of disease

Mortality rate is about 25% with death most often caused by respiratory failure during the first week of illness.

Diagnostic Tests

Identification of Botulinum toxin in patient body fluids, stool, or the suspected food. Several other diseases must be ruled out by their absence in a series of test results.

Treatment

Prevention is the best medicine; insure all food ingested is either well cooked, or is fresh produce that has always been exposed to air.

If ingestion of contaminated food is suspected, develop a careful history of the patient's food intake for the past several days. If the ingestion was within a few hours, induce vomiting, gastric lavage (via laxative), and give enemas.

Seek medical attention in any event. Antitoxin can be administered and other life support means can be used.

Implications

Botulinum has been recognized as a potential bioweapon for decades; indeed in the mid 1990s, an international arms control team found 19,000 liters of toxin in Iraq, some of which had been already prepared for military use.

Town water supplies, packaged food, and other means of mass food and drink delivery could be used to spread Botulinum toxins.