Botulism

Epidemiology:

• Botulism neurotoxins (a-f) could be transmitted by aerosol or contamination of food and water supplies
• Botulism is not transmitted from person to person

Clinical:

• Incubation period is 12-36 hours (can be several days)
• Early symptoms include blurred vision, diplopia, and dry mouth
• Later symptoms include dysarthria, dysphagia, dysphonia, ptosis and the development of a symmetrical, descending progressive paralysis and respiratory failure
• Patients are usually alert and afebrile

Laboratory Diagnosis:

• Diagnosis is primarily based on a compatible clinical presentation
• Spinal protein is normal and characteristic findings are seen on emg (facilitation of the compound muscle action potential on repetitive nerve stimulation)
• Toxin can bae detected in serum (collect 30 cc in red top) and stool (foodborne botulism) by mouse neutralization bioassay performed at California Microbial Diseases Laboratory

Patient Isolation:

• Standard precautions. Patients do not require isolation rooms

Treatment:

• Supportive care is the mainstay of therapy; prolonged ventilatory support is often required in severe cases
• Botulism anti-toxin (for a, b and e toxins) is in limited supply and is available only from the division of communicable disease control, california dept. of health services

Prophylaxis:

• Currently, there is no available post-exposure prophylaxis