Botulinum toxin is the most lethal substance known. Six modes of disease have been recognized: (1) food-borne botulism from eating foods contaminated with C botulinum, (2) wound botulism from wounds harboring C botulinum, (3) infant (intestinal) botulism from intestinal overgrowth of C botulinum in children less than 1 year of age, (4) "undetermined" botulism from intestinal overgrowth of C botulinum in adults with surgically altered gastrointestinal tracts, (5) inadvertent (injection-related) botulism from accidental injection of Botox, and (6) inhalational botulism from aerosol exposure to botulinum toxin, as might occur in a terrorist release. Recognition of the clinical presentation characterized by bulbar palsies and descending paralysis in the absence of sensory or central nervous systems symptoms is key to making an early diagnosis. Current treatment is to administer the trivalent antitoxin against types A, B, E for adult forms, and human-derived Botulism Immune Globulin for infant botulism. A preventive pentavalent toxoid vaccine exists but must be given before exposure. Prolonged ventilator support may be required in patients with advanced paralysis.
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine