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Botulism

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Epidemiology
  • Botulism neurotoxins (A-F) could be transmitted through aerosol or contaminated food and water supplies.
  • Botulism is not transmitted from person-to-person.

 

Clinical
  • Incubation period is 12-36 hours (up to 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 primarily through 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 be 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.
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