Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-A-3 – Botulism BOTULISM – QUICK REFERENCE

Bioterrorism Epidemiology: ? Botulinum toxins are considered the most lethal substances known toman. ? Intentional exposure could occur through contaminated food or water or by bioaerosol. ? Person to person transmission does not occur. Incubation Period: 12–36 hours following exposure, may be as long as several days, depending on the size of the inoculum and route of exposure Clinical Disease: Foodborne: Acute bilateral cranial nerve impairment, blurred or double vision, ptosis, dysphagia, dry mouth, slurred speech, afebrile, alert and oriented ? Cranial nerve palsies, dilated pupils (50%), urinary retention ? Symptoms may progress to a symmetrical flaccid paralysis in whichsensation is completely preserved and result in respiratory failure Inhalation: Symptoms would be similar to foodborne illness Diagnosis: ? Presumptive - based on symptoms ? Tensilon test may be slightly positive ? Brain imaging (CT or MRI), lumbar puncture and edrophonium chloride tests normal ? Electromyography may show decreased amplitude of action potentials in involved muscle group Treatment: (See overview) ? Botulism antitoxin – must be obtained through the local health department ? Most effective if administered early in disease ? Mechanical ventilation Isolation: ? Standard Precautions Any suspected case of botulism ( Clostridium botulinum ) MUST BE TREATED AS A PUBLIC HEALTH EMERGENCY and reported to the infection control practitioner [ insert telephone number ] and local health department [ insert telephone number ] immediately.

3