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 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.