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For further information, see CMDT Part 35-05: Clostridial Diseases
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Essentials of Diagnosis
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Recent ingestion of home-canned or smoked foods; recovery of toxin in serum or food
Recent injection drug use
Diplopia, dry mouth, dysphagia, dysphonia
Muscle weakness progressing to respiratory paralysis
Normal sensory examination
Pupils are usually fixed and dilated
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General Considerations
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A paralytic disease caused by botulinum neurotoxin, which is produced by Clostridium botulinum, a ubiquitous, strictly anaerobic, spore-forming bacillus found in soil
Four toxin types—A, B, E, and F—cause human disease
Botulinum toxin
Naturally occurring botulism exists in three forms
Food-borne botulism
Infant botulism
Wound botulism
Food-borne botulism is caused by ingestion of preformed toxin present in canned, smoked, or vacuum-packed foods such as home-canned vegetables, smoked meats, and vacuum-packed fish
Infant botulism
Wound botulism
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Visual disturbances, particularly diplopia and loss of accommodation, appear 12–36 hours after ingestion of the toxin
Characteristic signs
Other symptoms
Dry mouth
Dysphagia
Dysphonia
Nausea and vomiting may be present, particularly with type E toxin
The sensory examination is normal
The sensorium remains clear and the temperature normal
Symmetric, descending flaccid paralysis progressing to respiratory failure and death may occur unless mechanical assistance is provided
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Differential Diagnosis
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If botulism is suspected
Contact the CDC for advice and help with procurement of equine serum heptavalent botulism antitoxin and for assistance in obtaining assays for toxin in serum, stool, or food (https://www.cdc.gov/botulism/health-professional.html or 770-488-7100)
Skin testing is recommended to exclude hypersensitivity to antitoxin preparation
Antitoxin should be given as early as possible, ideally within 24 hours of onset of symptoms, to arrest progression of disease
Do not delay administration of antitoxin to await laboratory confirmation of diagnosis
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