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A frantic mother calls your office stating that her sister had just told her that feeding honey to children causes botulism. She had given a quarter teaspoon of a locally grown honey to her infant daughter three days earlier and was now in a panic. The mother states that the child appears normal and has shown no evidence of illness over the past three days, specifically no constipation, lethargy, or swallowing difficulty. You ask her to bring the child to your office where you examine her. The child appears healthy and in no respiratory distress. She is breathing normally and is not pooling secretions. The girl readily drinks a baby bottle of water without any difficulty. Her eyes are wide open with no proptosis, and her pupils are normal and react swiftly to a penlight. No cranial nerve findings or muscle hypotonia are present. You tell the mother that although botulism has been associated with honey in infants, none of the disease’s features of descending paralysis, or odynophagia, are present and reassure her that her child does not have the disease. The mother asks whether there is “a test” to prove it definitively and whether there is an antidote for botulism. What do you tell her?

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Botulinum is the first of the eight biotoxins in this book to be discussed. It is the only biotoxin included among the Category A agents, largely because of the ubiquity of the bacteria that produce it, its toxicity, the relative ease of production and dissemination, as well as the precedence of its use in warfare. Botulism is a neurologic syndrome caused by a toxic proteolytic enzyme produced by the bacteria Clostridia botulinum. Botulism derives its name from the Latin word for sausage because contaminated sausage was the source for several of the earliest described outbreaks of the disease. C. botulinum is a spore-forming, obligate anaerobe found most commonly in soil. The neurotoxin produced by the bacterium is responsible for the clinical disease known as botulism. Botulinum toxin includes seven different proteins (identified as A through G) that are secreted by four distinct but closely related types of Clostridia bacteria.

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Botulinum toxin (botulinum) is the most potent toxin in existence: If dispersed ideally, 1 g could kill over a million people. Botulinum is colorless, odorless, and said to be without taste. Botulism is a medical emergency since proper treatment must be implemented quickly, including antitoxin and life support systems, to prevent death. Botulinum toxin as a weapon of bioterrorism possesses several distinctive features compared to other Category A agents, the most obvious being that it is the product of the microbe and not the microbe itself that causes the disease.

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There are three naturally occurring forms of botulism: foodborne, wound, and intestinal. An additional form, resulting from the weaponization of botulism, is inhalational. Historically, many of the deaths associated with botulism resulted from exposure to improperly prepared and canned foods. It has found ...

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