Definition

Botulinum toxin is the most toxic substance known to man. Even a small amount is deadly. A certain bacteria makes the toxin. It has the potential to be used as a weapon. When used as a weapon, the toxin can be released into the air or placed in the food supply.

The toxin can be used to treat other health conditions.

Causes

Botulinum toxin poses a great threat. It’s easy to make and move around. Only 1 gram that’s evenly released and breathed in could kill 1 million people.

US troops get a botulinum toxoid vaccine. This protects them from disease. This makes it harder to use as a weapon against a military enemy.

Botulinum toxin doesn’t have any color or odor. The toxin can’t be passed between people.

Inhaled Toxin Pathway in Body Copyright © Nucleus Medical Media, Inc.

Risk Factors

Your chances of botulism are higher if you had:

• Exposure to the toxin during a terrorist attack.
• Food with the toxin. This happens if it’s not packaged or heated properly. This is rare.

Symptoms

Symptoms from an attack would start within 12-72 hours. A food attack could start problems within 2 hours or as long as 8 days after eating the toxin. The seriousness of the illness depend on how much got into your body.

Common problems:

• Double vision
• Blurry vision
• Swallowing problems
• Speaking problems
• Weakness when you clench your jaw
• Droopy eyelids
• Loss of head control
• Weakness, on both sides, starting at the head and working down the body
• Constipation
• Inability to move your arms and legs

Diagnosis

The doctor will ask about your symptoms and health history. The answers and a physical exam may point to botulism. You may also have:

• Blood tests
• Stool tests
• Tests on what's in your stomach
• Lumbar puncture —to test the fluid that surrounds the brain and spinal cord
• MRI scan.
• EMG and nerve conduction tests to see how your muscles and nerves are working

Public health officials will work quickly to find the source to set up testing and care.

Treatment

Care will start right away, even if your test results aren’t ready. This may involve:

• An antitoxin—it will stop the spread of paralysis, but cannot reverse it
• Supportive care in a special care unit, which may include:
  • Breathing support with a ventilator
  • Feeding tube to get nutrition
• Removing the toxin:
  • With enemas
  • By suctioning it out the stomach

Prevention

The vaccine is given to those who work in a lab or in the military.

The antitoxin would likely be given first to those with signs of illness.

An attack would be likely to happen without warning. This makes it hard to prevent illness. If something happens, you may be able to cover your mouth and nose with clothing or a towel. This may offer some defense.