TAB D – Botulism

Overview: The seven botulinum toxins (types A-G) produced by the bacterium Clostridium botulinum are among the most toxic substances known. The clinical syndrome produced by one or more of these toxins is botulism; left untreated, it kills as many as 60% of sufferers from skeletal muscular paralysis and respiratory failure. Aerosol delivery of toxin is likely over concentrations of troops. When inhaled, these toxins produce a clinical picture very similar to foodborne intoxication, although the time to onset of paralytic symptoms actually may take longer than for foodborne cases and may vary by toxin type and dose.[116]

Signs and Symptoms: Ptosis (a sinking feeling), generalized weakness, dizziness, dry mouth and throat, blurred vision and diplopia (double image vision), dysarthria (disturbance of speech and language), dysphonia (altered voice), and dysphagia (difficulty in swallowing) are the initial symptoms; symmetrical descending flaccid paralysis and development of respiratory failure follow. Symptoms begin as soon as 24 to 36 hours but may take several days to appear after inhaling the toxin.[117]

Desert Shield/Desert Storm Botulinum Toxin Prophylaxis:  As with anthrax, a vaccine can protect against botulinum toxin. Although US Central Command used the vaccine as an investigational new drug (see glossary) with a license held by the Centers for Disease Control and Prevention, approximately 8,000 Gulf War servicemembers received botulinum toxoid [vaccine] between January 23 and February 28, 1991. Immediately after the injection, a significant number of recipients experienced stinging and a sore arm for 2 to 4 days. These short-term effects are not significantly different from those the tetanus vaccination produces.[118]

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