Botulinum toxin poisoning is a rare disease causing food-borne botulism, wound botulism, and infant botulism. It is considered a potential bioterror agent.
Ask patients about details of exposure compatible with botulinum toxin poisoning, including exposure to homemade or poorly prepared commercial foods, injection drug use, or open wounds.
Ask patients about acute onset typical neurologic symptoms of botulinum toxin poisoning: disturbed vision, dysphagia, dysphonia, and descending bilateral weakness.
Ask parents of infants with possible infant botulism about lethargy, poor feeding, and constipation, especially in children with potential exposure to honey.
Look for cranial nerve abnormalities in patients with suspected botulinum toxin poisoning, and note that the most common presenting symptoms are dysphagia, diploplia, and dry mouth.
Collect body fluid samples quickly and send for toxin testing to confirm the diagnosis.
Consider obtaining nerve conduction studies to confirm botulinum toxin poisoning but do not delay treatment to obtain this test.
Administer equine antitoxin (ABE) early in the course of botulinum toxin poisoning.
Administer BIG-IV early in the course of infant botulism.
Treat wound botulism with debridement and consider antibiotic therapy with penicillin.
Provide intensive supportive care and assess the need for mechanical ventilation.
Initiate early involvement of rehabilitation services to prevent complications.