Botulism: the challenge of diagnosis and treatment

Botulism is a rare paralytic disease caused by a neurotoxin produced from the spore-forming bacterium Clostridium botulinum and in rare cases Clostridium butyricum and Clostridium baratii. Botulism has 4 naturally occurring syndromes: foodborne, wound, infant botulism, and adult intestinal toxemia. Inhalational botulism could result from aerosolization of botulinum toxin, and iatrogenic botulism can result from injection of toxin. All of these produce the same clinical syndrome of symmetrical cranial nerve palsies followed by descending, symmetric flaccid paralysis of voluntary muscles, which may progress to respiratory compromise and death. Treatment includes meticulous intensive care that includes mechanical ventilation, when necessary, and administration of antitoxin.