TY - CHAP M1 - Book, Section TI - Botulism A1 - Rao, Agam K. A1 - Maslanka, Susan A2 - Jameson, J. Larry A2 - Fauci, Anthony S. A2 - Kasper, Dennis L. A2 - Hauser, Stephen L. A2 - Longo, Dan L. A2 - Loscalzo, Joseph PY - 2018 T2 - Harrison's Principles of Internal Medicine, 20e AB - Botulism, recognized at least since the eighteenth century, is a neuroparalytic disease caused by botulinum toxin, one of the most toxic substances known. While initially thought to be caused only by the ingestion of botulinum toxin in contaminated food (food-borne botulism), three additional forms caused by in situ toxin production after germination of spores in either a wound or the intestine are now recognized worldwide: wound botulism, infant botulism, and adult intestinal-colonization botulism. In addition to occurring in these recognized natural forms of the disease, botulism symptoms have been reported in patients receiving higher than recommended doses of botulinum toxin (iatrogenic botulism) for therapeutic or cosmetic purposes. Moreover, botulism was once reported after possible inhalation of botulinum toxin in a laboratory setting. Botulism manifests as a clinical syndrome of bilateral cranial-nerve palsies that may progress to respiratory compromise, a descending bilateral flaccid paralysis of voluntary muscles, and even death. Patients exposed to the same contaminated food may have a varying constellation of cranial nerve palsies and varying illness severity. Cases are known to be misdiagnosed or suspected late in a hospital course. The mainstays of therapy are meticulous intensive care and treatment with antitoxin early in the clinical course while alternative diagnoses are still being worked up. Early suspicion of botulism and empirical treatment are critical to favorable clinical outcomes. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1155966540 ER -