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Botulinum Toxin—Biological Weapon

Definition

Botulinum toxin is a highly toxic substance. Even a small amount is deadly. It could possibly be used as a weapon. When used as a weapon, the toxin could be put into the air or the food supply.

The toxin can also be used to treat other health conditions.

Causes

A certain bacteria makes the botulinum toxin. The toxin poses a great threat. It is easy to make and move around. Only 1 gram that is evenly released and breathed in could kill 1 million people.

The toxin has no color or odor. It cannot be passed between people.

Inhaled Toxin Pathway in Body
Spores in lungs

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Risk Factors

The risk of botulism is higher for those who had:

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

Symptoms

Symptoms from an attack would start within 12 to 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 depends on how much gets into the body.

Symptoms may be:

  • Double vision or blurry vision
  • Problems swallowing or speaking
  • Droopy eyelids
  • Loss of head control
  • Weakness, on both sides of the body
  • Problems passing stool (poop)
  • Not being able to move arms and legs

Diagnosis

The doctor will ask about symptoms and past health. This may be enough to suspect botulism. Tests will be done to rule out other conditions and confirm the cause. This may include:

  • Blood tests
  • Stool tests
  • Tests on what is in the stomach
  • Lumbar puncture—to test the fluid that surrounds the brain and spinal cord
  • MRI scan
  • EMG and nerve conduction tests—to see how muscles and nerves are working
  • Tensilon test—uses an IV drug to rule out myasthenia gravis

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

Treatment

Treatment will start right away—even if test results are not ready. Hospital care may be needed for weeks or months. It depends on how severe the illness is. Treatment may involve:

  • An antitoxin drug—it will prevent further harm, but cannot heal the harm that was done
  • Removing the toxin:
    • With enemas
    • By suctioning it out the stomach
  • Supportive care (for severe illness), which may include:
    • Breathing support with a ventilator
    • Feeding tube to get nutrition

Prevention

A 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 likely happen without warning. This makes it hard to prevent illness. Covering the mouth and nose with clothing or a towel may offer some defense.

RESOURCES:

Centers for Disease Control and Prevention
https://www.cdc.gov

Ready—United States Government
https://www.ready.gov

CANADIAN RESOURCES:

Government of Canada—Biosafety and Biosecurity
https://www.canada.ca/en/services/health/biosafety-biosecurity.html

Health Canada
https://www.canada.ca

REFERENCES:

Botulism: biological terrorism. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/botulism/bioterrorism/index.html. Accessed September 21, 2021.

Botulism. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/botulism. Accessed September 21, 2021.

Botulism. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/botulism. Accessed September 21, 2021.

Botulinum toxin. Johns Hopkins Center for Health Security website. Available at: https://www.centerforhealthsecurity.org/our-work/publications/botulinum-toxin-botulism-fact-sheet. Accessed September 21, 2021.

Watson AK, Ellington S, et al. Preparing for biological threats: addressing the needs of pregnant women. Birth Defects Res. 2017;109(5):391-398.

Last reviewed July 2021 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 9/21/2021