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Signs and Symptoms
Flaccid Paralysis
Droopy Eyelids
Dry Mouth and Throat
Difficulty Talking and Swallowing
Blurred and Double Vision
Difficult Breathing
Asphyxia
WMD Response Guidebook. Third ed. Louisiana: Louisiana State University and A&M College, National Center for Biomedical Research and Training, Academy of Counter-Terrorist Education, 2006. 18.
The autonomic features of botulism are typical anticholinergic
signs and symptoms: dry mouth, ileus, constipation, and urinary retention. Nausea and
vomiting can occur. Dilated pupils occur in approximately 50 percent of cases. The motor
complications of botulism feature a descending paralysis leading to blurred vision and,
eventually, respiratory failure may occur. Symptoms usually begin 12 to 36 hours following
intoxication; time can vary according to the amount of toxin absorbed and could be reduced
to hours following a BW attack. The case-fatality rate in the US for food-borne botulism is
5 to 10 percent.
Potential Military Chemical/Biological Agents and Compounds. Fort Leonard Wood, Missouri: United States Army Chemical School, 2005. IV-23.
Symptoms usually begin with cranial nerve palsies, including ptosis, blurred vision, diplopia, dry mouth and throat, dysphagia, and dysphonia. These findings are followed by symmetrical descending flaccid paralysis, with generalized weakness and progression to respiratory failure. Symptoms begin as early as 12-36 hours after inhalation, but may take several days to develop after exposure to low doses of toxin.
USAMRIID's Medical Management of Biological Casualities Handbook. Sixth ed. Fort Dietrich, Maryland: U.S. Army Medical Research Institute of Infectious Diseases, 2005. 86.
Characteristic
Features
Symptoms (compiled from reports of foodborne botulism outbreaks caused by toxin types A, B, and E)b
Signs (compiled from cases of types A and B botulism reported to CDC in 1973 and 1974)d
—Alert mental status (90%) —Weakness of upper extremities (75%) —Ptosis (73%) —Weakness of lower extremities (69%) —Extraocular muscle weakness (65%) —Diminished gag reflex (65%) —Facial nerve dysfunction (63%) —Dilated or fixed pupils (44%) —Diminished or absent deep tendon reflexes in affected groups (40%) —Nystagmus (22%) —Ataxia (17%) —Other considerations: ~Patients generally afebrile ~Mental status generally intact, although patients may appear lethargic or have difficulty communicating because of bulbar dysfunction ~Sensory exam generally normal
Center for Infectious Disease Research & Policy Website. 2007. University of Minnesota. 21 Feb, 2011<http://www.cidrap.umn.edu>.
