Clostridium botulinum and the clinical laboratorian: a detailed review of botulism, including biological warfare ramifications of botulinum toxin.
OBJECTIVE
This review article is designed to thoroughly familiarize all health care professionals with the history, classification, epidemiology, clinical characteristics, differential diagnosis, diagnostic evaluation (including laboratory-based testing), treatment, and prognosis of botulism. It is especially targeted toward clinical laboratorians and includes a detailed enumeration of the important clinical laboratory contributions to the diagnosis, treatment, and monitoring of patients with botulism. Finally, the bioterrorism potential for botulism is discussed, with an emphasis on the clinical laboratory ramifications of this possibility.


METHODS
Included medical periodicals and textbooks accessioned from computerized and manual medical literature searches. More than 1000 medical works published from the 1800s through 2003 were retrieved and reviewed in this process.


RESULTS
Pertinent data are presented in textual and tabular formats, the latter including 6 tables presenting detailed information regarding the clinical parameters, differential diagnosis, diagnostic studies, laboratory testing, and therapeutic approaches to botulism.


CONCLUSIONS
Because botulism is such a rare disease, a keen awareness of its manifestations and prompt diagnosis are absolutely crucial for its successful treatment. The bioterrorism potential of botulism adds further urgency to the need for all health care professionals to be familiar with this disease, its proper evaluation, and timely treatment; the need for such urgency clearly includes the clinical laboratory.
Caya
James G
JG
Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, USA. jgcayamac@aol.com
Agni
Rashmi
R
Miller
Joan E
JE
D001694:Biological Warfare; D001905:Botulinum Toxins / Q000032:analysis / Q000276:immunology / Q000633:toxicity*; D001906:Botulism / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D019411:Clinical Laboratory Techniques; D003014:Clostridium botulinum / Q000302:isolation & purification; D006801:Humans; D011379:Prognosis; D012449:Safety
D001905:Botulinum Toxins