title: Bichat guidelines for the clinical management of botulism and bioterrorism-related botulism.
abstract: Botulism is a rare but serious paralytic illness caused by botulinum toxin, which is produced by the Clostridium botulinum. This toxin is the most poisonous substance known. It 100,000 times more toxic than sarin gas. Eating or breathing this toxin causes illness in humans. Four distinct clinical forms are described: foodborne, wound, infant and intestinal botulism. The fifth form, inhalational botulism, is caused by aerosolised botulinum toxin that could be used as a biological weapon. A deliberate release may also involve contamination of food or water supplies with toxin or C. botulinum bacteria. By inhalation, the dose that would kill 50% of exposed persons (LD50) is 0.003 microgrammes/kg of body weight. Patients with respiratory failure must be admitted to an intensive care unit and require long-term mechanical ventilation. Trivalent equine antitoxins (A,B,E) must be given to patients as soon as possible after clinical diagnosis. Heptavalent human antitoxins (A-G) are available in certain countries.
authors.affiliation: Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg. philippe.bossi@psl.ap-hop-paris.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Bossi
authors.forename: Anders
authors.initials: A
authors.lastname: Tegnell
authors.forename: Agoritsa
authors.initials: A
authors.lastname: Baka
authors.forename: Frank
authors.initials: F
authors.lastname: van Loock
authors.forename: Jan
authors.initials: J
authors.lastname: Hendriks
authors.forename: Albrecht
authors.initials: A
authors.lastname: Werner
authors.forename: Heinrich
authors.initials: H
authors.lastname: Maidhof
authors.forename: Georgios
authors.initials: G
authors.lastname: Gouvras
mesh_terms: D023482:Bioterrorism / Q000517:prevention & control* / Q000706:statistics & numerical data; D001906:Botulism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003140:Communicable Disease Control / Q000458:organization & administration*; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D005060:Europe; D005062:European Union; D006801:Humans; D011159:Population Surveillance / Q000379:methods*