Eurosurveillance, Volume
9, Issue
12,
01 December 2004
Guidelines
Bichat guidelines for the clinical management of botulism and bioterrorism-related botulism
P Bossi1, A Tegnell2, A Baka3, A Werner2, F van Loock2, J Hendriks2, H Maidhof2, G Gouvras2
Citation style for this article: Bossi P, Tegnell A, Baka A, Werner A, van Loock F, Hendriks J, Maidhof H, Gouvras G. Bichat guidelines for the clinical management of botulism and bioterrorism-related botulism. Euro Surveill. 2004;9(12):pii=505. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=505
Date of submission:
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Philippe Bossi*, Anders Tegnell, Agoritsa Baka, Frank Van Loock, Jan
Hendriks, Albrecht Werner, Heinrich Maidhof, Georgios Gouvras
Task Force on Biological and Chemical Agent Threats, Public Health Directorate,
European Commission, Luxembourg
*Corresponding author: P. Bossi, Pitié-Salpêtrière
Hospital, Paris, France, email: philippe.bossi@psl.ap-hop-paris.fr
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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.
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