While botulism is a rare condition (about 145 reported cases annually), it should still be considered in cases of descending neuromuscular weakness, as it can cause rapid loss of respiratory function and death (mortality < 8%). Check patient's vital capacity.
Botulism results from ingesting (onset of symptoms 6 to 48 hours) or having contamination of a wound (onset 4-14 days; associated with intravenous drug use) with Clostridium botulinum, an anaerobic, spore-forming bacteria; it has been used as a bio-terrorist agent as well.
Patients typically present with anticholinergic symptoms and the four "D's" - (1) dry moth, (2) dysarthria, (3) diplopia, and (4) dysphagia.
The definitive diagnosis is made by isolating the toxin in serum and/or stool.
Treatment is supportive and might include use of equine trivalent anti-toxin and human botulism immunoglobulin. Antibiotic and anti-cholinergic therapy has not been shown to be particularly effective.
References
Fernandez-Frackelton M. Bacteria. In: Marx J, Hockerberger R, Walls R, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice.Phila: Mosby; 2009:1686-9.
