Botulism.

Clostridium botulinum is ubiquitous in the environment, yet symptoms of botulism occur in humans only if toxin A, B, or E is ingested, absorbed in the intestine, and bound and eventually internalized in the neuronal receptors, producing neuromuscular blockade. Clinically, botulism is divided into four types: food borne, infantile, wound, and unclassified. Systemic neurological symptoms occur within 72 hours of gastrointestinal symptoms and can progress rapidly to respiratory paralysis. Diagnosis depends on a high index of suspicion, but cultures and special tests may be helpful. Treatment remains mostly supportive with good respiratory care emphasized. Use of botulism antitoxin and guanidine may be helpful in some cases.