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File: 970207_aadcn_011.txt� Specific Laboratory Diagnosis. Detection of toxin in serum or gastric contents from cases of foodborne botulism is often feasible by mouse innoculation. In the case of inhalation botulism, toxin may well be cleared from the blood by the time symptoms are noted. Nevertheless, serum should be obtained from representative cases for such attempts. Survivors probably will not develop an antibody response due to the small amount of toxin necessary to cause death. See Section III for details of sample collection and processing. THERAPY Respiratory failure secondary to paralysis of respiratory muscles is the most serious complication, and, generally, the cause of death. Reported cases of botulism prior to 1950 had a mortality of 60%. With tracheostomy and ventilatory assistance, fatalities should be greater than 5%. Intensive and prolonged nursing care may be required for recovery (which may take several weeks or even months). ANTITOXIN In isolated cases of foodborne botulism, circulating toxin is usually present, perhaps due to continued absorption through the gut wall. Equine antitoxin has been used in these circumstances, and is probably helpful. After aerosol exposure, it is unknown whether toxin circulates or antitoxin would be therapeutically useful after onset of symptoms. However, administration of antitoxin is reasonable if disease has not progressed to a stable state. A human pentavalent antitoxin produced by plasmaphoresis of toxoid vaccines is available [(b)(l)sec34(b)(2)] It is an Investigational New Drug (IND) and has never been tested for efficacy. Formal safety and pharmacokinetic studies are in progress. This product is useful for only highly specialized indications and should not be considered as generally available. [(b)(l)sec34(b)(2)] Polyvalent antitoxins have been prepared. It is felt that these antitoxins offer an option for therapy. Efficacy is 9
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