USAF PAMPHLET ON THE MEDICAL DEFENSE AGAINST BIOLOGICAL

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� 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

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