Botulism in Bioterrorism

Botulism, a potential lethal disease related to neurologic complications caused by neurotoxins most of then were produced by Clostridium botulinum. Food related botulism, infant botulism and wound botulism were reported all over the world after the first published by Kerner in 1820, botulism of adult with unknown was distributed in recent year which may due to colonization in gastrointestinal tract or toxin produced in vitro. The botulinal neurotoxin is the most lethal biological substance known, and it can be purified in laboratory. Bioterrorism is discussed after the terrier attack of United State in 2001 and botulism is one of the most possible agents. Prevention to the attack of biological weapons is impossible, it is emergent that clinicians should learn to recognize, diagnose and manage this rare but lethal disease, include the possibility of large outbreak due to terrorism. (Ann Disaster Med 2002;1 Suppl 1:S17-S25) Keyword: Botulism; Bioterrorism; Clostridium botulinum Introduction Botulism, caused by Clostridium botulinum; neurotoxin produced by this organism related to food borne disease and outbreak occasionally all over the world. Botulism is a life-threatening neuroparalytic disease caused by neurotoxins produced from Clostridium strains. C. botulinum causes most of the cases and a few other clostridial strains accounting for the others. The clinical infections of botulism include food borne botulism, infant botulism, wound botulism and botulism of undetermined etiology. The neurotoxins of botulism are designed types A through G based on antigens. The term of botulism derives from the Latin word botulus, means sausage. It was recognized since the early 19 century in Europe. In 1897, Van Ermengen reported the description of bolutism and the affected animals. Botulinal toxin, the paralytic agent that causes the clinical symptoms of botulism poisoning, had been used to achieve controlled paralysis of the extraocular muscles. Advances in the clinical use of botulinal neurotoxins continue in recent years, it is the advanced practice in the treatment of movement disorders, spasticity, From Section of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Address for reprints: Chien-Hsien Huang, Section of infectious disease, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Taipei, Taiwan Received: Aug 16 2002. Revised: Aug 31 2002. Accepted: Aug 2