Botulinum Toxin PoisoningModule information
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
References
Glossary
What's New
Patient Information
Guidelines and Systematic Reviews
Prevention
  • Support education about botulinum toxin poisoning in the community.
  • Prepare for the possibility of botulinum toxin poisoning as part of a bioterrorist attack.
  • Inform parents of new babies about measures to prevent and recognize infant botulinum toxin poisoning.
  • Recognize that botulinum toxin poisoning can occur in patients with traumatic wound infections or in those who inject heroin and other recreational drugs.
  • Note that immunization against botulinum toxin is not recommended for the general population.

Support education about botulinum toxin poisoning in the community. C

  • Learn about the clinical presentation of botulinum toxin poisoning and sources with the potential to cause widespread outbreaks due to intentional or accidental exposure.
  • Tell patients that 90% of foodborne botulism comes from home-canned or home-prepared foods that were improperly prepared and to be wary of poorly cooked or canned food such as home-canned tomatoes, cheese, oils, and salted or fermented fish or meat.
  • Direct patients who are concerned about botulinum toxin exposure to public health officials and the CDC for further information.
  • Educate Native Americans in Alaska about the dangers of home-processed foods consisting of aquatic mammal tissues or uneviscerated fish.
  • Ensure that ongoing education about botulism is available for first point-of-contact hospital personnel such as EMTs and ER nurses.
Background | Back to top


Prepare for the possibility of botulinum toxin poisoning as part of a bioterrorist attack. C

  • Ensure that local emergency departments have a rapid response system in place for assessing outbreaks of botulinum toxin poisoning resulting from a bioterrorist attack.
  • Know the contact information for reporting an outbreak and be able to activate a rapid notification of their key personnel in the event of an outbreak to limit the size and prevent further exposure.
  • Understand that physical containment by removing the materials containing the botulinum toxin and limiting the number of people who may eat or inhale the toxin are key to preventing the spread of the disease in the population.
  • Encourage local and state medical agencies to supply educational materials to physicians and other health personnel providing first-line care to potential victims of botulinum toxin poisoning.
  • Incorporate education about clinical recognition of botulinum toxin poisoning in CME for physicians who may treat victims of a bioterrorist attack.
Background | Back to top


Inform parents of new babies about measures to prevent and recognize infant botulinum toxin poisoning. C

  • To prevent infantile botulism in children under 1 year of age:
    • Do not feed honey or corn syrup
    • Wash or remove skins of fruits and vegetables before feeding
    • Minimize or prevent ingestion of soil that may contain spores
  • Inform parents to take the child to the pediatrician if progressive constipation, poor suck and cry, and weakness appear.
Background | Back to top


Recognize that botulinum toxin poisoning can occur in patients with traumatic wound infections or in those who inject heroin and other recreational drugs. C

  • Prevent botulinum poisoning by using:
    • Scrupulous wound care in patients with traumatic wounds
    • Clean needles and attention to skin lesions to prevent botulinum toxin poisoning in intravenous drug abusers
Background | Back to top


Note that immunization against botulinum toxin is not recommended for the general population. C

  • Reserve immunization with a serotype-specific botulinum toxin for at-risk military personnel and workers exposed directly to botulinum toxin in research and the pharmaceutical industry.
Background | Back to top

FAQs
The American College of Physicians is accredited by the Accreditation Council for continuing Medical Education (ACCME) to provide continuing education for physicians. The American College of Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity. Purpose: This activity has been developed for internists to facilitate the highest quality professional work in clinical applications, teaching, consultation, or research. Upon completion of the CME activity, participants should be able to demonstrate an increase in the skills and knowledge required to maintain competence, strengthen their habits of critical inquiry and balanced judgement, and to contribute to better patient care. Disclosures: Larry E. Davis, MD, FACN, FACP received honorarium from Merck & Co., provided expert testimony, received grants from the VA, NIH, and the University of New Mexico, received royalties from Fundamentals of Neurologic Disease. Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP. Because all PIER modules are updated regularly, printed web pages or PDFs may rapidly become obsolete. Therefore, PIER users should compare the date of the last update on the website with any printout to ensure that the information being referred to is the most current available.
PIER is copyrighted © 2013 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.