Toxicokinetics and evaluation of botulism
After exposure to Botulinum neurotoxin, the time to symptom onset depends upon the dose of the toxin and the relevant kinetics of absorption. For food-borne botulism, symptoms typically appear within 12 to 72 hours of ingesting contaminated food, nonetheless the literature reports indicate a timeframe from 2 hours to as long as 8 days. For infectious transmission, the onset depends on spore exposure time and time to germination. Bacterial species, toxin serotype, and the patient’s age and immunological status effect the time for colonies elaborate sufficient BoNT to cause symptoms. Authors from Brooklyn Hospital Center report that presentation of botulism may be subtle and easily missed. It classically begins with cranial nerve palsies (“bulbar symptoms”) that progress to the symmetrical descending weakness of the trunk, extremities, and smooth muscle, with eventual flaccid paralysis. Laboratory confirmation of botulism can be obtained with serum and stool assays for BoNT, stool microscopy for spores, stool cultures, and wound cultures in the case of wound botulism.