2014 NCTC Counterterrorism Calendar The NCTC Seal
Biological Threats
Clinical Features Diagnosis Medical Management
Botulinum Toxins
Symptoms appear several hours to one to two days after exposure.
An epidemic of cases of bulbar and neuromuscular disease.
Respiratory failure is the principal cause of death. Tracheostomy, endotrachael intubation, and ventilatory assistance may be required.
Blurred vision, drooping eyelids, difficulty understanding language, difficulty in speaking, muscle weakness.
Other causes could be considered; however, the extent and epidemiology of the outbreak will help diagnose and define whether or not there was an attack. Antitoxins are available, but they are horse serums and may produce reactions in those allergic to horse serum.
Progression—Day 3
Mucous in throat, neuromuscular symptoms, respiratory distress, difficulty in swallowing, feels like a cold without fever.

Progression—Day 4
Indistinct speech, pupils moderately dilated, retarded eye motions, “mental numbness.”
Incubation average 12 days. Symptoms begin acutely.
It is necessary to distinguish smallpox from chicken pox. Examination of vesicular scrapings under a microscope is the usual method for diagnosis. Strict quarantine for 17 days of all persons in contact with index cases.
Phase I Symptoms
Malaise, fever, chills, vomiting, headache, backache. Light-skinned patients may exhibit rash during this phase.

Phase II Symptoms
Facial rash and eruptions on mucous membrane leading to infectious secretions. Eruptions on lower extremities spreading to the trunk over the following eight to 14 days (these pustules later form scabs).
  No specific therapy.
  Supportive care to prevent secondary infections.

Picture of Botulinum Toxin

Botulinum Toxin


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