Snapshot A 43-year-old male presents to the clinic with acute onset nausea, weakness and blurred vision. Physical exam reveals bilateral ptosis, fixed and dilated pupils and opthalmoplegia, with symmetrical limb weakness and absent tendon reflexes. Patient admits to recently eating home canned green beans. He is admitted to the hospital for further monitoring. Introduction Classification bacteria gram-positive bacilli spore-forming Clostridium C. botulinum Presentation Adult preformed toxin ingested autolysis of bacteria releases toxin into food toxin is not actively secreted toxin ia protease that cleaves SNARE proteins required for acetylcholine release at the neuromuscular junction reversible, flaccid paralysis weakness, dizziness, blurred vision- Triple D's Diplopia Dysphagia Dysphonia Infant spores ingested from household dust or honey spores from the environment where soil botulinum spore counts are high, including but not limited to Utah, California, and Pennsylvania toxin produced in gut constipation, limpness, reversible flaccid paralysis Wound traumatic implantation of spores seen in drug users in vivo production of toxin symptoms similar to ingested toxin but without GI symptoms fever and leukocytosis Evaluation Adult serum analysis for toxin Infant presumptive clinical diagnosis confirm with stool studies for spores and toxin Wound isolation of spores from wound Treatment Adult respiratory support equine derived antitoxin Infant respiratory support bivalent human derived antitoxin use no antibiotics (may worsen or prolong) Wound antitoxin respiratory support amoxicillin Prevention, Prognosis and Treatment Good home canning techniques destroy spores Avoid honey in infants < 12 months Avoid injection of street drugs Prompt medical evaluation of infected wounds