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BOTOX: The next bio terror agent

Several mainstream media outlets have been talking about BOTOX...the cosmetic version of Clostridium Botulinum or botulism as the next possible biological terrorist weapon. Also within the past few days, I've recieved dozens of emails looking for information on BOTOX...many asking if this cosmetic botox could be used as an actual biologic agent. So, I thought this would be a good time to review.

What is bioterrorism? Simply put, bioterrorism is the use of microbes or toxins to cause illness or death, or poison the environment. Microbes such as bacteria and viruses could be used as well as toxins. BOTOX is a toxin. Remember, bacteria and viruses cause an infection while toxins result in inTOXication. Bacterial examples include anthrax, plague, and Tularemia. Virus examples include Smallpox, and hemorrhagic fevers. While toxins include botulism and ricin.

What is Botulism? Botulism toxin has several forms; toxin A - G...they are all some variety of Clostridium Botulinum. The cosmetic BOTOX is the toxin A variety and its estimated that it would take a huge amount of cosmetic BOTOX to cause serious biological threat. With that in mind, we have to reinforce the fact that BOTOX is BOTOX...cosmetic grade or pure strength. The symptoms are the same and the lethality is always a potential. In fact, there have been several deaths related to cosmetic BOTOX in the United States. We should point out that there are other medical uses for this toxin. BOTOX can be used to treat muscular diseases. In fact, a tragic case in California has highlighted the dangers of medical botox as a seven-year-old girl who was undergoing botox treatments for her cerebral palsy has died, attributed to the toxin treatment.

Alright, what are the symptoms of botox intoxication? First, you've got to remember that botox is botox...medical, cosmetic or pure toxin. If used improperly, with an incorrect dose, poor injection/administration technique, or intentional exposure to the pure toxin...the symptoms are the same. The general incubation period is 24 to 36 hours after exposure. By the way, estimates are that a single  gram pure botulinum is enough to kill one million people. Botox in general causes weakness, descending flaccid paralysis and eventually respiratory failure. Botox enters the nervous system via the bloodstream, binding to the receptors of peripheral synapses.  Again, all forms of Botox act in the same way...making the point that all forms of Botox have the potential for intoxication and the same set of neurological symptoms. The binding to peripheral synapses stops the release of Ach and the production of AchE.

The specific symptoms are:
  • Diplopia or double vision
  • Dytharthia, difficulty walking secondary to descending paralysis of skeletal muscle
  • Dysphonia or trouble speaking
There are other symptoms that should be addressed; most seriously is the respiratory failure that occurs when paralysis reaches the phrenic nerve and paralyzes the diaphragm. Of note, the Botox intoxicated patient remains afebrile and fully conscious.

Care is mainly supportive...not good news. Ventiliatory support, feeding support and mechanical ventilation may be needed for as little as 6-8 weeks or as much as 7 months.

With all that in mind, Botulinum Toxin being the most deadly toxins known is certainly capable causing thousands, maybe even millions of deaths, with a very small amount. The question then becomes one of production, availability, and dissemination.

Read Fatal Botox Reaction on MSNBC.com
Read Botox as next bio terror weapon in the Washington Post

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