A patient arrives at the emergency department after waking up in the morning with progressive weakness, blurred vision, photophobia, and a change in voice quality
The patient had attended a banquet the previous evening and was asymptomatic at that time. These symptoms most likely indicate which of the following biologic agent exposures? 1. Botulism
2. Staphylococcal enterotoxin B
3. Ricin
4. Tricothecene mycotoxins
Botulism
Rationale: Botulism is the most potent toxin known to mankind. Food-borne botulism is common in improperly prepared canned foods and presents 12 to 72 hours postexposure. Symptoms include symmetric and descending paralysis, blurred vision, photophobia, trouble talking, and an altered voice. Staphylococcal entertoxin B has an onset of symptoms generally within 3 to 4 hours and includes high fever, headache, myalgias, and a nonproductive cough. Ricin exposure causes nausea, vomiting, gastrointestinal necrosis, and renal, hepatic, and splenic failure. Ricin symptoms occur within 4 to 8 hours. Symptoms of tricothecene mycotoxins exposure include abdominal pain, nausea, vomiting, and diarrhea.
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