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File: 123096_sep96_decls23_0045.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
vision, diplopia, ptosis, and photophobia. Bulbu nerve dysfunction causes dysarthria, ANTITOXIN: In isolated cases of foddbome botulism, circulating toxin is usuajly
dysphonia, and dysphagia. This is followed by a symmetrical, dm@nding, progressive present, perhaps due to continued absorption through the gut wall. Equine antitoxin has been
weakness of the extremities along with weakness of the respiratory muscles. Development of used in these circumstances, and is probably helpful. After aerosol exposure, it is unknown
respiratory failure may be abmpt. whether toxin circulates or antitoxin would be therapeutically useful after onset of symptoms.
On physical examination, the patient is alert, oriented, and afebrile. Postural However, administration of antitoxin is reasonable if disease has not progressed to a stable
hypotension may be present. Ocular findings may include ptosis, extramulu muscle state.
paralysis, and fixed and dilated pupils. Mucous membranes of the mouth may be dry and A human pentavalent antitoxin produced by plasmapheresis of toxoid vaccinces is
coasted. Neurological examination shows flaccid muscle weakness of the palate, tongue, available in yM limited quantities. It is an Investigational New Doug (IND) and has never
larynx, r@pimtory muscles, and extremities. Deep tendon reflexes vary from intact to been tested for efficacy. Formal safety and ph@acokinctic studies are in progress, This
uld not be considered as
(although reports suggest that obtundation or wn@ry involvement may sometimes occur). generally available. There is no prospect for additional human antitoxin to be produced and
made available in the foreseeable future.
B. DIAGNOSIS A "d@pmiated' equine heptavalent antitoxin (vs types A, B, C, D, E, F, and 6) has
been prepared by cleaving the Fe fragments from horse IgG molecules, leaving F(ab@
1, Routine Laboratory Findings: Routine laboratory findings we of no value in fragments. It is felt that this antitoxin offers an option for therapy, and stocks have been
diagnosis. 'ne cerebrospinal fluid is normal. pre-positioned in the field. Its effi@cy is inferred from animal studies. Use requires
pretesting for sensitivity to horse semm (and desensitization for those allergic), and
2. Differential DiaEnosis: The occurrence of an epidemic with large numbers of disadvantages include rapid clearance by immune elimination, as well as a theoretical risk of
afebrile patients with progressive mulm, pharyngeal, respiratory, and muscular weakness and serum sickness.
paralysis hints strongly at the diagnosis. Single cases may be confused with various
D. PROPHYLAXIS
paralysis. 'ne edrophonium (tensilon) test may be transiently positive in botulism. Other
considerations include enteroviral infections; but in these patients, fever is present, paralysis A pentavalent toxoid of Clostfidium botutinum types A, B, C, D, and E is available
is often asymmetrical, and the cerebrospinal fluid is abnormal. In the present setting, it will under IND status. 'nis product has been administered to several thousand volunteers and
be necessary to distinguish ne@e-agent and atropine poisoning from botulinum intoxication. occupationally at-risk workers, and induces serum antitoxin levels that correspond to
Briefly, org@ophosphate nerve agent poisoning results in miotic pupils and copious protective levels in experimental animal systems. The currently recommended schedule (0,
secretions. In atropine poisoning, the pupils are dilated and mucous membranes are dry, but 2, and 12 weeks, then a I year booster) induces solidly protective antitoxin levels in an
central nervous system excitation with hallucinations and delirium is present. See Section IV acceptable percentage of vaceinms after I year. The few available data suggest that limited
for a more comprehensive differential.
and transient antitoxin levels are induced after three injmtions; there are no data currently
available to assess immunogenicity after one or two doses, although lower levels of antitoxin
or laboratory workers may well offer protection in a field
from cases of foodbome botulism is often feasible by mouse insulation. In the case of setting.
inhalation botulism, toxin may well be cleared from the blood by the time symptoms are At present, this product is available in limited quantities, and must be administered
noted. Nevertheless, semm should be obtained from representative cases for such attempts. under protocol. Contraindications include sensitivity to alum, formaldehyde, and thimerosal,
Survivors probably will not develop an antibody response due to the small amount of toxin or hypersensitivity to a previous dose. Reactogenicity is modest, with 2-4% of vaccinees
necessary to cause death. See Section III for details of sample collection and processing. reporting erythema, edema, or induration which peaks at 24-48 hours, then dissipates. 'ne
ftequency of local reactions increases with each subsequent insulation; after the second and
C. THERAPY third doses, 7-10% will have local reactions, with higher incidences (up to 20% or so) after
boosters. Severe local reactions are rare, consisting of more extensive edema or induration.
Respiratory failure secondary to paralysis ofrespiratory muscles is the most serious Systemic reactions are reported in up to 3%, consisting of fever, malaise, headache, and
ia. Incapacitating reactions (local or systemic) are uncommon. The vaccine should be
had a mortality of 60%. With trachmstomy and ventilatory assistance, fatalities should be stomd at refrigerator temperatures (= frozen).
< 5 %. Intensive and prolonged nursing cam may be required for recovery (which may take
several weeks or even months).
80 8
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996