A group of nurses respond to the scene of a bioterrorist attack in which employees at a mall were exposed to aerosolized botulinum toxin. Of the following, which describes the symptoms the nurses would expect to see in these clients?


•Any of these illnesses could be used as potential agents of bioterrorism. 

•Boltulism is a serious paralytic illness that could be used as an agent of bioterrorism. It is caused by a nerve toxin that is produced most commonly by the bacterium Clostridium botulinum. Foodborne botulism is caused by eating foods that contain the botulinum toxin (such as improperly preserved, canned foods). Botulinum toxin can be absorbed through the GI or respiratory tract, but not through the skin. It is highly toxic. Initial symptoms of botulinum toxin exposure are ptosis, diplopia, dysarthria, dysphagia, descending flaccid paralysis, difficulty breathing, and the victim eventually requires mechanical ventilation.

Incorrect options:

•Pneumonic Plague presents with fever, weakness, and rapid onset pneumonia with shortness of breath, cough, chest pain, and sometimes bloody sputum. Nausea and abdominal pain may occur. Without early intervention, pneumonic plague will usually cause respiratory failure, shock, and rapid death.

•Inhalation Anthrax occurs when a person inhales spores that are aerosolized, though it may be transmitted cutaneously as well if they come in direct contact with the spores, but Anthrax is not contagious. Symptoms include fever and chills, chest discomfort and shortness of breath, dizziness, a non-productive cough, nausea, stomach pains, headache, sweats (often drenching), extreme tiredness, and body aches. The patient may feel better for a day or two, then will usually progress to respiratory distress, stridor, cyanosis, and death. The mortality rate is nearly 100%.

•The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104 degrees Fahrenheit. Prolonged face-to-face contact is generally required to spread smallpox from one person to another. Smallpox also can be spread through contact with infected bodily fluids or contaminated bedding or clothing. A person becomes most contagious with the onset of rash, which starts in the mouth and face and spreads, first as bumps, then pustules and scabs. The infected person is contagious until the last smallpox scab falls off.

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