Inhalation, ingestion, or absorption through skin and mucous membranes leads to infection [91] . The toxins act by inhibiting protein synthesis and disrupting mitochondrial electron transport [37] . The main symptoms depend on the route of infection, and are cutaneous with blistering and skin necrosis, or respiratory with cough, dyspnea, and epistaxis. Neurological symptoms can include lethargy and incoordination. No rapid test is available for diagnosis; however, antigens and toxin metabolites can be detected in blood and urine within 1 month after exposure [91] . Treatment includes careful decontamination by washing with soap water, and 1% sodium hypochlorite solution with sodium hydroxide [91] , and is otherwise supportive.