Anatoxin A is a bicyclic amine produced by Anabaena flosaquae, a filamentous, freshwater bacterium found in pond scum worldwide [37] . A. flosaquae exhibits 2 mechanisms of action as an acetylcholine agonist by: 1) binding to postsynaptic acetylcholine receptors and 2) stimulating muscle contraction. As the binding to the receptor is permanent, continuous contraction of the affected muscle ensues [90] . Secondly, anatoxin A inhibits acetylcholinesterase, increasing the amount of acetylcholine in the synaptic cleft. Symptom onset occurs within a few minutes, and the combined effect of the 2 mechanisms of action of the toxins results in a flaccid paralysis [90] . Initially, symptoms may mimic organophaosphate poisoning, with miosis, excess oral and lacrimal secretions, and muscle fasciculations, [90] . Death results from respiratory arrest [37] . Supportive care is the mainstay of treatment. 2-pyridine aldoxime methyl (2-PAM) and physostigmine have shown some effect when used as pretreatment in animals [90] .