The clinical hallmark of botulism is an acute, afebrile, descending, symmetric, flaccid paralysis that always begins in the bulbar musculature [78] . Cranial nerve palsies invariably occur, making bulbar symptoms, such as ptosis, diplopia, dysphonia, and dysarthria, some of the earliest and most indicative symptoms of contamination [79] [14] . The earliest clinical signs are usually blurred vision from dilated pupils, ptosis, dry mouth, dysarthria, and dysphagia, as well as generalized weakness, fatigue, and dizziness. By the third day after exposure, patients will pool mucous in the throat, experience difficulty swallowing solid food, and have a sense of catching a cold, but without fever. Bilateral facial palsy is common.