The edrophonium chloride test is positive in most patients. Older diagnostic studies are based on the demonstration that the patient's serum is toxic to mice. Antigen specificity is established by neutralization tests conducted in mice injected with botulinum antitoxins. Specimens suspected of containing botulinum toxin can be tested in a similar manner. Because of the extreme potency of the poison, such material should be handled with maximum caution.
Older patients seem to be affected more adversely than younger patients.
Type A botulism appears to mandate ventilatory support and prolonged hospitalization more often than does type B disease. Of the 21 cases reported during 1979 and 1980 to the CDC, there were three fatalities. Deaths have been attributed to the failure to recognize the need for mechanical ventilation, to ventilator malfunction, to ventilator misuse, and to intercurrent pulmonary and systemic infection. Because botulism is usually food-borne, cases tend to cluster. All persons at risk should be carefully observed.