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== Disease ==

Of the seven serotypes of BTX, the forms that most often cause botulism in humans are A, B, and E. <ref name="Arnon" />The lethal doses for a human weighing 70 kg is 0.09-0.15 μg when administered intravenously or intramuscularly, 0.70 - 0.90 μg through inhalation, and 70 μg orally. <ref>  Franz DR, Pitt LM, Clayton MA, Hanes MA, Rose KJ. Efficacy of prophylactic and therapeutic administration of antitoxin for inhalation botulism. In: DasGupta BR, ed. Botulinum and Tetanus Neurotoxins: Neurotransmission and Biomedical Aspects. New York, NY: Plenum Press; 1993:473-476. </ref> <ref name="Herrero"> PMID: 4960839</ref> ~~Humans can be exposed to the neurotoxin through inhalation, ingestion, or surface wounds.~~ Within 12 to 72 hours of exposure to BTX, the inhibition of acetylcholine signaling at nerve synapses creates symptoms of vomiting, nausea, diarrhea, blurred vision, ptosis, dysarthria and dysphagia, and finally weakness of muscles beginning with the head and moving down to the lower extremities. <ref> Dembek, Z. F.; Smith, L. A.; Rusnak, J. Botulinum Toxin. In Medical Aspects of Biological Warfare; 2007.</ref> If not treated, BTX can cause death due to respiratory failure or due to complications when on prolonged medical ventilation.

Of the seven serotypes of BTX, the forms that most often cause botulism in humans are A, B, and E. <ref name="Arnon" /> Humans can be exposed to the neurotoxin through inhalation, ingestion, or surface wounds. The lethal doses for a human weighing 70 kg is 0.09-0.15 μg when administered intravenously or intramuscularly, 0.70 - 0.90 μg through inhalation, and 70 μg orally. <ref>  Franz DR, Pitt LM, Clayton MA, Hanes MA, Rose KJ. Efficacy of prophylactic and therapeutic administration of antitoxin for inhalation botulism. In: DasGupta BR, ed. Botulinum and Tetanus Neurotoxins: Neurotransmission and Biomedical Aspects. New York, NY: Plenum Press; 1993:473-476. </ref> <ref name="Herrero"> PMID: 4960839</ref> Within 12 to 72 hours of exposure to BTX, the inhibition of acetylcholine signaling at nerve synapses creates symptoms of vomiting, nausea, diarrhea, blurred vision, ptosis, dysarthria and dysphagia, and finally weakness of muscles beginning with the head and moving down to the lower extremities. <ref> Dembek, Z. F.; Smith, L. A.; Rusnak, J. Botulinum Toxin. In Medical Aspects of Biological Warfare; 2007.</ref> If not treated, BTX can cause death due to respiratory failure or due to complications when on prolonged medical ventilation.

The treatment for human exposure to BTX is an antitoxin developed from horse plasma. Horses are exposed naturally to ''Clostridium botulism'' in their gut and therefore produce antibodies against ''Clostridium botulism'' to prevent the bacteria population from growing to an extreme. Antitoxins have been developed by isolating this antibody from horses, and in some cases, removing the Fc from the immunoglobulin and leaving the F(ab')2 fragment. By removing the Fc fragment, the incidence of hypersensitivity and anaphylaxis are reduced. There are divalent, trivalent, and heptavalent antitoxins available that treat botulinum serotypes A and B (divalent), serotypes A, B, and C (trivalent), and all seven serotypes (heptavalent). An antitoxin, botulism immune globulin (BabyBIG) has also been developed that can be used in infantile cases of botulism. BabyBIG is produced by using the human antibodies produced when a person is injected with pentavalent botulinum toxoid vaccine. By using human antibodies, there is less of a risk of anaphylactic shock and hypersensitivity to equine antigens. <ref> Dembek, Z. F.; Smith, L. A.; Rusnak, J. Botulinum Toxin. In Medical Aspects of Biological Warfare; 2007.</ref>

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 == Disease ==
-Of the seven serotypes of BTX, the forms that most often cause botulism in humans are A, B, and E. <ref name="Arnon" />The lethal doses for a human weighing 70 kg is 0.09-0.15 μg when administered intravenously or intramuscularly, 0.70 - 0.90 μg through inhalation, and 70 μg orally. <ref> 	Franz DR, Pitt LM, Clayton MA, Hanes MA, Rose KJ. Efficacy of prophylactic and therapeutic administration of antitoxin for inhalation botulism. In: DasGupta BR, ed. Botulinum and Tetanus Neurotoxins: Neurotransmission and Biomedical Aspects. New York, NY: Plenum Press; 1993:473-476. </ref> <ref name="Herrero"> PMID: 4960839</ref>  Humans can be exposed to the neurotoxin through inhalation, ingestion, or surface wounds. Within 12 to 72 hours of exposure to BTX, the inhibition of acetylcholine signaling at nerve synapses creates symptoms of vomiting, nausea, diarrhea, blurred vision, ptosis, dysarthria and dysphagia, and finally weakness of muscles beginning with the head and moving down to the lower extremities. <ref> Dembek, Z. F.; Smith, L. A.; Rusnak, J. Botulinum Toxin. In Medical Aspects of Biological Warfare; 2007.</ref> If not treated, BTX can cause death due to respiratory failure or due to complications when on prolonged medical ventilation.
+Of the seven serotypes of BTX, the forms that most often cause botulism in humans are A, B, and E. <ref name="Arnon" /> Humans can be exposed to the neurotoxin through inhalation, ingestion, or surface wounds. The lethal doses for a human weighing 70 kg is 0.09-0.15 μg when administered intravenously or intramuscularly, 0.70 - 0.90 μg through inhalation, and 70 μg orally. <ref> 	Franz DR, Pitt LM, Clayton MA, Hanes MA, Rose KJ. Efficacy of prophylactic and therapeutic administration of antitoxin for inhalation botulism. In: DasGupta BR, ed. Botulinum and Tetanus Neurotoxins: Neurotransmission and Biomedical Aspects. New York, NY: Plenum Press; 1993:473-476. </ref> <ref name="Herrero"> PMID: 4960839</ref> Within 12 to 72 hours of exposure to BTX, the inhibition of acetylcholine signaling at nerve synapses creates symptoms of vomiting, nausea, diarrhea, blurred vision, ptosis, dysarthria and dysphagia, and finally weakness of muscles beginning with the head and moving down to the lower extremities. <ref> Dembek, Z. F.; Smith, L. A.; Rusnak, J. Botulinum Toxin. In Medical Aspects of Biological Warfare; 2007.</ref> If not treated, BTX can cause death due to respiratory failure or due to complications when on prolonged medical ventilation.
 The treatment for human exposure to BTX is an antitoxin developed from horse plasma. Horses are exposed naturally to ''Clostridium botulism'' in their gut and therefore produce antibodies against ''Clostridium botulism'' to prevent the bacteria population from growing to an extreme. Antitoxins have been developed by isolating this antibody from horses, and in some cases, removing the Fc from the immunoglobulin and leaving the F(ab')2 fragment. By removing the Fc fragment, the incidence of hypersensitivity and anaphylaxis are reduced. There are divalent, trivalent, and heptavalent antitoxins available that treat botulinum serotypes A and B (divalent), serotypes A, B, and C (trivalent), and all seven serotypes (heptavalent). An antitoxin, botulism immune globulin (BabyBIG) has also been developed that can be used in infantile cases of botulism. BabyBIG is produced by using the human antibodies produced when a person is injected with pentavalent botulinum toxoid vaccine. By using human antibodies, there is less of a risk of anaphylactic shock and hypersensitivity to equine antigens. <ref> Dembek, Z. F.; Smith, L. A.; Rusnak, J. Botulinum Toxin. In Medical Aspects of Biological Warfare; 2007.</ref>