botulism
Jump to navigation
Jump to search
Introduction
An acute, potentially fatal disease resulting from ingestion of Clostridium botulinum or Clostridium botulinum toxin.
Etiology
- exposure to home-canned foods
- infant botulism with honey
- wound contamination
Epidemiology
- 9 cases of wound botulism associated with injecting heroin from Sept 2017 to May 2018 in San Diego county []
Pathology
- several toxins (A-G)
- respiratory dysfunction (dyspnea) may result from upper airway obstruction vs diaphragm weakness
- not known to affect the central nervous system, likely because the causative neurotoxin is too large to cross the blood-brain barrier[3]
Clinical manifestations
- symptoms present within 24-72 hours of toxin exposure[3]
- incubation period 2 hours-8 days[3]
- sudden onset of symptoms
- afebrile with clear sensorium
- cranial nerve palsy; cranial nerves affected early
- include cranial nerve 7 palsy
- ocular findings
- symmetric descending flaccid paralysis
- descending weakness[3]
- headache
- dizziness
- dysphagia, dysarthria, dysphonia
- dry mouth (xerostomia)
- swollen tongue
- abdominal pain
- constipation
- nausea/vomiting
- diarrhea
- irregular respirations, respiratory dysfunction, dyspnea
- hyporeflexia
- ataxia
- infants < 6 months of age:
- flaccid paralysis, hypotonia, ptosis, weak cry or suck
Laboratory
- Clostridium botulinum toxin in specimen:
- Clostridium botulinum toxin DNA
- injection of suspected food into mice (mice die if food contains botulinum B toxin)
- Clostridium botulinum toxin A Ab in serum
- Clostridium botulinum culture
Differential diagnosis
- Guillain Barre syndrome (ascending symmetric weakness)
- Myasthenia gravis: pupils are normal
- Lambert-Eaton syndrome
- tick paralysis
- stroke
- intoxication from drugs, heavy metals, etc.
Management
- supportive
- Trendelenberg position may help with ventilation
- botulinum antitoxin
- human botulism immune globulin[2]
More general terms
Additional terms
- botulinum toxin
- Clostridium botulinum
- Guillain-Barre syndrome (GBS)
- Lambert-Eaton myasthenic syndrome (LEMS)
- myasthenia gravis
- tick paralysis
- toxicity; poisoning; overdose
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 869-70
- ↑ 2.0 2.1 Arnon SS et al, Human botulism immune globulin for the treatment of infant botulism. N Engl J Med 2006, 354:462 PMID: https://pubmed.ncbi.nlm.nih.gov/16452558
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Cherington M. Botulism: update and review. Semin Neurol. 2004 Jun;24(2):155-63. PMID: https://pubmed.ncbi.nlm.nih.gov/15257512
- ↑ David WS, Temin ES, Kraeft JJ, Hooper DC. Case records of the Massachusetts General Hospital. Case 3-2015. A 60-year-old woman with abdominal pain, dyspnea, and diplopia. N Engl J Med. 2015 Jan 22;372(4):364-72 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25607430 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1410936
- ↑ Zhang JC, Sun L, Nie QH. Botulism, where are we now? Clin Toxicol (Phila). 2010 Nov;48(9):867-79. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/21171845
- ↑ Peak CM, Rosen H, Kamali A, et al. Wound Botulism Outbreak Among Persons Who Use Black Tar Heroin - San Diego County, California, 2017-2018. MMWR Morb Mortal Wkly Rep 2019;67:1415-1418. https://www.cdc.gov/mmwr/volumes/67/wr/mm675152a3.htm
- ↑ Rao AK, Sobel J, Chatham-Stephens K, et al. Clinical guidelines for diagnosis and treatment of botulism, 2021. MMWR Recomm Rep. 2021;70:1-30. PMID: https://pubmed.ncbi.nlm.nih.gov/33956777
- ↑ CDC's botulism treatment program http://www.bt.cdc.gov/agent/botulism