botulism
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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
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
- ocular findings
- symmetric descending flaccid paralysis
- weakness
- headache
- dizziness
- dysphagia
- dysarthria, dysphonia
- abdominal pain
- constipation
- nausea/vomiting
- diarrhea
- irregular respirations, respiratory dysfunction, dyspnea
- swollen tongue
- 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
- ↑ Jump up to: 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://www.ncbi.nlm.nih.gov/pubmed/16452558
- ↑ Jump up to: 3.0 3.1 3.2 3.3 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
- ↑ Cherington M. Botulism: update and review. Semin Neurol. 2004 Jun;24(2):155-63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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
- ↑ CDC's botulism treatment program http://www.bt.cdc.gov/agent/botulism