| name: | Botulism |
| also known as: | Botulinum Poisoning; Botox; Food Poisoning; Clostridia Infection; Kerner's Syndrome; Sausage Poisoning; ICD 005.1 |
| also see: | Tetanus; Food Poisoning; Clostridia Infection; Botox; ICD |
| description: | Although no longer common in the USA, botulism is a serious, non-contagious infection where the toxin produced by the Clostridium botulinum bacteria severely affects the brain and nervous system, seen in incompletely cooked contaminated foods, risk increased in infants and with home-canned foods, vacuum-packed foods, smoked foods. The botulin toxin prevents acetycholine release in pre-synaptic nerve synapses. Botulism is often classified into six groups depending upon the route of infection: 1. Food - eating contaminated food, especially home-canned foods. Symptoms can occur anywhere from 12-48 hours after ingestion and up to 2 weeks. 2. Infantile - cutting the umbilical cord with a contaminated instrument, ingesting spores, eating contaminated honey 3. Wound - a laceration or puncture wound from a contaminated object, IV drug use, "skin popping" with symptoms occurring from 4-14 days after injury. 4. Intestinal also called hidden - occurs in people already with compromised intestine, such as Crohn's 5. Unknown - possibly adult variant of infantile with symptoms similar to infantile. 6. Airborne/inhalation such as from deliberate release in a terrorist attack (Biologic Warfare). A synthesized, purified form of the botulism toxin, called botox, is used in medicine to treat certain conditions, such as spastic vocal cords, facial ticks and facial spasm, and the wrinkles of aging, such as between the eyes, forehead, and crow's feet. |
| signs & symptoms: | Food borne - nausea, vomiting, malaise, blurred vision, double vision, slurred speech, dry mouth, constipation, urinary retention, drooping eyes from facial paralysis and other cranial nerve paralysis, general muscle weakness and descending paralysis, difficulty swallowing, fixed and dilated pupils. Infantile - feeble cry, constipation, poor head control, bobbing head, poor suck reflex, weak facial expression, facial paralysis, muscle weakness Wound - similar to food borne but less intestinal symptoms |
| diagnosis: | Signs, symptoms, history and physical exam, blood count, blood chemistry, and possibly analysis of the suspected food culprit or blood sample looking for the toxin or stool sample looking for the toxin and/or bacteria. EMG not diagnostic but is abnormal. Differential diagnosis includes polio, myasthenia gravis, Eaton Lambert syndrome, tick paralysis such as Colorado tick fever, Rocky Mountain spotted fever, Guillain-Barre syndrome, familial periodic paralysis, inorganic phosphorous poisoning, Amanita mushrooms, shellfish, stroke, encephalitis, sepsis, polio. Clinical pearl: in an IV drug abuser with facial paralysis, think botulism from black tar heroin and "skin popping." |
| treatment: | Requires emergency care possibly including administration of botulism antitoxin injections (trivalent A-B-E antitoxin, as well as hospitalization, antibiotics such as high dose penicillin or flagyl, supportive care of major organ functions, such as ventilation support for respiratory failure. Infected wounds require urgency debridement to remove toxin producing bacteria. Enemas might remove intestinal bacteria quicker. Some authors feel infantile botulism should be treated with Human Botulism Immune Globulin, currently available in the US only from the California State Health Department. |
| prevention: | Cook canned foods properly, especially home canned foods. Avoid bulging canned foods. No honey to infants. |
| outcome: | Early treatment translates into cure although 10-20% will die from aspiration pneumonia, respiratory failure. |
skynetMD suggests the following:
| if: | If the person is suspected of having botulism food poisoning, such as described above |
| go to: | Go to the hospital for emergency care. |
Last updated 11/25/2008