Botulism: Difference between revisions
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==Infantile Botulism== | ==Infantile Botulism== | ||
===Background=== | ===Background=== | ||
*Due to consumption of botulinum spores | *Due to consumption of botulinum spores | ||
**Ingestion of honey, corn syrup, and vacuum/environmental dust | |||
**Higher GI tract pH of infants makes them more susceptible | **Higher GI tract pH of infants makes them more susceptible | ||
*Most cases occur in < | *Most cases occur in <1 yr, 90% occur in <6m | ||
===Clinical Features=== | ===Clinical Features=== | ||
*Floppy Baby Syndrome | |||
**Loss of facial expression | |||
**Noticeable neck and peripheral weakness | |||
*GI symptoms | |||
**Poor feeding | |||
**Constipation | |||
**Decreased suckling | |||
*Other | |||
**Lethargy | |||
**Weak cry | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 00:09, 24 April 2015
Adult Botulism
Background
- Clostridium botulinum produces toxin that blocks Ach release from presynaptic membrane
- Cases due to:
- Improper canning
- Black-tar heroin use
- Wound infection (contaminated wounds, C-section, tooth abscess, sinus infection)
- Symptoms begin 6-48hr after exposure
Clinical Features
- GI
- N/V, abd cramps, diarrhea or constipation
- Not seen in pts who contract botulism from heroin or contaminated wound
- Neuro
- Vertigo is common
- Symmetrical descending weakness leading to paralysis
- Cranial nerves and bublar muscles are affected first: diplopia, dysarthria, dysphagia
- Will progress to respiratory depression if not treated
- Anticholinergic signs
- Decreased salivation: due to cholinergic fiber blockage
- Dry mouth, painful tongue, sore throat
- Urinary retention, dry skin/eyes, hyperthermia
- Decreased salivation: due to cholinergic fiber blockage
- Dilated pupils (in contrast to pts w/ MG)
Infantile Botulism
Background
- Due to consumption of botulinum spores
- Ingestion of honey, corn syrup, and vacuum/environmental dust
- Higher GI tract pH of infants makes them more susceptible
- Most cases occur in <1 yr, 90% occur in <6m
Clinical Features
- Floppy Baby Syndrome
- Loss of facial expression
- Noticeable neck and peripheral weakness
- GI symptoms
- Poor feeding
- Constipation
- Decreased suckling
- Other
- Lethargy
- Weak cry
Differential Diagnosis
Weakness
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Treatment
- Ventilatory support
- Consider intubation when VC <30% predicted or <12cc/kg
- Antitoxin/immune globulin
- Infant
- Supportive care only (no benefit from antitoxin or abx)
- Consider human botulism immunoglobulin (BabyBIG)
- Supportive care only (no benefit from antitoxin or abx)
- Wound
- Antitoxin, wound irrigation & debridement, Pen G 10-20 mil units/day
Disposition
- Admit to ICU