Botulism

Adult Botulism

Background

1. Clostridium botulinum produces toxin that blocks Ach release from presynaptic membrane
2. Cases due to:
   1. Improper canning
   2. Black-tar heroin use
   3. Wound infection (contaminated wounds, C-section, tooth abscess, sinus infection)
3. Symptoms begin 6-48hr after exposure

Clinical Features

1. GI
   1. N/V, abd cramps, diarrhea or constipation
   2. Not seen in pts who contract botulism from heroin or contaminated wound
2. Paralysis
   1. Descending, symmetric
   2. Cranial nerves and bublar muscles are affected first: diplopia, dysarthria, dysphagia
      1. Will progress to respiratory depression if not treated
3. Anticholinergic signs
   1. Urinary retention, dry skin/eyes, hyperthermia
4. Dilated pupils (in contrast to pts w/ MG)

Infantile Botulism

Background

• Due to consumption of botulinum spores (usually from honey)
  • Higher GI tract pH of infants makes them more susceptible
• Most cases occur in <1yr, 90% occur in <6m

Clinical Features

1. GI
   1. Constipation
   2. Poor feeding
2. Lethargy
3. Weak cry
4. Floppy infant

DDx

1. Myasthenia Gravis
2. Lambert-Eaton
3. Guillain-Barre
4. Poliomyelitis
5. Tick Paralysis
6. Diphtheria
7. Hyperthyroidism
8. Paralytic fish poisoning
9. Magnesium toxicitiy

Treatment

1. Ventilatory support
   1. Consider intubation when VC <30% predicted or <12cc/kg
2. Antitoxin/immune globulin
3. Infant
   1. Supportive care only (no benefit from antitoxin or abx)
4. Wound
   1. Antitoxin, wound irrigation & debridement, Pen G 10-20 mill units/day

Dispostion

1. Admit to ICU

See Also

• Weakness
• Bioterrorism