Human & Infant Botulism - Symptoms & Treatment
Botulism (say: bah -chuh-lih-zum) is a serious kind of food poisoning, but fortunately it's also very rare. This life-threatening paralytic illness results from an exotoxin produced by the gram-positive, anaerobic bacillus Clostridium botulinum. It occurs as botulism food poisoning, wound botulism, and infant botulism.
Botulism occurs worldwide and affects adults more often than children. The incidence of botulism in the United States had been declining, but the current trend toward home canning has resulted in an upswing in recent years.
The mortality rate is about 25% , with death most often caused by respiratory failure during the first week of illness. Onset within 24 hours of ingestion signals critical and potentially fatal illness.
Botulism usually results from eating improperly preserved foods, such as home-canned fruits and vegetables, sausages, and smoked or preserved fish or meat. Rarely, it results from wound infection with C. botulinum.
Honey contaminated with C. botulinum spores is a common source of infection in infants. Findings have shown that an infant's GI tract can become colonized with C. botulinum and then the exotoxin is produced within the infant's intestine.
Signs and Symptoms
The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In food borne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.
Identification of the exotoxin in the patient's serum, stool, or gastric contents, or in the suspected food, confirms the diagnosis. An electromyogram showing diminished muscle action potential after a single supra maximal nerve stimulus also is diagnostic.
Diagnosis must rule out conditions often confused with botulism, such as Guillain-Barre syndrome, myasthenia gravis, cerebrovascular accident, staphylococcal food poisoning, tick paralysis, chemical intoxication, carbon monoxide poisoning, fish poisoning, trichinosis, and diphtheria.
For adults, treatment consists of I.V. or I.M. administration of botulinum antitoxin (available through the Centers for Disease Control and Prevention).
Early elective tracheotomy and ventilatory assistance can be lifesaving in respiratory failure. The patient needs nasogastric suctioning and total parenteral nutrition (TPN) if he develops significant paralytic ileus.
ALERT Antibiotics and aminoglycosides shouldn't be administered because of the risk of neuromuscular blockade. They should be used only to treat secondary infections.
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