References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
- Lecturer (Notario)
| Agent | BACTERIUM. Clostridium botulinum. An anaerobic gram-positive bacillus |
| Reservoir | Soil Animal Fish |
| Vector | None |
| Vehicle | Food Wound contamination with soil (occasionally) |
| Incubation Period | 1 to 2 days |
| Diagnostic Tests | Electrophysiologic (EMG) pattern. Isolation of organism from food (occ. from infant stomach). Mouse toxin assay |
| Typical Adult Therapy | Heptavalent (types A-G) or trivalent (types A, B, E) antitoxin [following test dose] 10 ml in 100 ml saline over 30 min. Additional 10 ml at 2 and 4 hours if necessary. Respiratory support |
| Typical Pediatric Therapy | As for adult |
| Vaccine | Botulism antitoxin |
| Clinical Hints | Clinical manifestations similar to those of atropine poisoning: dysarthria, diplopia, dilated pupils, dry mouth, constipation, flaccid paralysis, etc); onset approximately 36 hrs after ingestion of poorly-preserved food. |
| Synonyms | Botulisme, Botulismo, Botulismus, Kerner’s disease |
CDC Case Definition for Foodborne, Infant and Wound Botulism
- Neurological syndrome (diplopia, blurred vision, bulbar weakness, symmetric paralysis); or
- Infant exhibiting constipation, poor feeding and failure to thrive, followed by progressive weakness, impaired respiration and death.
Symptoms and signs of botulism reflect characteristic electrophysiological abnormalities and include diplopia, blurred vision, ptosis, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants are lethargic, ‘floppy,’ constipated and feed poorly
- Exhibiting a weak cry and poor muscle tone.
- In food-borne botulism, symptoms generally begin 18 to 36 hours after ingestion (range 6 hours to 10 days).
- Type F botulism is characterized by the appearance of respiratory failure within 24 hours, quadriplegia by the fifth day and rapid recovery beginning on the eighth day.
- A case of asymmetric cranial nerve demyelination due to type F botulism has been reported.
- If untreated, these symptoms progress to paralysis of the arms, legs, trunk and respiratory muscles.
- Patients who experience nausea and vomiting, cranial neuropathy or urinary retention are most likely to develop respiratory failure.
- Botulinum toxin may persist in the serum of patients for as long as 12 days. Infant botulism should be suspected if a previously healthy infant (age <12 months) develops constipation and weakness in sucking, swallowing, or crying; hypotonia; and progressive bulbar and extremity muscle weakness.
- Approximately 50% of patients require mechanical ventilation.
- Lumbar puncture and brain imaging studies are usually normal, in contrast to other causes of flaccid weakness.
- The findings of infant botulism may mimic those of Hirschprung’s disease or acute abdomen.
Summary
Botulism is a common form of food poisoning. Botulinum toxin, produced by the bacterium Clostridium botulinum, is among the most potent toxins. It is able to induce lethal effects at concentrations in the nanograms (one-billionth of a gram).
- Its nature is neurotoxic, and many variants exist—botulinum toxin type A through G. Botulinum toxins type A, B, E, and F are those that affect humans. The end effect of toxicity is nerve damage producing respiratory and muscle paralysis.
- The bacterium Clostridium botulinum is commonly found in home-made canned, preserved, or fermented food. The most common form of transmission of the bacterium is through the ingestion of contaminated food.
- Diagnostic Evaluation: a diagnosis of botulism is made after the observation of the toxin in the serum, stool, or consumed food.
- Clinical Manifestations: descending paralysis. The specific problem related to this manifestation is respiratory failure, appearing 12 to 36 hours after exposure to C. botulinum.
- Management: botulism antitoxin is highly effective, especially when administered early.
- In severe cases when respiratory failure appears, mechanical ventilation may be required. Supportive therapies are provided as indicated.
- Preventive Measures: maintenance of hygiene, especially in food preparation and storage. Raw and cooked food should be separated. Cooking should be done thoroughly.