Botulism
Basics
Description
Description
- Rare in the U.S., causing <200 cases/yr; however, has significant bioterrorism potential
- Caused by a polypeptide, heat-labile exotoxin produced by Clostridium botulinum:
- Most potent poison known
- Toxin blocks neuromuscular transmission in cholinergic nerve fibers
- Symptoms occur by inhibition of acetylcholine release from presynaptic nerve membranes:
- Damage is permanent
- Recovery is by formation of new synapses through sprouting from the axon
- Onset: 12–72 hr after exposure; may be up to 1 wk after exposure:
- Death can occur 24 hr after onset of symptoms
- Slow recovery; symptoms often persist for months
- Mortality:
- Untreated: 60–70%
- With supportive care: 3–10%
- 3 major types: Foodborne botulism, wound botulism, and infantile botulism (see Pediatric Considerations). Absorbed through mucosal surfaces or nonintact skin
- Foodborne botulism:
- Occurs by ingestion of preformed toxin; from improperly canned food, improper refrigeration
- Conditions required for exposure:
- Food product contaminated with C. botulinum bacilli or spores
- Proper conditions for germination of spores exist
- Time and conditions permit production of toxin before eating
- Food not heated sufficiently to destroy botulism toxin
- Toxin-containing food ingested by susceptible host
- Wound botulism:
- Clinical evidence of botulism after trauma with a resultant infected wound and no history suggestive of foodborne illness
- C. botulinum isolated in about 50% of cases
- Wounds are usually contaminated with soil
- Majority of US cases are from IV drug use
- Other types:
- Adult intestinal toxemia botulism:
- Seen in adults with functional or structural GI abnormalities, are immunocompromised or with prolonged antibiotic use
- Predisposes to clostridial colonization
- May have sporadic or recurrent botulism with no known source and even after immunoglobulin treatment
- Iatrogenic botulism:
- Doses found in cosmetic applications are insufficient to cause systemic symptoms
- No known recent cases from medical use
- Symptoms would be expected to be classic
- Inhalation botulism:
- Aerosolization of toxin may have bioterrorism applications. Last reported naturally occurring case was in 1962 from the disposal of animal remains
- Adult intestinal toxemia botulism:
Pediatric Considerations
- Infantile botulism occurs from the ingestion of C. botulinum spores, which germinate in the gut and produce the toxin
- Accounts for 50–76% of botulism cases
- 90% occur in children <6 mo:
- Associated with patient or family exposure to soil, dust, or agricultural industry
- May also be associated with weaning from breast milk, which may alter intestinal flora and increase susceptibility to clostridial infection
- Usually presents with change in stool pattern or constipation, progressing over several days to symptoms of bulbar weakness, then descending flaccid paralysis
- Slower onset is attributed to the toxin being produced locally as opposed to being ingested in 1 dose
- C. botulinum spores found in honey:
- Honey not recommended for children <1 yr
Etiology
Etiology
- C. botulinum is a large spore-forming, usually gram-positive, strictly anaerobic bacilli ubiquitous in nature
- Each strain produces antigenically distinct toxins, designated types A–G:
- Types A, B, E, and rarely F are responsible for most human cases
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Citation
Schaider, Jeffrey J., et al., editors. "Botulism." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307361/all/Botulism.
Botulism. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307361/all/Botulism. Accessed December 10, 2024.
Botulism. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307361/all/Botulism
Botulism [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307361/all/Botulism.
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