Botulism (C. Botulinum)
Botulism is poisoning by a thermolabile botulinum toxin produced by a Gram-positive bacterium Clostridium botulinum. The essence of poisoning is a reduced amount of acetylcholine released from a neuron on the neuromuscular disc. Botulinum toxin is also sometimes referred to as "sausage poison" (lat. botulus - sausage).[1] [2]
Etiology a pathogenesis[edit | edit source]
Clostridium botulinum is a G+, anaerobic, sporulating rod that produces the neurotoxic botulinum toxin (sausage poison[1]), which is thermolabile and is formed in anaerobic conditions, often in cans[2]. The source of the toxin for children tends to be honey bee[3].
Clinical presentation[edit | edit source]
The incubation time is on average 24 hours (sometimes 6 to 72 hours).[2]
The classic triad of symptoms should lead to suspicion of botulism:
- 1. Acute, symmetrical, descending flaccid paresis with distinct bulbar palsy.
- 2. Normal temperature
- 3. Normal sensitivity[4]
- Initially, GIT symptoms (nausea, vomiting, diarrhoea, but also constipation), mucosal dryness and profuse sweating appear.[2]
- Gradually, nervous disorders (diplopia, convergence disorder, mydriasis, swallowing disorder and aphonia) appear. The paresis gradually descends to the neck and limb muscles. The course of the infection is temperature-free, fluid is normal, consciousness is not altered.[2]
When the respiratory and cardiac centres are affected, the patient's life is in immediate danger.[1]
Diagnostics[edit | edit source]
- Klinický obraz (triáda). [4]
- EMG.[4]
- Detection of toxin in serum and food residues.[1] It is performed by neutralization experiment on mice. The type of antitoxin is used to infer the type of toxin.[3]
- Symptoms are similar in people who have ingested the same food.[1]
- Cultivation of Cl. botulinum on anaerobic soils (7-10 days).
- An ELISA of a nasal mucosal sample to detect aerosolized botulinum toxin was developed for military use.[4]
Differential diagnosis[edit | edit source]
- In encephalitis, unlike botulism, the finding in the liquor is abnormal.
- Thrombosis of the a. basilaris is excluded by angiography.
- In acute myasthenia gravis, antibodies against the acetylcholine receptor of the neuromuscular disc are present in the plasma.[1]
Treatment and prognosis[edit | edit source]
- There are monovalent sera for 6 types of Cl. botulinum if the antigenic type is known (i.m. application 3-5 days).[2] If the type is unknown, polyvalent serum is applied at a dose of 10 000 IU. The possibility of treating paresis with strychnine is mentioned.[2]
- Supportive therapy is also important. The patient should lie in the reverse Trendelenburg position (i.e. bed raised 20-25% on the head side, patient on the back) for better ventilation. Respiratory support is needed in approximately 20% of adult and 60% of pediatric patients. Fluid and nutrient levels are monitored or supplemented.[4]
- Lethality is up to 20% in botulism. The prognosis for survival is favourable, the correction of paresis takes months.[1]
Links[edit | edit source]
Related articles[edit | edit source]
External links[edit | edit source]
References[edit | edit source]
- ↑ a b c d e f g SEIDL, Zdeněk – OBENBERGER, Jiří. Neurologie pro studium i praxi. 2. edition. Praha : Grada Publishing, 2004. ISBN 80-247-0623-7.
- ↑ a b c d e f g DOSTÁL, Václav, et al. Infektologie. 1. edition. Praha : Karolinum, 2005. 338 pp. ISBN 80-246-0749-2.
- ↑ a b BEDNÁŘ, Marek – SOUČEK, Andrej – FRAŇKOVÁ, Věra, et al. Lékařská mikrobiologie : Bakteriologie, virologie, parazitologie. 1. edition. Praha : Marvil, 1996. 558 pp. ISBN 8023802976.
- ↑ a b c d e BASNET, Sangita. Botulism, Botulinum Toxin, and Bioterrorism: Review and Update: Microbiology and Toxicology [online]. ©2004. [cit. 2012-01-06]. <https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL3ZpZXdhcnRpY2xlLzQ4MjgxMl8y&ac=401,>.
