Botulism (C. Botulinum)

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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]

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]

  1. 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.
  2. a b c d e f g DOSTÁL, Václav, et al. Infektologie. 1. edition. Praha : Karolinum, 2005. 338 pp. ISBN 80-246-0749-2.
  3. a b BEDNÁŘ, Marek – SOUČEK, Andrej – FRAŇKOVÁ, Věra, et al. Lékařská mikrobiologie : Bakteriologie, virologie, parazitologie. 1. edition. Praha : Marvil, 1996. 558 pp. ISBN 8023802976.
  4. a b c d e BASNET, Sangita. Botulism, Botulinum Toxin, and Bioterrorism: Review and Update: Microbiology and Toxicology [online]. ©2004. [cit. 2012-01-06]. <,>.