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Botulism Handout

Botulism Handout

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Published by Brian Perrin

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Published by: Brian Perrin on Mar 30, 2012
Copyright:Attribution Non-commercial


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 Infantile Botulism
(adapted from Medscape – emedicine.medscape.com/article/961833-overview)
Botulism is a potentially lethal illness that affects the neuromuscular junction by inhibiting therelease of acetylcholine from presynaptic neurons, effectively deenervating the muscles triggered by the post synaptic receptor. It is caused by the botulinum toxin produced by the bacterium
Clostridium botulinum
, a gram positive, anaerobic, spore-forming rod in the same family as the pathogens causing tetanus (
C. tetani
), pseudomembranous colitis (
C. difficile
), and gangrene (
C. perfringens
).Botulinum toxin is the most potent naturally occurring toxin known to man, being lethal at thefentogram level (10
gram), making it approximately 15,000-100,000 times more lethal thansarin nerve gas. There is variance in the specific botulinum toxins produced by the bacterium,classified as types A-G, even though only types A, B, E, and F cause disease in humans.Among the varying etiologies of botulism (food borne, wound, infantile), infantile botulism isthe most frequently occurring type in the United States, representing at least 1444 of 2310(~63%) reported botulism cases from 1973-1996. While honey is classically taught as a vector for 
spores, currently only approximately 15% of infantile botulism cases are directlyattributed to honey consumption, with the remainder originating from undetermined sources.The peak age of incidence is between the first 2-4 months of life.Infants who are breastfed appear to have some protection from lethal fulminant disease, however exclusively breastfed children are at greater risk. This may be due to a relatively underdevelopedor undiversified bowel flora that is more conducive to spore germination and toxin production.Following ingestion of the spores, incubation occurs over 2-4 weeks. Early signs and symptomsinclude constipation, suckling poorly, lethargy, and listlessness. Descending weakness and paralysis (the classic “floppy baby syndrome”) occur later as in food-borne disease.On physical examination infants will have signs of autonomic dysfunction, including dry mouth, blurred vision, orthostatic hypotension, ptosis, mydriasis, decreased ocular motility, as well asdysphagia, dysarthria, muscle weakness, or flaccid paralysis. The frequencies of the mostcommon symptoms of infantile botulism are as follows:
Poor ability to suck - 96%Poor head control - 96%Hypotonia - 93%Weak crying - 84%Constipation - 83%Lethargy - 71%Facial weakness - 69%Irritability - 61%Hyporeflexia - 52%Sluggish pupils - 50%Respiratory difficulty - 43%
If one is familiar with the SLUDGE or DUMBBELSS mnemonics for symptoms of cholinergicexcess in organophosphate/carbamate poisoning, you can think that the opposite effects wouldapply in a state of cholinergic deficiency such as botulism. You can also think of it in terms of “rest and digest” “gone wild” – either depict the characteristic dysautonomia.

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