Name: Joaquin Diego R.

Moreno
Yr. and Section: BSN 3A
REPORT NCM 104

Botulism
 Is a rare but very serious illness that transmits through food, contact with
contaminated soil, or through an open wound. Without early treatment, botulism
can lead to paralysis, breathing difficulties, and death
 Food poisoning caused by a bacterium (botulinum) growing on improperly
sterilized canned meats and other preserved foods
 Caused by Clostridium botulinum
 (Most potent biologic toxin in the world)

Types of Botulism
1. Infant Botulism (most common)
- Ingestion of honey or corn syrup contaminated with spores

Signs and symptoms:

- Constipation
- Weak suck, feeble cry, poor gag reflex, pooled secretions
- Generalized weakness, hypotonia, loss of head control
- “Floppy baby” (loss of muscle tone)

2. Food-borne Botulism
- Toxin that is produced by the bacterium in containers of food that have been
improperly preserved is the most common cause of food-borne botulism
- Inadequately preserved or undercooked foods
- Home canning
- Symptoms usually appear 12–36 hours after eating, but can also appear within 6
hours to 10 days

3. Wound Botulism
- Wounds contaminated by spores
- Iatrogenic or inadvertent from cosmetic or therapeutic injection

Note: Botulism is not transmitted person to person

Signs and Symptoms

 Descending, symmetric, flaccid paralysis (Upper > Lower)
- tachypnea and respiratory failure
- DTRs (Deep tendon reflex) may be decreased
- Nonspecific flu-like illness
- Postural hypotension
 Cranial nerve deficits
- Diplopia (double vision)
- Ptosis (drooping or falling of the upper eyelid)
- Pupillary dilation
- Dysphonia (difficulty in speaking)
- Dysphagia (difficulty swallowing)
- Dysarthria (difficult or unclear articulation of speech)
- poor gag reflex
- Decreased salivation
- GI ileus (temporary arrest of intestinal peristalsis)
- Urinary retention
Diagnostic Test
 Toxin neutralization mouse bioassay (serum, stool)
 Infant botulism
- C. botulinum organism or toxin in feces
- Testing is done in reference laboratories under biosafety regulations

Pathophysiology

Once Clostridium botulinum enters the bloodstream

It will infiltrate the myoneural junction blocking acetylcholine (neurotransmitter that

transmit motor impulse to the muscles)

End results: Generalized paralysis and weakness (drooping eyelid, weak voice, etc.)

Death is due to respiratory paralysis

Prevention
 vegetative form of the bacteria is destroyed by boiling
 prevention measure for infant botulism is to avoid giving honey to infants less
than 12 months of age, as botulinum spores are often present. In older children
and adults the normal intestinal bacteria suppress development of C. botulinum.
 When canning or preserving food at home, attention should be paid to hygiene,
pressure, temperature, refrigeration and storage. When making home preserves,
only acidic fruit such as apples, pears, stone fruits and berries should be bottled.
Tropical fruit and tomatoes are low in acidity and must have some acidity added
before they are bottled

Management/treatment
 Contact CDC (Centers for Disease Control)
 Supportive care
 Respiratory monitoring
 Equine serum heptavalent botulism antitoxin (> 1 year old)
 Human-derived botulism immune globulin (< 1 year old)
 Antibiotics (for wounds)
 Vaccine - Botulinum pentavalent toxoid
- Not available to general public
- Limited supply provided by CDC
- Long lasting immunity – prohibits future therapeutic use of toxin
- Onset too slow to be effective PEP

Nursing considerations
 Use of standard precautions
 Isolation room not required
 Observe for possible respiratory distress which can occur rapidly
 Assist patient with communication if on a mechanical ventilator
 Prevent nosocomial infections through use of good hygiene
 Prevent deep vein thrombosis
 Give appropriate bowel and bladder care
 May need extensive rehabilitation for swallowing, speech, muscle strength
 Address psychosocial issues and fears associated with the progressive paralysis
and loss of voluntary movement and speech
 CDC recommends decontamination of patients and their clothing with soap and
water if exposed to aerosolized botulism toxins and decontamination of exposed
surfaces by cleaning with a bleach solution.