Botulism

This life-threatening paralytic illness results from an exotoxin produced by the gram-positive, anaerobic bacillus Clostridium botulinum. It occurs as botulism food poisoning, wound botulism, and infant botulism.

Botulism occurs worldwide and affects adults more often than children. The incidence of botulism in the united States had been declining, but the current trend toward home canning has resulted in an upswing in recent years.

The mortality rate is about 25% , with death most often caused by respiratory failure during the first week of illness. Onset within 24 hours of ingestion signals critical and potentially fatal illness.

Causes

• Eating food contaminated with the bacteria and its toxin. It is the toxin produced by the bacteria—not the bacteria itself—that causes botulism in humans. Foods that may be contaminated with the toxin include: Home-canned goods, Sausage, Meat products, Seafood, Canned vegetables.
• An infant swallowing the bacteria's spores, which grow in the baby's body and produce the toxin. Unlike adults and older children, infants become sick from toxin produced by bacteria growing in their own intestines. Honey is a prime source of infant botulism. Other sources include soil and dust.
• A wound becomes infected with the bacteria. The toxin then travels to other parts of the body through the bloodstream.

Symptoms and Signs

The symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.

Diagnostic tests

Identification of the exotoxin in the patient's serum, stool, or gastric contents, or in the suspected food, confirms the diagnosis. An electromyogram showing diminished muscle action potential after a single supramaximal nerve stimulus also is diagnostic.

Diagnosis must rule out conditions often confused with botulism, such as Guillain-Barre syndrome, myasthenia gravis, cerebrovascular accident, staphylococcal food poisoning, tick paralysis, chemical intoxication, carbon monoxide poisoning, fish poisoning, trichinosis, and diphtheria.

Treatment

For adults, treatment consists of I.V. or I.M. administration of botulinum antitoxin (available through the Centers for Disease Control and Prevention).

Early elective tracheotomy and ventilatory assistance can be lifesaving in respiratory failure. The patient needs nasogastric suctioning and total parenteral nutrition (TPN) if he develops significant paralytic ileus.

ALERT Antibiotics and aminoglycosides shouldn't be administered because of the risk of neuro­muscular blockade. They should be used only to treat secondary infections.

Prevention

Kids are not the ones canning food, but if their parents do, they can talk to them about the safety rules. And kids also can remind grown-ups that babies shouldn't have honey. There's one more thing kids can do to prevent the spread of germs.

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