z Botulism

Infectious Disease Compendium

Botulism

Diagnosis

Muscle weakness, especially starting with the eyes and moves down.

Diplopia, Blurry vision Ptosis, slurred speech, dysphagia, dry mouth.

"Botulism is confirmed in the laboratory by identifying botulinum neurotoxin in the serum, feces, vomitus, or gastric contents of the patient, and/or in remnants of a food consumed by the patient." CDC.

Epidemiologic Risks

Eating Clostridia botulinum contaminated food: home canned is most common, can also occur in wounds especially heroin users.

Also occurs from drinking Pruno, illicit fruit based alcohol brewed in prison toilets. I can't make this stuff up (PubMed).

Black tar heroin is associated with wound botulism (PubMed) and some will get it more than once. Can you say addicting?

Native Alaskans have a form of food pickling that leads to Botulism (PubMed) and eating beached whale blubber.

Baked potatoes wrapped in aluminum foil, raw honey and other foods like nacho cheese dip served at a gas station. Prepare the food wrong, get botulism.

Inhaling cocaine (PubMed).

And there have been Botox botulism.

Microbiology

Due to the toxic of C. botulinum types A, B, E and F.

Ddx: includes the Miller-Fisher variant of Guillain-Barre' Syndrome.

Empiric Therapy

Penicillin G IV at maximal dose is traditional, but probably does little. Debride the wound.

Call your state health department asap.

The CDC has antitoxin: Days phone (404) 639-2206 (Monday-Friday, 8:30 AM-4:30 PM, eastern time) Nights/weekends phone (404) 639-2888.

Patients (in this case heroin users) who receive the antitoxin <12 hours after presentation do better.

Pearls

The food may not taste bad CDC.

One microgram is fatal if inhaled.

Botulism comes from the latin word for sausage.

Other animals can get botulism, it kills thousands of ducks a year. Even fruir flies and leeches can get it.

5% die. Recovery can take weeks to months and they may have fatigue and shortness of breath for years.

Rants

Last Update: 05/14/18.