Infectious Disease Compendium

Botulism

Diagnosis

Muscle weakness, especially starting with the eyes and moves down. "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 espcially heroin users.

Also occurs from drinking Purno, 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?

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. 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. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_a.htm

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Botulism 005.1.