Botulism

Botulism is a serious condition caused by Clostridium botulinum bacteria, leading to cranial nerve symptoms and muscle weakness. Treatment involves hospitalization, respiratory support if needed, and antitoxin administration. For infants, human-derived botulism immune globulin is used. Foodborne botulism may require laxatives, wound botulism needs debridement and antibiotics.

Botulism: Introduction and Clinical Presentation

Botulism is a potentially life threatening neuroparalytic syndrome resulting from the action of a neurotoxin elaborated by the bacterium Clostridium botulinum. Botulism is classically described as an acute onset of bilateral cranial neuropathies (manifests as blurred vision, diplopia, nystagmus, ptosis, dysphagia, dysarthria, and/or facial weakness) associated with symmetrical descending weakness to the trunk, upper and lower extremities. (1, 2)

Treatment Approach for Suspicious Botulism

Treatment of suspicious botulism requires hospitalisation and meticulously monitoring for signs of respiratory failure. The treatment approach to all patients with botulism includes prompt intubation for respiratory failure, administration of antitoxin and intensive care for those with paralysis. Intubation should be considered for patients with a vital capacity less than 30% of predicted. (3, 4)

Antitoxin Therapy for Botulism

Antitoxin is the main therapeutic option for botulism and should be administered as soon as possible after the diagnosis of botulism is made. Various forms of botulinum antitoxin therapies are available worldwide. They include enquine serum heptavalent botulism antitoxin for children older than one year of age and adults; and human-derived botulism immune globulin for infants less than one year of age. For adults, one vial should be administered intravenously (IV). For children aged 1 to 17 years, 20 to 100% of the adult dose should be given. For infants <1 year of age, 10% of the adult dose might be appropriate, depending on CDC consultation. Also, botulinum immune globulin is available for intravenous use in infants less than one year of age who are diagnosed with infant botulism. (5, 6)

Management of Foodborne Botulism

Additionally, in cases of foodborne botulism, laxatives, enemas, or other cathartics could be given, provided no significant ileus is present. Patients presenting with wound botulism should undergo extensive debridement and antibiotics (penicillinG (3 million units IV every four hours, or metronidazole 500 mg IV three times daily as an alternative). These patients should also receive tetanus boosters as well if it has been five or more years since their last immunization. (7, 8)

References

1- Hodowanec A, Bleck TP. Clostridium botulinum (Botulism). In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed, Bennett JE, Dolin R, Blaser MJ (Eds), Elsevier Saunders, Philadelphia 2015. p.2763.

2- United States Centers for Disease Control and Prevention. Botulism in the United States 1899-1996: Handbook for Epidemiologists, Clinicians & Laboratory Workers, 1998. http://www.cdc.gov/ncidod/dbmd/ diseaseinfo/files/botulism.pdf

3- Blitzer A, Binder WJ. Current practices in the use of botulinum toxin A in the management of facial lines and wrinkles. Facial Plast Surg Clin North Am. 2001;9:395–404.

4- Mcnally RE, Morrison MB, Berndt JE, et al. Effectiveness of medical defense interventions against predicted battlefield levels of botulinum toxin A, Science Applications International Corp, Joppa 1994.

5- Bleck TP. Clostridium botulinum (botulism). In: Principles and Practice of Infectious Diseases, 6th ed, Mandel, GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2005. p.2822.

6- BAT, Botulism antitoxin heptavalent (A, B, C, D, E, F, G) - (equine) sterile solution for injection. http://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/UCM345147.pdf

7- Middlebrook JL. Relative lethality of selected toxins. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning, 2nd ed, Ellenhorn MJ, Schonwald S, Ordog G, et al (Eds), Williams and Wilkins, Baltimore 1997. p.1055.

8- Centers for Disease Control and Prevention. How can botulism be prevented http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/#prevent