Friday, December 19, 2014
     


Botulism

Epidemiology:

  • Botulism neurotoxins (a-f) could be transmitted by aerosol or contamination of food and water supplies
  • Botulism is not transmitted from person to person

Clinical:

  • Incubation period is 12-36 hours (can be several days)
  • Early symptoms include blurred vision, diplopia, and dry mouth
  • Later symptoms include dysarthria, dysphagia, dysphonia, ptosis and the development of a symmetrical, descending progressive paralysis and respiratory failure
  • Patients are usually alert and afebrile

Laboratory Diagnosis:

  • Diagnosis is primarily based on a compatible clinical presentation
  • Spinal protein is normal and characteristic findings are seen on emg (facilitation of the compound muscle action potential on repetitive nerve stimulation)
  • Toxin can bae detected in serum (collect 30 cc in red top) and stool (foodborne botulism) by mouse neutralization bioassay performed at California Microbial Diseases Laboratory

Patient Isolation:

  • Standard precautions. Patients do not require isolation rooms

Treatment:

  • Supportive care is the mainstay of therapy; prolonged ventilatory support is often required in severe cases
  • Botulism anti-toxin (for a, b and e toxins) is in limited supply and is available only from the division of communicable disease control, california dept. of health services

Prophylaxis:

  • Currently, there is no available post-exposure prophylaxis